1. Introduction to the Mental Health Act 1983 as amended by the Mental Health Act 2007

2. Introductions and Housekeeping

3. What is mental illness? w ‘Mental illness’ is a general term that refers to a group of illnesses affecting the mind, in the same way that physical illness refers to illnesses which affect the body. w Episodes of a mental illness can come and go through people's lives. Some people experience their illness only once and then fully recover. For others, it may recur throughout their lives.

4. Mental Health Statistics w Around 300 people out of 1,000 will experience mental health problems every year in Britain w 230 of these will visit a GP w 102 of these will be diagnosed as having a mental health problem w 24 of these will be referred to a specialist psychiatric service w 6 will become inpatients in psychiatric hospitals Source: based on figures from Goldberg, D. & Huxley, P, 1992, Common mental disorders ­ a bio-social model, Routledge.)

5. What is the purpose of mental health legislation? ‘To regulate the circumstances in which the liberty of persons who are mentally disordered may be restricted and, where there is conflict, balance their interests against those of public policy’ McGowan LJ in R v Secretary of State for the Home Department ex p K [1990] 3 All ER 562

6. Mental Health Act Definitions w Under the new Act, there is a single definition of mental disorder: ‘any disorder or disability of the mind’ w Exclusions: Learning disability, unless ‘associated with’ abnormally aggressive or seriously irresponsible behaviour Dependence on alcohol and drugs

7. People who may be involved in the admission process w General Practitioner w Approved Clinician (AC) w Approved Mental Health Professional (AMHP) w Nearest Relative w Carer w Police w Ambulance Crew w Magistrate w Administration Staff

8. What are the most common elements of the Mental Health Act? w Section 2 – admission for assessment (up to 28 days) w Section 3 – admission for treatment (up to 6 months, may be renewed) w Section 4 - Admission for assessment in cases of emergency w Section 5(2) - Doctors and Approved Clinicians Holding Power (up to 72 Hours) w Section 5(4) - Nurses Holding Power (up to 6 Hours) w Part 3 – provision for mentally disordered offenders w Section 117 Aftercare

9. Section 2: Admission for Assessment w Duration - Up to 28 days w Application - AMHP or Nearest Relative. (report from AMHP required) w Medical Recommendation x 2-One by ‘S12’ doctor. The other by doctor who has previous knowledge of patient, if practicable. w Criteria – The patient is: a) suffering from a mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or assessment followed by medical treatment) and b) ought to be detained in the interests of his/her own health or safety or with a view to the protection of other persons. w Appeal - Apply to Mental Health Review Tribunal within 14 days. Must take place within 7 days. Decision within 3 days.

10. Section 3: Admission for Treatment w Duration - Up to 6 months: Renewable for 6 months, thereafter 12 months. w Application - AMHP or Nearest Relative. w Medical Recommendation x 2 - One by ‘S12’ doctor. The other by doctor who knows the patient, if practicable. w Criteria - a) Mental illness of a nature or degree which makes it appropriate for him/her to receive medical treatment. b) It is necessary for the health or safety of the patient or for the protection of other persons. w Appeal - Can apply to Mental Health Review Tribunal once in each period.

11. Section 117 Aftercare w Section 117 aftercare applies to people who have been detained under Section 3. w The Local NHS Trust and Social Services must provide after-care services for anyone who is eligible until practitioners are satisfied that the person concerned no longer needs them.

12. The Mental Health Act Commission w Reviews the operation of the Act and the way in which powers of detention are exercised. w Carries out official visits to Hospitals w Provides Second Opinion Appointed Doctors (SOAD) for Consent to Treatment. w Receives complaints in regard to any matter relating to the detention and treatment of patients under the Act. w Monitors deaths of detained patients. w From April 2009 these duties will be carried out in Wales by Health Inspectorate Wales (HIW).

13. The ‘New’ Mental Health Act w The Mental Health Act 2007 amends existing current legislation, including: Mental Health Act 1983 Mental Capacity Act 2005 Domestic Violence, Crime & Victims Act 2004

14. What are the key changes to the Mental Health Act? w Responsible Medical Officer (RMO) to Responsible Clinician (RC) Functions generally the same and has ‘overall responsibility for the patient’s case’ Must be approved (an ‘approved clinician’) Can now be a registered medical practitioner, a chartered psychologist, a first level nurse (MH or LD), an occupational therapist or a social worker

15. What are the key changes to the Mental Health Act? w ASW to Approved Mental Health Practitioner (AMHP) Functions generally the same, with additional functions under Supervised Community Treatment (SCT) Approved by Local Social Services Authorities AMHP regulations allow for a social worker, a chartered psychologist, a first level nurse (MH or LD) or an occupational therapist.

16. What are the key changes to the Mental Health Act? w Independent Mental Health Advocacy (IMHA) For patients who are liable to be detained under the Act An Independent Mental Health Advocate (IMHA) will meet with the patient on their request, or that of the nearest relative, the RC or an AMHP An IMHA can help the patient obtain and understand information about their treatment or rights, and help exercise those rights

17. What are the key changes to the Mental Health Act? w Supervised Community Treatment (SCT) Provides for some patients to live in the community while still being subject to powers under the Act to ensure they continue with the treatment they need The aim of SCT is to break the cycle in which some patients leave the hospital and do not continue with their treatment. Can only be offered (through a Community Treatment Order – CTO) to patients subject to a Section 3. Initially lasts for 6 months: can be extended for 6 months then one year at a time.

18. What are the key changes to the Mental Health Act? w The Mental Health Act 1983 Code of Practice for Wales A Code of Practice specifically for Wales for the first time, reflecting Welsh policy and strategy Provides the principles and guidance on how the Act should be applied in practice. Nine guiding principles, under three broad headings of equity, empowerment and effectiveness & efficiency: should be considered during any decision making process under the Act

19. Other legislation amended by the Mental Health Act 2007 w Mental Capacity Act 2005 has been amended to: Provide additional safeguards for people who lack capacity to consent, and Whose care or treatment necessarily involves a deprivation of liberty, but Who either are not, or cannot be, detained under the Mental Health Act 1983. w These safeguards are referred to as deprivation of liberty safeguards (DoLS) and are expected to commence in April 2009

20. Deprivation of Liberty Safeguards w Come into play when: Someone who has a mental disorder, and Who lacks capacity to make decisions for themselves, Is (or is to be) deprived of their liberty In a hospital or care home w Except where that person: Is detained under the provisions of the Mental Health Act 1983, or Is under 18 years of age

21. For further information w Participants Packs and printouts of slides w Web resources: www.opsi.gov.uk for the 2007 Act and explanatory noteswww.opsi.gov.uk www.wales.gov.uk for Welsh measureswww.wales.gov.uk w For more information on implementation of the new Act in Conwy & Denbighshire, contact w Liz Grieve, MHA Act Implementation Manager, on 01745 443167 or liz.grieve@cd-tr.wales.nhs.uk

22. Thank You w Please hand in your completed evaluation sheet and collect your certificate of attendance.