Title: Mental Health Act Amendments Briefing Session
1Mental Health Act AmendmentsBriefing Session
2Programme
10.00 Introductions / Learning Outcomes 10.15 Over
view of the MHA Amendments 10.45 Questions
10.50 Supervised Community Treatment 11.15 Key
Questions and Concerns 11.20 Break 11.35 Feedback
from Key Questions 11.45 Pennine Cares Action
Plan 12.10 Future Plans and Developments 12.30 Fin
ish
3Programme
13.00 Introductions / Learning Outcomes 13.15 Over
view of the MHA Amendments 13.45 Questions
13.50 Supervised Community Treatment 14.15 Key
Questions and Concerns 14.20 Break 14.35 Feedback
from Key Questions 14.45 Pennine Cares Action
Plan 15.10 Accessing Further Information 15.30 Fin
ish
4Learning Outcomes
- To be able to
- Know what changes have been made by the MHA and
how they will affect you in practice - Know what principles are introduced into the new
COP and how they will affect you in practice - Understand how the MHA, the COP and the
principles work together to support best
practice - An introduction to and basic understanding of
Deprivation of Liberty Safeguards - Know how to access further materials to extend
your understanding of the key changes brought
about by MHA - Know how to access further resources that will
extend your knowledge and skills generally for
best practice in this most difficult area of the
use of compulsion in mental health and social
care. -
5The Mental Health Act objectives
- To ensure patients receive the care they need to
protect them and the wider public from harm - To support modernised services
- To strengthen patient safeguards
- Remedy Human Rights incompatibilities
6Whats New?
- Definition of Mental Disorder
- Criteria for Detention
- Professionals Roles
- Nearest Relative
- Supervised Community Treatment
- MHRT
- Deprivation of Liberty safeguards
-
7Guiding Principles
- 1. Respect for Pts wishes and feelings
- 2. Respect for diversity (Equality Act, sec 35)
- 3. Minimising restrictions on liberty
- 4. Involvement of Pt in all aspects of care and
treatment - 5. Avoidance of unlawful discrimination
- 6. Effectiveness of treatment
- 7. Views of carers and other interested parties
- 8. Patient well being and safety
- 9. Public safety
8Definition of Mental Disorder the 1983 Mental
Health Act
Applies to section 2
Mental disorder
Mental Illness
Psychopathic disorder
Severe mental impairment
Mental impairment
Learning disability must be associated with
abnormally aggressive or seriously irresponsible
conduct
Other sections of 1983 Act (e.g. section 3) have
to categorise the type of mental disorder
9Definition Mental Disorder what will change
with the amendments?
Mental disorder
Applies to all sections decision Should be
based on risk and need rather than category
Learning disability must be associated with
Abnormally aggressive or seriously irresponsible
conduct ( autism spectrum is not a learning
disability)
10Definition of Mental Disorder Exclusions
- 1983 Act excludes promiscuity other immoral
conduct. Bill removes these exclusions as self
evident they are not mental disorder - 1983 Act does not permit detention due to
dependence on alcohol or drugs the Bill retains
this - Amendment July 07 the Code of Practice statement
of principles must address respect for diversity,
particularly religion, culture and sexual
orientation
11Criteria for Detention
- 1983 Act
- 1. Must be suffering from mental disorder
(specified category) - 2. Must be of a nature or degree to warrant
detention - 3. Must be no other viable alternatives
- 4. Must be in the interests of the patients
health, safety or protection of others - 5. Mental impairment psychopathic disorder
must be treatable
- The Amendments
- 1. Must be suffering from mental disorder
- 2. Must be of a nature or degree to warrant
detention - 3. Must be no other viable alternatives
- 4. Must be in the interests of the patients
health, safety or protection of others - 5. Appropriate treatment must be available for
all detained patients
12Criteria for Detention - Treatment
- Can only detain if medical treatment appropriate
to mental disorder and all other circumstances
of their case, is available - Will include distance from home, cultural
requirements etc - Must have a holistic assessment
- Must be clinical purpose to detention
- Amendment July 07 purpose of treatment must be
to alleviate or prevent worsening of the disorder
or its symptoms - Amendment July 07 - require hospital managers to
ensure that for voluntary or detained patients,
under 18yr olds, must be in an environment
suitable for their age, subject to their needs.
13Professionals involved in decisions 1983 Act
1983 Act requires 2 Doctors to make a
recommendation that the person requires
compulsory treatment. An Approved Social Worker
reviews all the circumstances and where no
alternative care plan can be made, they will
make an application for the person to be
compulsorily admitted.
