The Mental Health Act

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The Mental Health Act

• Tim Maddocks
• Approved Mental Health Practitioner

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The Mental Health Act 1983

• 25 year old law amended by Mental Health Bill
  2007
• New laws implemented on November 3rd 2008
• Long standing concerns at public and political
  level about the perceived risk of people with a
  mental disorder who require treatment
• Only occasion you can be locked up without
  suspicion of having committed a crime!

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Some Definitions

• In order to be detained under the Act someone has
  to be deemed to be suffering from a Mental
  Disorder
• any disorder or disability of the
  mind
• Mental Health Act 1983, Section 1 (2)
• In theory this could embrace a broad range of
  conditions and behaviour ..

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Examples of Mental Disorder

• Affective disorders such as depression and
  bipolar disorder
• Schizophrenia/psychoses and delusional disorders
• Neurotic stress related such as anxiety, phobic
  disorders, obsessive compulsive disorders, post
  traumatic stress disorder
• Organic mental disorders such as dementia and
  delirium
• Personality and behavioural changes caused by
  brain injury or damage
• Personality Disorders
• Mental and behavioural disorders caused by
  psychoactive substance use
• Eating disorders, non-organic sexual disorders
  and sleep disorders
• Learning disabilities

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Can anyone be detained?

• The fact that someone has a mental disorder is
  never sufficient grounds for any compulsory
  measure to be taken under the Act.
• Compulsory measures are permitted only where
  specific criteria about the potential
  consequences of a persons mental disorder are
  met
• There are many forms of mental disorder unlikely
  ever to require compulsory measures
• Mental Health Act 1983 Code of Practice
  2008

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Those involved in the initial assessment

• A psychiatrist - who receives additional
  training
• Another medical practitioner
• One of the medical practitioner to have had
  previous knowledge of the person ideally their GP
• An Approved Mental Health Practitioner - usually
  a social worker but can now be a nurse,
  occupational therapist or psychologist
• All three have to agree before anyone can be
  detained

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Some of the challenges

• Gaining access to the person
• Managing peoples safety eg should police attend?
• Establishing a clear picture of what is going on
  eg client wont talk, family have different
  perspective etc
• Assessing and managing risk of detaining/not
  detaining
• Fear and anxiety on part of person
• Family often frightened and exhausted
• Conveying the person into hospital
• The implications of in patient care particularly
  for younger people eg stigma, strange and
  unsettling environment

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The two most common Sections

• Section 2
• Allows for a period of assessment in hospital
  lasting up to 28 days
• Section 3
• Allows for a period of treatment in hospital
  lasting up to 6 months

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Grounds for making an application for detention
under Section 2

• A person can be detained under Section 2 only if
  both the following criteria apply
• The person is suffering from a mental disorder
  of a nature or degree which warrants their
  detention in hospital for assessment (or
  assessment followed by treatment) for at least a
  limited period
• and
• The person ought to be so detained in the
  interests of their own health or safety or for
  the protection of others
• Section 2 (2) (a) and (b)
  
  

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Section 3 Criteria

• A person can be detained under Section 3 only if
  the following criteria
• The person is suffering from a a mental disorder
  of a nature or degree which makes it appropriate
  for them to receive medical treatment in
  hospital
• and
• It is necessary for the health or safety of the
  person or for the protection of other persons
  that they should receive such treatment and it
  cannot be provided unless the patient is detained
  under this section
• and
• Appropriate medial treatment is available
• Setion 3 (2) (a) (c) and (d)

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Additional considerations

• The least restrictive alternative always to be
  considered
• The assessing team will need to explain why the
  patient ought to be admitted to hospital and why
  informal (voluntary) admission is not appropriate
• The persons wishes and needs
• The persons social and family circumstances
• The effect of a decision to admit or not to admit
  under the Act

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Implications for the detained person

• Forcibly taken to hospital
• Kept in a controlled ward with their movement
  restricted
• Forced to take medication if they refuse
• Subject to constant observation, at least
  initially
• No leave without written agreement
• If AWOL, police have powers to return to
  hospital
• Will be recorded in health records
• Future implications eg work, travel abroad

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Safeguards for the Sectioned patient

• Can appeal against decision to a Mental Health
  Tribunal
• Access to independent advocacy
• Role of nearest relative to request discharge
• To have a second opinion review of their medical
  treatment automatically after 3 months
• Visits and complaints procedure by the
  independent Mental Health Act Commission

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The nearest relative

• Identified in law husband/wife/partner, child,
  parent, grandparent or other relative, or
  nominated by service user
• Can request that the local authority consider
  undertaking a MHAct assessment
• Can make an application themselves for detention
  (very rare)
• Right to be consulted by AMHP re potential
  compulsory admission
• Power to block a Section 3 admission if they
  voice their objection
• The right to order the discharge of detained
  person
• Right to certain information from Hospital re the
  detained person
• His/her views to be made known at an appeal to
  the Tribunal

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Some other key features of the Act

• New Supervised Community Treatment requiring
  the person to comply with treatment plan
  including medication or risk being recalled to
  hospital
• Section 17 allows planned controlled leave
  while an in patient
• Section 117 Aftercare
• Section 136 police can arrest someone in a
  public area if they believe them to be suffering
  form a mental disorder
• Large range of legislation covering those in
  Criminal Justice System

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The benefits

• At times people need this level of containment
  for their own health and/or safety
• Allows for a period of observation to help in
  assessment
• Ensures treatment can commence under observation
• Opportunity for change and potential to commence
  on road to recovery
• Relief for families and carers
• Allows plans to be made for the future