1. The 2015 Act
Desktop Resource 1

2. The 2015 Act
Listed Initiators 19
Mental Health Act Forms – 6
Advance Statements
New Treatment Forms 7
Medical Conflict of Interest 23 – 24
Suspension of Orders 8
Cross Border Transfers – 26
Suspension of Detention 9
Other Transfers 27
Suspension of Other Measures 10
Transfer Forms 28
Suspension Forms 11
Services & Accommodation for Mothers 29
Nurses Power to Detain Pending
Orders Regarding Level of Security 30
Medical Examination 12
Yet to be Implemented 31
MHO Duties 13
Mentally Disordered Offenders 14 – 15
Mentally Disordered Offender Forms 16
Named Persons – 18 2

3. The 2015 Act
Part 1 makes provision about the operation of the Mental Health (Care and Treatment) (Scotland) Act 2003.
Part 2 amends the Criminal Procedure (Scotland) Act 1995 in relation to the treatment of mentally disordered offenders. It amends timescales for assessment and treatment orders and provides for variations of certain orders.
Part 3 of the Act creates a new notification scheme for victims of some mentally disordered offenders . This will allow certain information to be provided to victims of offenders subject to certain orders and to allow victims to make representations in certain circumstances in connection with the release of the patient from detention.
Victims or qualifying persons entitled to information concerning an offender subject to a Hospital Direction or TTD upon first suspension and which does not impose a supervision requirement
Like wise for a Compulsion Order with a Restriction Order (CORO). Information to include: whether CO or CORO has been revoked; decision to appeal against revocation; date of death of offender; variation of CO; transfer out with Scotland; order for conditional discharge and terms; recall to hospital; absconsion from hospital; return to hospital after absconding; suspension of detention; revocation of suspension
A victim of a crime may make representations before a decision to suspend detention without supervision by RMO; decisions by the Tribunal and by Scottish Ministers. Applies to Hospital Directions, TTDs and COROs. 3

4. Mental Health Act Forms
There are new version 7.0 of almost all forms which should be used and are available from the Scottish Government’s website:
Forms for an application to the Tribunal have been split into A and B forms at the Tribunal’s request – one for the application and one for the Tribunal e.g. CTO5A and CTO5B. 4

5. Mental Health Act Forms Emergency Detention Certificate DET1 v7.0
Short-Term Detention Certificate DET2 v7.0
Short-Term Detention Extension Certificate DET4 v7.0
Social Circumstances Report - SCR1 v7.0
S.113(5) (Non-compliance with CTO) added to list of orders which, if a person is already subject to, neither an EDC nor an STDC can be granted
We have lots of new forms please remember to use the new versions
This is particularly important for the statutory treatment forms 5

6. Mental Health Act Forms
Mental Health Report to Accompany a CTO Application - CTO 2 v7.0
Determination to extend a CTO or CO - CTO3a v7.0
MHO - Further Information Where CTO or CO is Extended - CTO3c v7.0
Application to Vary a CTO or CO - CTO5 Part A - v7.0
Section 112 Detention CTO7 v7.0
Section 113 Certificate CTO8 v7.0
Section 114, 115 Certificate CTO9 v7.0
Non-provision of Recorded Matter - CTO10 Part A v7.0 6

7. New Treatment Forms (T2s and T3s)
There are now separate forms for ECT and other treatments:
T2A (S237) - ECT
T2B (S240) - medication
T2C - artificial nutrition
T3A (S237) - ECT
T3B (S240) - medication or artificial nutrition
All the T2 and T3 forms, apart from T2C, are “statutory” forms.
This means that the actual form needs to be used and properly completed to authorise treatment.
Any T2 or T3 form completed from needs to be on a new form.
If an old form is completed after it is not valid.
Old forms completed before continue to be valid.
When completing a certificate for medical treatment for ECT,
surgical operations and ‘over time’ treatment, persons to be
consulted now include Guardian or Attorney.
NB Signed consent must exist at the time the T2 is completed
Person cannot consent after the T2A/B/C has been signed
The Commission advises that the T2A/B/C should not be issued more than 7 days after the patient signs the consent form.
T2B medication time periods include any prior EDC, STDC, ICTO, CTO, TTD
or orders under the Criminal Procedure (Scotland) Act 1995 which relate only to a single period of detention. 7

8. Suspension of Orders S.7 (S.43) / S.8 (S.56)
Measures authorised under an Interim Compulsory Treatment Order, Compulsory Treatment Order or a Compulsion Order will cease to have effect for the duration of any concurrent use of a S.36 or S.44.
The giving of medical treatment in accordance with Part 16 of the 2003 Act is excepted.
ICTO, CTO and CO Measures cease to have effect when either a S.36 or S.44 is taken concurrently 8