14New Professional Roles-AMHP
- Introduction of Approved Mental Health
Professional- appropriately trained and qualified
mental health professional - Functions will be the same as Approved Social
Worker - Training will be accredited and based on current
ASW training
15Professional Roles Responsible Clinician
- At point of assessment, 2 Doctors must make
medical recommendations. - Amendment July 07 for renewals, RC must consult
with MH professional from another background - 1983 Act -Detained patients all have a
Responsible Medical Officer - Amendments will replace RMO with a Responsible
Clinician - Responsible Clinician can be any trained and
approved mental health professionals - Role to have an overview of all assessment
treatment - Responsible Clinician is appointed according to
the needs of the patient
16Nearest Relative
- AMENDMENTS
- Nearest Relative is person defined in law
- Includes civil partners
- NR rights remain and apply also to Supervised
Community Treatment - Courts can displace the nearest relative where it
is deemed reasonable - Patient has rights to apply to the courts for
displacement - Courts can displace the nearest relative for an
indefinite period
- 1983 ACT
- Nearest relative is person defined in law
- NR has various rights including to be consulted,
to object to admission to discharge - Can only be displaced from this role through
Court and grounds for this are limited
17Mental Health Review Tribunals
- Amendments
- Reduce time period from referral to hearing
- Right of appeal for those on SCT
- Those on SCT who are recalled for more than
72hrs, must be referred to MHRT - Automatic referral from point of detention
- Referral process to include those pending
displacement hearings (sec 29) - Minimum automatic referral period 3 yrly,
amendment June 07 extends annual automatic
referral of children, to 16/17 yr olds
- 1983 Act
- Detained patients have right to appeal in each
term of detention - Hospital will arrange a tribunal where the person
has not done so themselves
18Deprivation of Liberty Safeguards Proposals
(DOLS) Care for those without Capacity
- Mental Capacity Act does not permit deprivation
of liberty - Mental Health Bill will amend the Mental Capacity
Act to provide a legal means of authorising
deprivation of liberty - Will affect
- 1.Those lacking capacity to give informed consent
to their care - 2. Where the nature of the care could be
depriving them of their liberty - 3. Must be over 18
19DOLs Proposals
- Deprivation of liberty must be authorised via a
legal procedure - Assessment must establish eligibility criteria
and best interest necessary proportionate
no other viable alternative - Assessor can attach conditions to the
authorisation including time period of
authorisation - Maximum period of authorisation is 12mths
- Person has right of appeal and a representative
appointed - Amendment June 07 where the representative is
an unpaid person, they have right to refer to an
IMCA on any issue
20Additional Amendments
- Detained patients have statutory right to
advocacy - Informal patients have right to advocacy where
treatment is under sec 57 requiring consent and
second opinion (psycho surgery hormone
implants) - Informal patients under 18yr olds have right to
advocacy for sec 58 treatments ECT, medication
beyond 3mths
21Additional Amendments
- Victims have rights to information about the
discharge of mentally disordered offenders - Patients in a place of safety (for the purpose of
assessment sec 136, 135) can be transferred
between places of safety - Criminal offence - 5 yrs max (Oct 07)
22Questions?
23Supervised Community Treatment
24SCT or CTO
- Supervised Community treatment is the name given
to the whole approach - The name of the section that details the
requirements and powers is a Community Treatment
Order s17a Mental Health Act 1983 (as amended by
the 2007 Mental Health Act) -
25What is SCT?
SCT is intended to support patients who have a
mental disorder, have been detained for
treatment, and are likely to disengage from
treatment once they are discharged. The order
introduces the ability to recall the patient
subject to certain conditions
26Criteria
- The relevant criteria are
- the patient is suffering from mental disorder of
a nature or degree which makes it appropriate for
him to receive medical treatment - (b) it is necessary for his health or safety or
for the protection of other persons that he
should receive such treatment - (c) subject to his being liable to be recalled as
mentioned in paragraph (d) below, such treatment
can be provided without his continuing to be
detained in a hospital - (d) it is necessary that the responsible
clinician should be able to exercise the power
under section 17E(1) below to recall the patient
to hospital and - (e) appropriate medical treatment is available
for him.
27Consenting?
COP 25.14 Patients do not have to consent
formally to SCT. But in practice, patients will
need to be involved in decisions about the
treatment to be provided in the community and how
and where it is to be given, and be prepared to
co-operate with the proposed treatment.
