Mental Health Care and Treatment Scotland Act 2003

1
Mental Health (Care and Treatment) (Scotland)
Act 2003

• Stephen McGinness
• Clinical Project Manager.

2
Why update the 1984 Act?

• 84 Act consolidating legislation some parts
  date back to 1950s
• Shift towards community care
• Growth of user carer movements
• More emphasis on rights person centred care
• Changes in professional roles

3
Review Process

• Feb 99 Millan Committee set up
• Jan 01 Report of Millan Committee
• Sep 02 Mental Health (Scotland) Bill introduced
  in Scottish Parliament
• Apr 04 Bill given Royal Assent

4
Compulsory Powers - Criteria

• Mental disorder (mental illness, personality
  disorder, learning disability)
• Medical treatment available
• If treatment not provided, there would be a
  significant risk to person or others
• Persons decision making ability is significantly
  impaired
• Use of compulsory powers is necessary

5
Compulsory Powers Emergency Detention

• Required urgently
• Assessment
• Authorised by doctor
• Consent of MHO where practicable
• Detention in Hospital
• Up to 72 hrs
• No right of appeal

6
Compulsory Powers Short-term Detention

• Assessment Treatment
• Authorised by specially trained doctor
• Must have MHO consent
• Detention in hospital
• Up to 28 days
• Right of appeal

7
Compulsory Treatment Order

• Application by MHO to Tribunal
• 2 medical reports, MHO report and a proposed care
  plan
• Patient, named person, primary carer etc can have
  objections heard
• Patient can have legal rep advocate
• Based in hospital or community
• Can seek variation or revocation after 3 mths
• 6mths, renewable for 6 mths, then annually

8
Community-based CTO Possible Requirements

• Treatment in accordance with part 16
• Attend at specified places/times for treatment
• Attend specified community care services
• Reside at specified place
• Allow visits by specified persons in patients
  home
• Notify MHO / Obtain permission of MHO for
  proposed change of address

9
Medical Treatment

• Wide definition covers medical treatment,
  nursing, care, psychological interventions,
  habilitation rehabilitation
• Special safeguards for more controversial
  treatments eg NMD, ECT, long term drug treatment,
  drugs to reduce sex drive

10
Other Powers

• Nurses holding power to stop voluntary patient
  from leaving hospital in order to allow
  assessment
• 2 hrs ( 1hr for examination)
• Police power to remove to place of safety
  24hrs. (Police cell should only be used as a
  last resort)

11
Safeguards - Principles

• Non-discrimination
• Equality
• Respect for
• diversity
• Reciprocity
• Informal care

• Participation
• Respect for carers
• Least restrictive alternative
• Benefit
• Child welfare

12
Safeguards Mental Health Tribunal

• Replaces Sheriff Court as forum for hearing cases
• Wide remit deciding on CTOs, considering care
  plans, hearing appeals
• 3 members 1. Legal (chair) 2. Medical
• 3. General (could be user or carer)
• Atmosphere should be as relaxed as possible to
  encourage participation

13
Safeguards Named Person

• Service user can nominate NP
• Nomination in writing, witnessed
• If no-one nominated, will be primary carer, or
  nearest relative
• Unsuitable NP can be removed and replaced

14
Safeguards Independent Advocacy

• Right of access to independent advocacy for every
  person with a mental disorder
• Duties on Health Boards and local authorities to
  ensure provision of independent advocacy services

15
Safeguards Advance Statements

• Statement setting out wishes for future care and
  treatment
• Tribunal and people giving treatment must have
  regard to them
• If treatment given that conflicts with AS - must
  record reasons and notify patient, named person,
  MWC

16
Safeguards Mental Welfare Commission

• Broad protective role
• Monitor operation of Act
• Promote best practice
• Bring matters to attention of Ministers and
  others
• Carry out visits / investigations / enquiries
• Refer cases to Tribunal
• Can take people off sections (but may not)

17
Safeguards Right of Appeal Against Excessive
Security

• Should help patients entrapped at the State
  Hospital, Carstairs
• Should encourage development of local medium
  secure units
• Tribunal can make declaration and require Health
  Board to find suitable placement for patient

18
Duties Health Boards

• Must respond to request for assessment within 14
  days
• Provide age appropriate services for children and
  young people
• Provide mother and baby units for women with post
  natal depression
• Co-operate with local authorities

19
Duties Local Authorities

• Must respond to request for assessment within 14
  days
• Provide care and support services
• Provide services to promote well-being and social
  development
• Assist in providing transport to above services
• Co-operate with Health Boards

20
Local Authorities Duty to Inquire

• Where a person with mental disorder living in
  community may be at risk
• E.g. situations of neglect or ill-treatment, risk
  to property, or where a person is unable to look
  after him/herself
• Can seek warrants from Sheriff or Justice of the
  Peace entry to premises, medical examination,
  removal to place of safety

21
Potential Issues for Community Care Providers

• Community based CTOs involvement of community
  care providers in care plan, Tribunal proceedings
  etc. Effect on relationship with service user.
  Monitoring role?
• Principles need to take these into account as a
  guide for conduct

22
Potential Issues for Community Care Providers

• Named persons support worker may be asked to be
  named person. Conflict of interest?
• Advance statements staff may be asked for
  advice, service may be included in statement
• Others?????