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Mental Health Act Amendments Briefing Session

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10.15 Overview of the MHA Amendments. 10.45 Questions. 10.50 Supervised ... 11.35 Feedback from Key Questions. 11.45 Pennine ... have to categorise the type ... – PowerPoint PPT presentation

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Title: Mental Health Act Amendments Briefing Session


1
Mental Health Act AmendmentsBriefing Session
2
Programme
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
3
Programme
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
4
Learning 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.

5
The 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

6
Whats New?
  • Definition of Mental Disorder
  • Criteria for Detention
  • Professionals Roles
  • Nearest Relative
  • Supervised Community Treatment
  • MHRT
  • Deprivation of Liberty safeguards

7
Guiding 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

8
Definition 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
9
Definition 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)
10
Definition 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

11
Criteria 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

12
Criteria 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.

13
Professionals 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.
14
New 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

15
Professional 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

16
Nearest 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

17
Mental 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

18
Deprivation 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

19
DOLs 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

20
Additional 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

21
Additional 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)


22
Questions?
23
Supervised Community Treatment
24
SCT 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)

25
What 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
26
Criteria
  • 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.

27
Consenting?
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.
28
Mandatory 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

29
Other 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

30
Recall / 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.

31
What 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

32
The 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

33
SCT 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

35
How 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

36
Recalled 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

37
Key Questions and Concerns
38
Break
39
Feedback from Key Questions
40
Future 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.

41
Future 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

42
Future 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

43
Future 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

44
Future 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

45
Accessing 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.

46
Accessing 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.

47
Finish
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