THE

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THE MENTAL HEALTH ACT 1983 ALISON
WHEELTON SENIOR MHA ADMINISTRATOR JAG
BARHA DEPUTY SENIOR MHA ADMINISTRATOR
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The Code of Practice
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It is important that we have a modern legal
framework within which clinicians can intervene
where necessary to protect people with mental
disorders themselves and, sometimes, to protect
other people as well. But with the power to
intervene compulsorily comes the responsibility
to do so only where it is right and to the
highest standards possible. Alan Johnson
Secretary of State for Health (2007) Code of
Practice
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GUIDING PRINICIPLES

• Purpose principle
• Least restriction principle
• Respect principle
• Participation principle
• Effectiveness, efficiency and equity principle

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PURPOSE PRINCIPLE

• Decisions under the Act must be taken with a view
  to minimising the undesirable effects of mental
  disorder, by maximising the safety and well being
  (mental and physical) of patients, promoting
  their recovery and protecting other people from
  harm.

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LEAST RESTRICTION PRINCIPLE

• People taking action without a patients consent
  must attempt to keep to a minimum the restriction
  they impose on the patients liberty, having
  regard to the purpose for which the restrictions
  are imposed.

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RESPECT PRINCIPLE People taking decisions under
the Act must recognise and respect the diverse
needs, values and circumstances of each patient,
including their race, religion, culture, gender,
age, sexual orientation and any disability. They
must consider the patients views, wishes and
feelings (whether expressed at the time or in
advance), so far as they are reasonably
ascertainable, and follow those wishes wherever
practicable and consistent with the purpose of
the decision. There must be no unlawful
discrimination.
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PARTICIPATION PRINCIPLE
Patients must be given the opportunity to be
involved, as far as is practicable in the
circumstances, in planning, developing and
reviewing their own treatment and care to help
ensure that it is delivered in a way that is as
appropriate and effective for them as possible.
The involvement of carers, family members and
other people who have an interest in the
patients welfare should be encouraged (unless
the are particular reasons to the contrary) and
their views taken seriously.
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• EFFECTIVENESS, EFFICIENCY AND EQUITY PRINCIPLE
• People taking decisions under the Act must seek
  to use the resources available to them and to
  patients in the most effective, efficient and
  equitable way, to meet the needs of patients and
  achieve the purpose for which the decision was
  taken.

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The Mental Health Act in Practice Following the
Patients Pathway

• For this session YOU are the patient, yes YOU!

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The Mental Health Act in Practice Following the
Patients Pathway

• Remember - You are the patient
• What questions would you want to ask?
• What information would you need?
• What does a section mean?
• What rights do you have?

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The Mental Health Act in Practice Following the
Patients Pathway

• You have been admitted to Mental Health Unit as
  an informal patient

Q What does informal mean?
As an informal patient you have agreed to come
into hospital voluntarily and be a patient on
the ward it is likely that you know you are
unwell and need to be given help and support
As an informal patient you are not subject to
any restrictions on leaving the ward while you
are an inpatient we continue to have a duty of
care towards you.
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The Mental Health Act in Practice Following the
Patients Pathway

• You become agitated and insist you are going to
  leave the ward with the intent of self harm

Q What happens next?
The nurse has expressed concerns about you
leaving the ward, however you are insistent. The
nurse decides to use section 5(4) of the Mental
Health Act. A doctor soon arrives and you are
placed on section 5(2).
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The Mental Health Act in Practice Following the
Patients Pathway
Section 5(4) The use of section 5(4) is the
decision of the nurse (of the prescribed class)
and provides emergency detention for up to six
hours whilst awaiting the arrival of a
doctor. Section 5(2) Section 5(2) is applied by
the doctor and provides for emergency detention
for up to 72 hours to allow for further
assessment.
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The Mental Health Act in Practice Following the
Patients Pathway

• You are now detained under the Mental Health Act

Q What information will I be given?
You should continually be informed about what is
happening to you and the implications for you
legally. The information should be provided
to you both orally and in writing and in a
format that you understand. This will be the
case whenever there are changes to your legal
status.
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The Mental Health Act in Practice Following the
Patients Pathway
Section 132 Duty to give information to detained
patients (and relatives) Effective
communication is essential in ensuring
appropriate care and respect for patients
rights. How do we do this? By involving the
patient Using leaflets Department of Health,
Trust Leaflets e.g. IMHAs, CQC Recording
information Trust forms and patients
healthcare records
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The Mental Health Act in Practice Following the
Patients Pathway

• Your Responsible Clinician arrives on the ward
  within the 72 hour period and together with
  another doctor makes a further assessment.
• The two doctors complete recommendations for a
  section 2. An Approved Mental Health Practitioner
  (AMHPs) arrives, assess you and completes an
  application.
• The nurse accepts these documents and you are now
  subject to section 2 for up to 28 days for
  further assessment.
• During this period a further assessment takes
  place and your section status is changed to a
  section 3 for treatment, with an initial period
  of 6 months detention, this may be followed by a
  further 6 months and then annually renewed if
  appropriate.

Q What rights do I have?
As with any changes to your status you will be
kept informed as described previously.
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The Mental Health Act in Practice Following the
Patients Pathway

• Rights under sections 2 and 3
• Rights of appeal for discharge
• Managers Panel Members Lay people who are
  appointed and trained to undertake this role
  specifically. The Panel Members also have a duty
  to review the decision to renew a section.
• Tribunal Service Body with statutory functions
  who are independent of the Trust. The Tribunal
  may also be involved in the decision to renew the
  section.
• The patients nearest relative (under section 26
  of the Act) also has rights of appeal on behalf
  of the patient to the above.

