Mental Health Act Amendments Briefing Session

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Mental Health Act AmendmentsBriefing Session
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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
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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
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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.

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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

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Whats New?

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

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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

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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
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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)
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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

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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

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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.

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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.
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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

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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

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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

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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

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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

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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

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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

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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)

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Questions?
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Supervised Community Treatment
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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)

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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
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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.

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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.
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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

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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

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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.

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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

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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

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SCT and Consent to Treatment
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• 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

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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

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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

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Key Questions and Concerns
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Break
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Feedback from Key Questions
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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.

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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

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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

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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

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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

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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.

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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.

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Finish