THE MENTAL HEALTH ACT 2007. The Mental Health Act 2007 Amends the mental Health Act 1983 Does not...
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Transcript of THE MENTAL HEALTH ACT 2007. The Mental Health Act 2007 Amends the mental Health Act 1983 Does not...
THE MENTAL HEALTH ACT 2007
The Mental Health Act 2007
Amends the mental Health Act 1983
Does not replace the 1983 Act
Mental Health Act 2007 – objectives
• To ensure patients receive the care they need to protect themselves and other people from harm
• To support modernised services• To strengthen patient safeguards• Remedy Human Rights incompatibilities
What’s Changing?
• Supervised Community Treatment (SCT)• Definition of Mental Disorder• Criteria for Detention • Consent & ECT safeguards • Professionals Roles• Nearest Relative• References to MHRT• Right to advocacy• Deprivation of Liberty Safeguards (DOLS)
Code of Practice Principlesmust inform decisions and address…
• Respect for patients past and present wishes and feelings
• Respect for diversity• Minimise restrictions• Involve patients in their
care and treatment• Efficient use of
resources• Equitable distribution of
services
• Avoid unlawful discrimination
• Effectiveness of treatment
• Views of carers and others
• Patient well being and safety
• Public safety
Definition of Mental Disorder – the 1983 Mental Health Act (now)
Psychopathic disorder
Mental disorder
Severe mentalimpairment
Applies to section 2
Other sections of 1983 Act (e.g. section 3) have to categorise the type of mental disorder
Mental Illness
Mental impairment
Definition of Mental Disorder – what will change with the amendments?
Learning disability must be associated with abnormally aggressive or seriously irresponsible conduct
(autistic spectrum disorders are not learning disabilities)
Mental disorder - “Any disorder or disability of the mind”
Applies to all sections – Decisions about compulsory interventions should
be based on risk and need rather than category
Definition of Mental Disorder Exclusions
• 1983 Act (now) excludes promiscuity & other immoral conduct. 2007 Act removes these exclusions as self evident they are not mental disorder
• Exclusion is “sexual deviancy” is removed• 1983 Act excludes dependence on alcohol or
drugs – the 2007 Act retains this
Criteria for DetentionUnchanged from 1983 Act (now):• must be suffering from a mental disorder in one of the 4
categories• disorder must be of a nature or degree to make
treatment in hospital appropriate• treatment in hospital must be necessary for patient's
health or safety, or for protection of others• detention is the only way of delivering the treatment
Changing:• if mental impairment or psychopathic disorder,
treatment must be likely to alleviate or present deterioration ("treatability”)
• replaced by “appropriate medical treatment available"
Appropriate Medical Treatment Test
• Can only detain if medical treatment appropriate to mental disorder – and all other circumstances of their case, is available
• Might include distance from home, cultural requirements etc
• Must have a holistic assessment• Purpose of treatment must be to alleviate or
prevent worsening of the disorder, its symptoms or manifestations
• Must be clinical purpose to detention
Consent and ECT Safeguards
• Except in emergencies, a person must consent to ECT - or where they lack capacity, a second opinion Doctor (SOAD) must give authorisation
• People who have capacity cannot have wishes over ridden except in an emergency
• SOAD cannot give a certificate if this conflicts with a valid and applicable advance decision, objection by a donee (LPA) or deputy (appointed by Ct Protection)
• Where a person gives consent, but then loses capacity before or during the ECT treatment, a second opinion must be sought
Consent and Young People• Patients under 18 who are not detained, will have
statutory right to advocacy for section 58 treatments• ECT for under 18s (detained or informal) is not allowed
without a SOAD’s authorisation unless it is an emergency
• 16 and 17 year olds who have capacity, cannot have their refusal to be admitted to or remain in hospital for mental health treatment over-ruled by a person with parental responsibility - now commenced
• Hospital managers must ensure that voluntary or detained patients, under 18 years old, must be in an environment suitable for their age, subject to their needs
1983 Act – Existing Community Powers
• Guardianship – can require to reside; give access; attend for treatment (cannot enforce medication); attend for occupation and education