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The Mental Health Act in Practice Following the
Patients Pathway

• Now you are detained under section 3 and your
  doctor wants to give you treatment, which you are
  unhappy about.

Q What will happen next?
You should always be involved in your treatment
and care plans. Under section 3 the doctor can
give you treatment without your consent for the
first three months and this will include the time
you were detained under section 2. If,
following consultation, the doctor wishes to
continue to treat you but you do not (or cannot
because of capacity issues) consent to that
treatment, the doctor will request a second
opinion from the Care Quality Commission doctor
who will subsequently visit you. It will then be
the decision of this second doctor as to whether
or not your treatment continues.
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The Mental Health Act in Practice Following the
Patients Pathway

• You have been on section 3 now for some time and
  your mental health is improving.

Q What options are there for me now?
The clinical team will continue to assess your
condition and working in partnership will plan
towards discharge from both the section and the
hospital. Part of this plan may be the use of
section 17 Leave of Absence which is authorised
by your doctor and provides for periods of time
outside of the hospital whilst still on section.
In longer term planning for your discharge, the
doctor may also consider the use of a Community
Treatment Order. This provides a framework of
care for you within the community, but also
provides for the ability for the doctor to recall
you to hospital should your condition deteriorate
at which point the original section 3 may be
reinstated.
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The Mental Health Act in Practice Following the
Patients Pathway
Statutory forms required
2 Nearest Relative Application Form A1 or 2 AMHP
Application Form A2 and 2 Joint Medical
Recommendation Form A3 or 2 Medical
Recommendation (x2) Form A4 and 2 Record of
Detention Form H3 3 Nearest Relative
Application Form A5 or 3 AMHP Application Form
A6 and 3 Joint Medical Recommendation Form
A7 or 3 Medical Recommendation (x2) Form
A8 and 3 Record of Detention Form H3 3 Renewal
Form Form H5 4 Nearest Relative
Application Form A9 or 4 AMHP Application Form
A10 and 4 Medical recommendation Form
A11 5(4) Nurses Holding Power Form H2 5(2)
Report Form H1
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The Mental Health Act in Practice Following the
Patients Pathway
Statutory forms required
CTO Community Treatment Order Form
CTO1 CTO Variations of Conditions Form
CTO2 CTO Notice of Recall to Hospital Form
CTO3 CTO Record of Patients Detention in
Hospital after Recall Form
CTO4 CTO Revocation of CTO Form CTO5 CTO Report
Extending the CTO Form CTO7 CTO S64c(4)
Certificate of Appropriateness of Treatment to be
given to Community Patient Form
CTO11 S25 Report barring Discharge by Nearest
Relative Form M2
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The Mental Health Act in Practice Following the
Patients Pathway
Statutory forms required
S57 Certificate of Consent to Treatment 2nd
Opinion Form T1 S58 Consent to
Treatment Form T2 S58 Second Opinion Form
T3 S58 Consent to Treatment (patients at least 18
yrs old) Form T4 S58 Certificate of Consent to
Treatment 2nd Opinion (patient under
18) Form T5 S58 Certificate of 2nd
Opinion Form T6
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The Mental Health Act in Practice Following the
Patients Pathway
Part 3 of the MHA Forensic Sections Forensic
sections refer to the part of the Act that is
dealt with through the Criminal Justice System.
The Court, on advise from a doctor, decide that
a hospital setting would be more appropriate than
a custodial sentence, or following a period of
custodial sentence. The most common of these
used within this Trust is a section 37 which
mirrors a section 3.
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The Mental Health Act in Practice Following the
Patients Pathway
Independent Mental Health Advocates (IMHAs) IMHA
services provide an additional safeguard for
patients who are subject to the Act. IMHAs are
specialist advocates who are trained specifically
to work within the framework of the Act to meet
the needs of patients. In Leicestershire these
services are provides by LAMP in the City and
County . N.B. not to be confused with IMCAs
(this will not be a spelling mistake)! - IMCAs
Mental Capacity Act
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The Mental Health Act in Practice Following the
Patients Pathway

• IMHAs WHO IS ELIGIBLE?
• Detained certain categories
• Conditionally discharged
• Guardianship
• SCT
• IMHAs do not replace other advocacy services but
  work in conjunction.
• IMHAs do not replace solicitors of the patients
  rights to legal aid.

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The Mental Health Act in Practice Following the
Patients Pathway

• IMHAs the Role
• To help patients obtain information and
  understand
• their rights and the rights of others (e.g. the
  nearest relative)
• the parts of the Act that relate to them
• any conditions or restrictions
• medical treatment and the reasons why
• the legal authority under which treatment is
  being given
• In order to do the above the IMHA will require
  relevant and up to date information for which
  they have the authority to access the patients
  healthcare record, this should be done so in a
  constructive and inclusive manner i.e. relative
  to the purpose for which the access is intended.

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The Mental Health Act in Practice Following the
Patients Pathway

• Where does the MHA Office fit into this Pathway?
• The Office has two distinct roles
• To ensure that patients rights under the Act are
  upheld
• To provide a monitoring system on behalf of
  clinical staff to ensure the timescales laid down
  in the Act are met
• Thereby playing our part in protecting the Trust
  from litigation!

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THANK YOU FOR ATTENDING ALISON WHEELTON SENIOR
MHA ADMINISTRATOR JAG BARHA DEPUTY SENIOR MHA
ADMINISTRATOR