9. Suspension of Detention
S.9 (S.127, S.221 and S.224) / S.10 (S.127, S.128 and S.224)
People on hospital-based CTOs or Compulsion Orders can only be granted up to 200 days suspension of detention in any 12 month period.
Any period of suspension of detention which lasts for 8 hours or less does not count as a day towards the allowable total of 200 days. This is likely to include escorted and unescorted daytime visits or placements.
Periods of more than 8 hours but less than 24 hours count as a day towards the 200 day total.
Any certificate granted before will continue to be valid, even if it authorises suspension of detention beyond 200 days.
Interim guidance on suspension of detention
Can only be granted up to 200 days suspension of detention in any 12 month period
Periods of 8 hours or less do not count
Periods of more than 8 hours but less than 24 hours do 9

10. Suspension of Other Measures
The 2015 Act changes the maximum cumulative total allowed to 90 days in a 3 month period, excluding any period of less than 8 hours or a series of more than one individual period within an overall 3 month period.
Applicable to Interim CTOs, CTOs, Treatment Orders, Interim Compulsion Orders, Temporary Compulsion Orders; Compulsion Order and a Restriction Orders, Hospital Directions or Transfer for Treatment Directions.
The purpose for which suspension is necessary must be recorded in the certificate.
Consent of the Scottish Ministers is no longer required to enable a person to attend hearings in criminal proceedings or a medical / dental appointment.
Eg workplace attendance, rehab activities, visits to family etc. 10

11. Suspension Forms
The new SUS1A form should be used to authorise suspension of detention (SUS3A for restricted patients).
Suspension Certificate - CTO or CO detention - SUS1a v7.0
Suspension Certificate – Measures other than detention SUS1b v7.0
Revocation of Suspension Certificate SUS1c v7.0
Suspension of Detention Certificate Restricted patients & patients with restricted status - SUS3a v7.0
Revocation of Suspension Certificate by RMO SUS3b v7.0
Leave Planner 11

12. Nurse’s Power to Detain Pending Medical Examination
S.20 (S.299)
Nurse’s power to detain has been simplified so that a person in hospital may be detained there by nursing staff for up to three hours to enable a medical practitioner to carry out an examination.
Nurse's Power To Detain Pending Medical Examination - NUR1 - v7.0
Interim Guidance on Nurse’s Power to Detain 12

13. MHO Duties
MHO report required for a S.86 or S.152 determination to extend a CTO / CO where a Tribunal is required to review the determination to extend as per S.101 / S.165 (change in diagnosis, MHO disagrees with, or does not give view) . Report to be sent to Person, Tribunal, Named Person, RMO and MWC.
S.28 (S.261) MHOs to ensure arrangements are made to assist people with communication difficulties when interviewing for the purposes of an STDC, CTO, Compulsion Order or Hospital Order, when the interview is not in hospital. If the interview takes place in hospital, the responsibility lies with hospital managers.
S.19(2) (S.295A) MHO must notify the Commission if Sheriff makes or refuses to make a Removal Order, it’s Recall or Variation.
S.34 (S.136) MHO agreement is required for a Transfer for Treatment Direction. 13

14. Mentally Disordered Offenders
Timings of Criminal Procedures Act 1995 (CPSA) Orders
S.38 - S.45 (S.52, S.53, S.57, S Act)
Time periods for authority conferred by CPSA 1995 orders have been synchronised with criminal court calculations. This affects Assessment Orders, Treatment Orders, Interim Compulsion Orders, Compulsion Orders, and Hospital Directions.
eg a Compulsion Order now authorises compulsory treatment for one full day longer
and the two month period for the RMO’s first mandatory review commences one day later
Extension of Assessment Order
Courts can now, on one occasion only, extend an assessment
order by up to 14 days under S.52G(4).
Previously only for up to 7 days. 14

15. Mentally Disordered Offenders
(S.35(3)) (Schedule 3 1A) When a person is subject to a HD or a TTD, and an application is made for a CTO, Scottish Ministers must be notified.
(S.46) (S Act) RMO may transfer a person subject to Assessment Order, Treatment Order, Interim or Temporary Compulsion Order from a specified hospital to another hospital or to another unit within the same hospital.
S.61A (5) RMO must inform person and managers of discharging hospital along with obtaining consent of admitting hospital and Scottish Ministers.
S.48(2) (S.218A ) Persons subject to a Compulsion Order and Restriction Order (CORO), Hospital Direction or TTD may be transferred to another unit within the same hospital. 15