• Supervised Discharge - can require to reside; give access; attend for treatment (cannot enforce medication); attend for occupation & education – no power of recall
• Section 17 leave of absence – for patients already detained
Amendments - Supervised Community Treatment
• Supervised discharge will be abolished• Community Treatment Orders (CTOs) can only be
applied for person already detained under section 3 or some sections imposed through the courts
• Similar criteria to sec 3; i.e. must still require treatment and no other less restrictive alternatives could be used
• Decision made by Responsible Clinician + second opinion of Approved Mental Health Professional (AMHP)
• Must be necessary to be able to recall the patient to hospital for treatment
SCT continued…• Conditions of care can be imposed • Purpose of conditions must be explicit & can only be
made to ensure medical treatment or prevent harm to patient’s health or safety or protection of others
• Must be necessary having regard to patient’s history• Care provided free of charge• Medication cannot be enforced in the community
except in certain limited emergency situations• Can be recalled• Re-detention by Responsible Clinician, agreed by
AMHP• Rights to appeal to tribunal and must be referred to
MHRT if the CTO is revoked
Professionals involved in decisions – 1983 Act (now)
• 1983 Act requires two 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.
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
New Professional Roles - RC• 1983 Act - Detained patients all have a
Responsible Medical Officer • Amendments will replace RMO with a
Responsible Clinician• At point of assessment, two doctors must make
medical recommendations• For renewals, RC must get agreement from MH
practitioner from another profession • Role to have an overview of all assessment and
treatment• Responsible Clinician is appointed according to
the needs of the patient
Nearest Relative1983 Act (now)• ‘Nearest relative’ is a
person defined in law • NR has various rights
including to be consulted, to object to admission and to discharge
• Can only be displaced from this role through Court, and grounds for this are limited
Amendments• Includes civil partners • NR rights remain and apply
also to SCT• Courts can displace the
nearest relative where it is deemed reasonable on the ground the NR is “unsuitable”
• Patient has new right to apply to the courts for displacement
• Courts can displace the nearest relative for an indefinite period
Mental Health Review Tribunals1983 Act (now)
• Detained patients have right to appeal in each term of detention
• Hospital must refer patient’s case periodically if they don’t apply themselves
Amendments• Right of appeal for those on
SCT• Those whose SCT is
revoked must be referred to MHRT
• Automatic referral after 6 months from start of detention, not just start of section 3
• Reference after exactly 3 years/ 1 year of last hearing - not at the next renewal point
• 1 year period applies to under 18’s, not under 16’s as previously
Statutory Right to Advocacy
• All detained, SCT and guardianship patients have right to advocacy
• Informal patients have right to advocacy where treatment is under sec 57 – requiring consent and second opinion (i.e. psychosurgery) - this also applies to under 18’s in respect of ECT
• Patients have to be given information about advocacy
• Advocates have right of access to records (with patients permission)
• Can advocate in areas of treatment, care planning, reviews
Deprivation of Liberty Safeguards (DOLS)
– care for those without capacity • Mental Capacity Act does not permit deprivation
of liberty• Mental Health Act 2007 amends the Mental
Capacity Act to provide a legal means of authorising deprivation of liberty
• Will affect those over 18 who lack capacity to give informed consent to their care where the nature of the care could be depriving them of their liberty
• If patent objects to hospital admission and could be detained under the MH Act instead, DOLS cannot be used
Deprivation of Liberty Safeguards
• 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• Where the representative is an unpaid person, they
have right to refer to an IMCA on any issue
Additional Amendments
• Rights of victims to information about discharge of certain mentally disordered offenders extended from restricted offenders to unrestricted offenders as well
• Patients in a place of safety (for the purpose of assessment – sections 136 and 135) can be transferred between places of safety