Module 4: Ending Compulsion

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Module 4 Ending Compulsion
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Learning Outcomes

• Understand the legal basis for discharge
• Discuss the role of Mental Health Review Tribunal
• Understand the role of Hospital Managers

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Powers to Discharge Patients from Compulsion

• Power of Discharge by RC, Hospital Managers, MHRT
  and Nearest Relative.
• Patients subject to the following
• Part 2 Civil Sections 2,3,7,17A
• Forensic sections under Part 3 of the Act

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Powers to Discharge Patients from Compulsion -
Changes

• Power of Discharge is given to non-medical RC as
  well as medical RC
• Power of Discharge for Patients on SCT is given
  to Hospital Managers, MHRT NR

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Criteria for Discharge Changes

• The criteria for discharge reflect the criteria
  for detention change in exclusions
  treatability test!
• Therefore the new criteria for detention, ie
  Mental Disorder and for Treatment sections
  appropriate treatment being available will need
  to be considered.
• SCT Section 17a will require consideration of the
  nature of the Mental Disorder rather than the
  degree

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Changes under MHA 2007 Rules Regulations

Amend the Act to achieve earlier access to the
Mental Health Review Tribunal for all civil
patients.

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These changes are as follows

• Reference to the MHRT by Hospital Managers after
  the first six months for patients on Section 3,
  who have not lodged an appeal to the MHRT during
  that period, will take into account any time they
  may have been detained under Section 2
• Reference of minors who have not appealed to the
  MHRT during their annual renewal must be made on
  an annual basis instead of the 3 yearly basis
  that remains the case for adult patients, those
  18 and over.

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These changes are as follows (cont)

• Automatic referrals to the MHRT by Hospital
  Managers of community patients who have their CTO
  revoked under Section 17F
• Automatic referrals to the MHRT by Hospital
  Managers of patients returned from guardianship
  to hospital
• The Tribunal Panel for children and young people
  under 18 years shall have a medical specialist in
  CAMHS (Child and Adolescent Mental Health
  Service) on the panel
• The Secretary of State will be able to reduce the
  current reference period to the MHRT as and when
  he thinks fit.

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Further Changes to the MHRT

• There will now be one MHRT for England and one
  for Wales.
• Patients subject to Section 17A Community
  Treatment Order will be able to apply or be
  referred to the MHRT
• There shall be one President of the Tribunal in
  England and one in Wales
• The legal member of the Tribunal Panel shall be
  known as the Chairman rather than the President
  of the Tribunal
• The current Rules of the Tribunal are being
  reviewed. (Rule 6 that reports must be submitted
  within 3 weeks of receipt of an application will
  not be changed)

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Organisation of the MHRT
The organisation of the MHRT is currently
undergoing changes brought about by a review of
the Tribunals system in England and Wales. These
will be implemented by the Ministry of Justice.
These changes include the introduction of a two
tier Tribunal system.
This tier will act as 1) a point of appeal and
2) a place to clarify points of law.
Tier two
Tier One
This tier will hear the majority of cases. Cases
will be divided by type and each group will
have its own president
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Activity 1 (p 123)

• Continuing Eddies story

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Hospital Managers
The Role of the Hospital Manager
The managers of the hospital or registered
establishment in which a patient is detained are
responsible for making sure that a patient who is
subject to compulsion (in hospital or on SCT)
understands what this means, and what their
rights to appeal are. This should happen as soon
as possible once the patient is placed on
section.  
Managers need to consider the new legal
requirements around appropriate treatment and
how it effects the decision making!
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Hospital Managers
The wider role of the hospital managers

• For example
•  
• Responsibility for age appropriate accommodation
  for young people
• Responsibility for the ways in which the hospital
  as a whole operates mental health law
• Making sure that where they delegate duties to
  other people (for example, to nurses who receive
  papers on their behalf) that those people are
  able to exercise those duties competently.

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Hospital Managers

• Responsibilities of Managers of
• Foundation Trusts
• In the case of an NHS foundation trust, a panel
  can consist of any three or more people appointed
  for the purpose by the trust whether or not they
  are members of the trust itself or any of its
  committees or sub-committees.

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Hospital Managers
The Legal Basis for Hospital Managers

• Hospital Managers function arises from the
  following sections
•  
• Section 23 - power of discharge
• Section 132 - duty to inform a detained patient
  of their rights, and
• Section133 - duty to inform a detained patients
  nearest relative of their rights under the MHA.
•