16. Mentally Disordered Offender Forms
Review Of Hospital Direction Or Transfer For Treatment Direction - HD1 v7.0
Medical Report Transfer for Treatment Direction in respect of person serving a sentence of imprisonment - MHT Annex C
Admission of Part 8 or Part 11 Patient - ADM1 - v7.0
Revocation or Termination - REV5 - v7.0
Application to extend Compulsion order - CO1 Part A v7.0
Review of Compulsion Order and Restriction Order - CORO1 - v7.0 16

17. Named Persons
(S.22-S.25) (S.250-S.257)
People do not have a Named Person unless they nominate someone. For a nomination to be valid, the nominated person has to consent in writing to be the Named Person which needs to be witnessed.
Those who can act as a witness are: independent advocacy workers; medical practitioners; arts therapists, dieticians, occupational therapists, physiotherapists, practitioner psychologists and speech and language therapists (if registered with the Health and Care Professions Council); persons employed in the provision of, or managing the provision of, a care service; registered nurses; social workers; and solicitors.
Nominations can be revoked at anytime. MHOs are no longer required to inform Tribunal and MWC if people do not have a Named Person or if the existence of one cannot be established.
Anyone who does not want their Named Person to continue can make a declaration removing them and no new Named Person will be appointed in their place.
If an order expires or is revoked the default named person will cease to hold that role.
This includes a STDC or interim CTO ending and being
replaced by a CTO. 17

18. Named Persons Interim Guidance Named Persons Flowchart
With the exception of time-to-time reviews and appeals, the default named person will cease to hold the role from the time of a mandatory review of a longer-term order from 30 September This is:
the first mandatory review of a CTO by the RMO at section 77(2) of the 2003 Act
further mandatory reviews of a CTO by the RMO at section 78(2) of the 2003 Act
the first mandatory review of a compulsion order by the RMO at section 139(2) of the 2003 Act
further mandatory reviews of a CO by the RMO at section 140(2) of the 2003 Act
mandatory reviews of a hospital direction or transfer for treatment direction by the RMO at section 206(2) of the 2003 Act.
If there are still any default named persons holding their role by 30 June 2018, these will cease on that date.
Named Persons can end their role by giving notice to the Tribunal, L.A. and person.
Named Persons Interim Guidance
Named Persons Flowchart
Default named person ceases to hold role from 30 September 2017
All remaining default named persons will cease on 30 June 2018
Role can be ended by giving notice to the Tribunal, L.A. and person 18

19. Listed initiators include: welfare guardian
S.25 / S.257A
The 2015 Act has inserted Section 257A. This makes provisions for others, known as “listed initiators”, to initiate applications or appeals to the Tribunal if a person does not have capacity to exercise those rights themselves.
Listed initiators include:
welfare guardian
welfare attorney (must be operational)
primary carer (if any)
nearest relative
The primary carer and nearest relative cannot act as a listed initiator if the person has made a written declaration precluding them doing so.
People making a declaration need to be capable of doing so
and this needs to be witnessed.
People who lack capacity and have no named person are still protected by the listed initiators safety net.
Enables a carer, nearest relative, welfare guardian or welfare guardian to initiate applications / appeals and receive information at specified points when (a) there is no named person and (b) the individual does not have capacity to do so on their own behalf.
This is not a continuous role, it is application specific. 19

20. Advance Statements
Made when the person is able to understand and make decisions about their treatment
In writing
Signed by the person
Signed by a witness to certify the ability to make an Advance Statement
The witness must be a:
Doctor (medical practitioner)
Clinical Psychologist
Occupational Therapist
Manager of a care service
Registered Nurse
Social Worker
Solicitor
(MWC 2016) 20

21. Advance Statements
(S.26) (S.276)
NHS Grampian is required to inform the Commission that they have a copy of this document, and where it is kept.
There is a new ADV1 form for medical records to use to inform the Commission of this.
The Commission now keeps a register of this information which MHOs have the right to inspect
The Commission should not be sent a copy of the document itself unless asked for (or unless the advance statement has been overridden).
Advance Statements Interim Guidance. 21

22. Advance Statements
Advance Statements can be sent to the address below, with a compliment slip saying Advance Statements for filing.
The Advance Statement will then be filed in either the manual or scanned psychiatric mental health record:
Medical Records Contact:
Catherine A Birse
Records Manager
Records Department
Clerkseat Building
Royal Cornhill Hospital
Tel: (x-57330) 22

23. Medical Conflict of Interest
S.29 (S.291A) New Regulations pertaining to medical examinations for detentions in hospital:
For CTO applications, two doctors working in the same NHS hospital can now do the two required medical examinations as long as, one is a consultant, and the other does not work directly with or under the supervision of that consultant.
This may assist with difficulties being experienced in some areas around obtaining second medical reports 23