28Mandatory Conditions
- The following two conditions must be applied
(under s17b of the MHA) - that the patient must make himself available for
examination of whether his CTO should be extended
under s20A - That if a SOAD doctor needs to see him/her, he
must also make himself available
29Other Conditions
- Other conditions may be imposed as long as they
are necessary or appropriate, for one or more
of the following reasons - ensuring that the patient receives medical
treatment and/or - preventing risk of harm to the patients health
or safety and/or - it is necessary to protect other people
- An AMHP must also agree that any such
conditions are necessary or appropriate - These conditions could include reside at a
particular place, make himself available at
particular times and places for medical treatment
or abstaining from a particular conduct. - Conditions can be varied or suspended without
approval of the AMHP
30Recall / Revocation
- If the compulsory conditions are breached, the
Responsible Clinician can recall the patient - If other conditions set are breached, recall can
only happen if - the patient needs to receive treatment for mental
disorder in hospital and - there would be a risk of harm to the health or
safety of the patient or to other persons if the
patient were not recalled. - If the above criteria are met, the person can be
recalled whether or not they have breached their
conditions.
31What this Means in Practice
- It is possible to recall the patient at an
earlier stage, if it is considered that
non-compliance with medication would lead to
further deterioration in their mental health - This will usually relate to the nature of their
mental disorder, rather than its degree - The advantage of this is not just for the
patients mental health but also avoids the
potentially stigmatising effects (such as police
involvement) often associated with later
intervention
32The Effect of Recall / Revocation
- The patient may be recalled to hospital and this
may last for up to 72hrs - During the 72 hours the Responsible Clinician
will assess the patient to see if the CTO needs
to be revoked - If the order is revoked, the CTO reverts to its
previous status (i.e. s3, s37 etc). - The Section starts again, 6 months, 6 months and
a year for renewal. The patient is subject to
Part 4 and is treated on the basis of the SOAD
certificate whilst on SCT
33SCT and Consent to Treatment
34- People on a treatment order (e.g. s3) are subject
to pt 4 of the Act - People on SCT in the Community are subject to pt
4A (this introduces elements of the MCA, like
advance decisions LPA donees) - People who are recalled to hospital are subject
to s62a
35How that Works?
- SCT patients aged 16 or over with capacity or
competence to refuse treatment cannot be treated
against their will unless recalled to hospital
except in very limited emergency situations - SCT patients aged 16 or over who lack capacity or
competence to refuse treatment cannot be treated
forcibly if they object without being recalled to
hospital, (except in emergencies) - Treatment must be authorised within one month of
the SCT by a SOAD
36Recalled Patients
- Treatment can be given on recall even if a
patient does not (or cannot) consent, provided it
is authorised by the Act - Treatment is authorised if
- Its authorised on Part 4A certificate
- Discontinuing would cause serious suffering (62A)
- Patient went onto SCT less than a month ago
(64B(4)) - Its less than three months since treatment was
first given (58(1)(b)) - The Treatment is immediately necessary
37Key Questions and Concerns
38Break
39Feedback from Key Questions
40Future Plans and Developments
- Policy and Procedure Development
- Policies and procedures in place for 3rd Nov
2008. (SCT) visit intranet and internet. - Over 40 policies and procedures have been revised
to include the amendments - Working groups were established across the Trust
with members being recruited from a variety of
professions including nursing, social care,
consultants and managers.
41Future Plans and Developments
- Training
- Ongoing training program to run jointly with
LA/users and carers - This will be through the Essential Skills
Training that is currently being piloted. There
will be18 sessions per year. - Locally the MH Law Forums will identify
additional training programs that may be required
42Future Plans and Developments
- Workforce Development
- Ongoing discussion with partners to widen role of
AMHP/RC to other professionals (project plan to
follow) - These discussions will include how to allow staff
to access the training required and where the new
roles will be most effective - Governance Framework
- MH Law Scrutiny Committee is in place to monitor
activity and Mental Health Law Forums have been
strengthened to support a more robust governance
framework and monitor activity
43Future Plans and Developments
- Communications
- Briefing sessions will be available for service
users and carers - Written information will be available on the
internet site including discussion documents to
be used when speaking to service users and carers - Continued development of the internet site that
is available to staff and public
44Future Plans and Developments
- Partnership Development
- Through the implementation program and existing
committees and forums we are working with partner
agencies to ensure consistency and to agree
standards for implementing the Amendments - Discussions with Commissioners on IMHA
45Accessing Further Information
- Internet Resources
- http//www.penninecare.nhs.uk/practitioners/mental
-health-law/mental-health-act-amendments/ - The Trust internet site contains information on
the policies, action plans and link to other
documents and sites. We will also post the answer
and references to any questions that have been
recorded here today. - http//www.mhact.csip.org.uk/
- The Care Services Improvement Partnership site
is a useful site for practitioners. This site
also has an area dedicated to Service User and
Carer information. - Statutory Material
- The Code of Practice 2008 is available on all
wards and through your local Mental Health Act
Office. - The Reference Guide 2008 which replaces the
Memorandum is available through your local Mental
Health Act Office.
46Accessing Further Information
- Other resources
- If you cannot find the information you need in
the locations we have listed then you may contact
your local MHA Office to ask for their advice and
assistance.
47Finish