1. The Mental Health Act 2007 Genevieve Smyth College of Occupational Therapists 22 nd January 2009

2. Introduction Content of amendments New roles Supervised Community treatment

3. Amendment 1 Removal of categories of mental disorder e.g. mental illness and mental impairment replaced by new definition “any disorder of mind or brain”

4. Amendment 2 Exclusions of the Act – promiscuity, immoral conduct, sexual deviancy Drug or alcohol dependency

5. Amendment 3 The treatability test- from “is likely to alleviate or prevent deterioration” of a condition to “alleviate or prevent worsening of the disorder or one of its symptoms or manifestations” Personality disorder

6. Amendment 4 Change in definition of “medical treatment” from “medical treatment includes nursing, care, habilitation and rehabilitation under medical supervision” to “..includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care”

7. Amendment 5 Advocacy – a new statutory duty for services to provide advocacy services for all those detained Advocates will have unfettered right to meet service users in private, meet with professionals, access to patient records Independent Mental Health Advocate (IMHA)

8. Amendment 6 Nearest relative –civil partnerships now recognised Services users can now able to apply for the displacement of a nearest relative if the person is “not a suitable person to act as such”

9. Amendment 7 Changes to ECT –except in an emergency ECT may not be given to service users who have the capacity to refuse A SOAD must approve ECT for those under 18 years

10. Amendment 8 Age appropriate treatment – for any service user under age of 18 years, there must be consultation to ensure the environment is suitable for age and needs

11. Amendment 9 Mental Health Review Tribunals – automatic referral to the MHRT after 6 months of detention

12. Amendment 10 ASW now Approved Mental Health Professional (AMHP) –now open to OTs, nurses and psychologists RMO now Approved/Responsible Clinician (AC/RC)- now open to OTs, nurses and psychologists

13. New roles under the Mental Health Act 2007 New Ways of Working Career opportunity The best person for the job Competence based practiced Permissive legislation

14. Approved Mental Health Professional (AMHP) Function is exactly the same as ASWs Previous ASWs automatically became AMHPs on 3 rd November 2008 Training now open to the other professional groups Training based role

15. AMHPs cont. HEIs offering training Must be nominated by local employer Fundamentally alter relationship between health and social care Release for training, job description, supervision, insurance

16. Principles for selection for entry to AMHP training: Experience of working with people with mental disorders Experience of community settings Basic understanding of key aspects of mental health law, mental capacity and consent, human rights, children and adults safeguards, codes of practice Understanding of the social perspective of mental disorder and ability to view people holistically

17. Principles for selection for AMHP training cont. An ability to work assertively and make independent decisions An ability to work in an anti- discriminatory manner Working competence of the Ten Essential shared Capabilities

18. What can OTs do to prepare for the role? Develop a social perspective Develop an understanding and ability to apply anti- discriminatory and anti-oppressive practice Develop an understanding of legislation Develop advanced reflection and critical analysis skills

19. Approved/Responsible Clinician (AC/RC) Functions practically identically to the RMO role Previous RMOs automatically became RCs on 3 rd November 2008 Application to become a AC now open to other professional groups Competence based role not training based

20. AC/RC Potential applicants for AC approval will be very experienced, well qualified professional who given the additional training and development opportunities should be able to demonstrate the full range of competencies for the AC role. Applicants need to be nominated by their employer and submit a portfolio of evidence to an approval panel.

21. AC/RC cont. Acceptance by the approval panel to act as a AC –2 days training to be able to act as a RC Allocation of RC based on needs of service user e.g. if needs primarily occupational rehabilitation, OT may be the most appropriate person Extension of care –coordinator role Limitations of role e.g. medication

22. Competencies of the RC Legal and policy framework Assessment -An ability to identify the presence and severity of mental disorder, whether severity warrants compulsion, the ability to undertake MH assessment incorporating biological, psychological, cultural and social perspectives, ability to assess risk

23. Competencies of RC cont Treatment -Understanding of MH treatments including physical, psychological and social interventions, understanding the applicability to to different service users, ability to determine whether person has capacity, ability to formulate, review and lead on treatment appropriate to skills Care planning

24. Competencies of RC cont. Ability to effectively to lead an MDT, assimilate diverse views and make decisions ain complex cases Equality and diversity –up to date knowledge The ability to communicate effectively

25. Evidence of competence for RC role A summary of experience relevant to the RC role Minimum of 2 case studies relating to involvement in the care of a detained service user. This should reflect on MH legislation, assessment. Treatment, care planning, leadership, equality and diversity 2 testimonies from senior professionals –one from different professional background 360 degree appraisal to include service user and care feedback

26. Amendment 11 Supervised Community Treatment – supervised discharge with the power to require compliance with a treatment regime and power to recall in the face of default or for other reasons of concern

27. Community Treatment Orders (CTOs) CTO for service user who has been under section and is made by the RC supported by an AMHP Same duration as a Section 3 – six months (replaces supervised discharge) Criteria for CTO –it is necessary for the health and safety of the service user or protection of other persons that the service user receives treatment and that it can be provided outside of hospital

28. CTOs cont. Service users on a CTO must make themselves available for medical examination. RC can recall the person to hospital by notice in writing Medication cannot be enforced in the community except in limited emergency situations

29. CTOs cont. Conditions may stipulate where the person lives, treatment plan to be complied with, places to attend to support the care plan, avoiding use of illegal drugs and alcohol. It may be appropriate to require a service user to try to avoid certain situations if directly relevant to their health and safety or the protection of others.

30. Further reading Carr J (2007) The Mental Health Act 2007. Mental health Occupational Therapy, 12(3),96. Carr J (2007) The introduction of the new roles under the Mental Health Act. Mental Health Occupational Therapy, 12 (3) 99-100. Carr J (2008) An update on the Mental Health Act. Mental Health Occupational Therapy, 13(1), 25-17. Carr J (2008) The Mental Health Act 2007. Mental Health Occupational Therapy, 13(2), 86-87. Carr J (2008) Mental Health Act updates. Mental Health Occupational Therapy, 13(3) 129-130.

31. Further reading NLIAH (2008) Guide for employers on the workforce implications of the Mental Health Act 2007. All above accessed at : http://www.nliah.com/portal/microsites/CMSPageDisplay.a spx?CMSPageID=344 http://www.nliah.com/portal/microsites/CMSPageDisplay.a spx?CMSPageID=344 Mental Health Act commission (2007) Policy briefing for commissioners –the Mental Health Act. Email mat.kinton@mhac.org.uk

32. Contact details Genevieve.Smyth@cot.co.uk 0207 450 5220