The New Mental Health Act

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The New Mental Health Act

• Dr Owen Samuels
• Consultant Forensic Psychiatrist
• Robin Pinto Unit
• 8 October 2008

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• the Bill is not the step forward for people
  with mental health problems that we all wanted,
  it is not the Bill that we needed and it will not
  be the legislation that we need .
• Baroness Barker
• House of Lords
• 2 July 2007

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Riding the crest of the wave
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• Every barrier that gets in the way of getting
  treatment to people with serious mental health
  problems puts both patients and the public at
  risk
• Rosie Winterton MP
• Health Minister
• 1 March 2007

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Lines of battle were drawn
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Scottish Mental Health (Care and Treatment) Act
2003
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9 Key changes to MHA 1983

• Single definition for mental disorder
• Criteria for the use of compulsion
• Age appropriate services
• Professional Groups
• Nearest Relative
• Independent mental health advocacy service
• Patients and ECT
• Supervised community treatment
• Referral to the MHRT

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Key Change 1 Mental Disorder

• Four forms of Mental Disorder in the 1983 Act -
  replaced by a single definition of Mental
  Disorder
• Mental Disorder means any disorder or
  disability of mind
• Amendments remove the exclusions in s. 1(3) of
  the 1983 Act namely immorality, promiscuity and
  sexual deviancy leaving only dependence on
  alcohol or drugs
• Extends compulsory powers to people with
  developmental disorders and those with learning
  disabilities in exactly the same way as the
  unamended Act
• Leaves some confusion with the overlap with the
  Mental Capacity Act

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Key Change 2 Criteria for Compulsion

• May be detained under s. 3 whether or not they
  have a disorder which fits into one of those
  current four categories
• Treatability test abolished and replaced by
  appropriate medical treatment test
• Medical Treatment includes nursing,
  psychological intervention and specialist mental
  health habilitation, rehabilitation and care

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• Medical treatment which is for the purpose of
  alleviating or preventing a worsening of a
  disorder, symptom or manifestation
• Purpose is not the same as likelihood
• Does not have to be the most appropriate
  treatment
• Does not have to address every aspect of the
  persons disorder
• Must be available not theoretically be provided

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In summary S. 3

• An application for admission for treatment may be
  made in respect of a patient on the grounds that
• He is suffering from mental disorder of a nature
  or degree which makes it appropriate for him to
  receive medical treatment in a hospital and 
• Repealed treatability test
• It is necessary for the health or safety of the
  patient or for the protection of other persons
  that he should receive such treatment and it
  cannot be provided unless he is detained under
  this section and
• (d) Appropriate medical treatment is available to
  him

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Section 37

• The court is satisfied on the written or oral
  evidence of two registered medical practitioners,
  that the offender is suffering from mental
  disorder and
• the mental disorder from which the offender is
  suffering is of a nature or degree which makes it
  appropriate for him to receive medical treatment
  in a hospital and
• Appropriate medical treatment is available to him

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Key Change 3 Supervised Community Treatment

• AGAINST
• More patients subjected to compulsory powers
• Increased meds
• Disproportionately impact on BEM
• Inadequate community services

• FOR
• More flexible
• Community-based service delivery
• Shorter hospital stays
• Revolving door patients

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Revolving door patients
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Churchill et al 2007 International Experience
of Using CTO

• No evidence of change in outcomes of
• Hospital admissions
• Hospital bed days
• Compliance with treatment
• Violence
• Symptoms
• Offences resulting in arrests
• Social functioning
• Quality of life, care or satisfaction
• Perceived coercion

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Problems with CTOs

• AMHP and RC from same team unlikely to disagree
• Discharge safety net for those risk averse
• Difficult being discharged by Tribunals

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The Process

• S. 25A repealed
• S. 17A introduced
• Only for those detained for treatment (not s. 2
  or s. 136)
• AMHP
• Appropriate
• Conditions are necessary and appropriate
• Subsequent conditions do not need AMHP

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Criteria for RC and AMHP to agree

• Mental disorder of nature or degree for medical
  treatment
• Necessary for health or safety or protection of
  others
• Rx can be provided without patient being detained
  in hospital
• RC should be able to recall
• Appropriate medical treatment is available

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Conditions

• At least two conditions
• Patient must be available for examination for
  extension of CTO
• Patient must be available for examination for
  Part 4A certificate

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Key Change 4 Professional Groups

• AMHPs
• Widens pool of professionals
• Nurses, psychologists, OTs
• Must be able to demonstrate social perspective
  and independence
• ACs
• Medical Practitioners, Chartered Psychologists,
  First Level Nurses, Ots, Social Workers
• Relevant Competencies Schedule 2 Mental Health
  (Approved Clinician) Direction 2008

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• RCs
• Is an AC with overall responsibility for the
  patient
• May change over time
• Another professional can carry out roles that the
  RC cannot do e.g. prescribing
• NB changes to renewal (s. 20)

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Other Changes

• Key Change 5 Nearest Relative
• Key Change 6 IMHA
• Key Change 7 ECT
• Key Change 8 Changes to Tribunals

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The Guiding Principles

• The purpose principle
• The least restrictive principle

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Respect principle

• Participation principle
• Effectiveness, efficiency and equity principle

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Dont worry you are not the only ones battling to
understand it all!