24. Medical Conflict of Interest
Private Hospitals
CTO applications for detention in an independent hospital, one of the medical examinations can now be undertaken by a doctor employed by that independent hospital*.
For a person who is, or will be, detained in an independent hospital under a CTO, CO or CORO, a medical examination for a mandatory review can be undertaken by the RMO or an AMP employed by that independent hospital*
if…….the person has an additional examination undertaken during the mandatory review period by an AMP who is not.
* means “employed by or to provide services in or to that independent healthcare service” 24

25. Cross Border Transfers (S.32- S.33) (S.289, S.290, S.309A)
Cross-border return of a patient subject to detention in a hospital elsewhere in the UK who has absconded into Scotland
Scottish Ministers advise a person cannot be removed from Scotland under cross-border absconding provisions if they have been detained under Scottish legislation.
If the person is detained under Scottish legislation, a cross-border transfer application to Scottish Ministers should be made if it is proposed to transfer out of Scotland.
RMOs need to complete the TX1a form which has been extensively updated to include new changes and to gather information the Ministers require to consider the request.
New EU Provision
Regulations now extend to cover all EU member states.
MHO Duties remain the same, within 7 day notification period must interview patient, inform of rights, advocacy, inform RMO if MHO agrees/disagrees
Earliest application to appeal is advisable 25

26. Cross Border Transfers
New application for fast-track removal with consent for transfers to a place within the UK requiring:
Person’s consent in writing
an Approved Medical Practitioner (not the RMO) to certify person is capable of giving consent
Named Person’s consent in writing
Notification of proposed application given to Primary Carer and Nearest Relative if no Named Person. All parties notified have right to make representations direct to Scottish Ministers.
Removal from Scotland must be within 7 days after the end of the standstill period which, remains in place during an appeal to the Mental Health Tribunal Scotland submitted before the end of the standstill period.
Advice to RMOs is that no-one should be transferred while an appeal to the Tribunal is outstanding.
If the person is not transferred within 7 days a new application is required.
28 day period for EU transfers
Transfer out timescale begins from day of transfer
Transfer in timescale continues from existing order 26

27. Other Transfers
S.11-S.13, S.18 (S.36, S.44, S.71, S.124, S.136 )
Enables transfer in and to hospital units, or within hospitals for EDCs, STDs, ICTOs, CTOs, HDs, TTDs. 27

28. Transfer Forms
Application to Transfer a Patient to a Hospital outside Scotland - TX1a - v7.0
Request for the Transfer of a Patient into Scotland - TX1b - v7.0
Transfer from Specified Unit or to other Hospital within Scotland - TX2 - v7.0
Appeal Against Transfer - TX3 v7.0
Notification of Appeal Against Transfer to a State Hospital - TX3a - v7.0
Appeal Against a Cross-Border Transfer - TX4 v7.0
Review of Patient following a cross-border transfer into Scotland - TX5 v7.0
Information on the new arrangements can be sought from
the Scottish Government's Cross-border Transfer Team on 28

29. Services and Accommodation for Mothers (S.31) (S.24)
Extends the duties in S.24 of the 2003 Act to provide services and accommodation to mothers with a mental disorder other than post-natal depression.
There is now a duty to provide these services and accommodation.
Reflects Keeping mothers and babies in mind led by Dr Juliet Brock
1 in 5 women may be affected by perinatal MH problems
GAMH admissions impact on infant mental health & mother-baby attachments
High risk (suicide is a leading cause of maternal mortality)
Preventable & Treatable can result in a faster recovery time in MBU
7 MBU admissions in Grampian for
MH Strategy to fund introduction of a Managed Clinical Network to improve the recognition and treatment of perinatal mental health problems. 29

30. Orders Regarding Level of Security
S.16 (S.268-S.271) On 16 November 2015 the new right of appeal of conditions of excessive security was
extended to Medium Secure facilities. The Orchard, Rowanbank and Rohallion Clinics were designated as
‘qualifying hospitals’ for this purpose.
S.14 (S.264, S.268) Must be accompanied by a medical report stating patient does not require conditions of
security which apply in a state hospital or medium secure
Detention In Conditions Of Excessive Security Guidance 30

31. Yet to be Implemented
Measures Until Application Determined
S.1 (S.64(8A), (8B) and S.65(7) )
Period of CTO or Interim CTO to be reduced by the time person has been detained under a S.47 STDC extension certificate or whilst waiting for a hearing to be convened.
The interim and / or final order will be reduced by 3 and / or up to a further 5 days or similar permutation.
Implementation still being negotiated with MHTS and MWC. 31