Transcript Mental Health Act Training Presentation

THE
MENTAL HEALTH ACT 1983
ALISON WHEELTON
SENIOR MHA ADMINISTRATOR
JAG BARHA
DEPUTY SENIOR MHA ADMINISTRATOR
The Code of Practice
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
GUIDING PRINICIPLES

Purpose principle

Least restriction principle

Respect principle

Participation principle

Effectiveness, efficiency and
equity principle
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.
LEAST RESTRICTION PRINCIPLE
People taking action without a
patient’s consent must attempt to
keep to a minimum the restriction
they impose on the patient’s liberty,
having regard to the purpose for
which the restrictions are imposed.
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 patient’s 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.
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
patient’s welfare should be encouraged (unless
the are particular reasons to the contrary) and
their views taken seriously.
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.
The Mental Health Act in Practice
Following the Patient’s Pathway
For this session YOU are the patient,
yes YOU!
The Mental Health Act in Practice
Following the Patient’s 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?
The Mental Health Act in Practice
Following the Patient’s 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.
The Mental Health Act in Practice
Following the Patient’s 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).
The Mental Health Act in Practice
Following the Patient’s 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.
The Mental Health Act in Practice
Following the Patient’s 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.
The Mental Health Act in Practice
Following the Patient’s 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
The Mental Health Act in Practice
Following the Patient’s 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.
The Mental Health Act in Practice
Following the Patient’s 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 patient’s nearest relative (under section 26 of the Act) also has
rights of appeal on behalf of the patient to the above.
The Mental Health Act in Practice
Following the Patient’s 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.
The Mental Health Act in Practice
Following the Patient’s 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.
The Mental Health Act in Practice
Following the Patient’s Pathway
Statutory forms required
2
2
2
2
2
3
3
3
3
3
3
4
4
4
5(4)
5(2)
Nearest Relative Application
AMHP Application
Joint Medical Recommendation
Medical Recommendation (x2)
Record of Detention
Nearest Relative Application
AMHP Application
Joint Medical Recommendation
Medical Recommendation (x2)
Record of Detention
Renewal Form
Nearest Relative Application
AMHP Application
Medical recommendation
Nurse’s Holding Power
Report
Form A1 or
Form A2 and
Form A3 or
Form A4 and
Form H3
Form A5 or
Form A6 and
Form A7 or
Form A8 and
Form H3
Form H5
Form A9 or
Form A10 and
Form A11
Form H2
Form H1
The Mental Health Act in Practice
Following the Patient’s Pathway
Statutory forms required
CTO
CTO
CTO
CTO
Community Treatment Order
Form CTO1
Variations of Conditions
Form CTO2
Notice of Recall to Hospital
Form CTO3
Record of Patient’s 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
The Mental Health Act in Practice
Following the Patient’s Pathway
Statutory forms required
S57
S58
S58
S58
S58
S58
Certificate of Consent to Treatment & 2nd Opinion
Form T1
Consent to Treatment
Form T2
Second Opinion
Form T3
Consent to Treatment (patients at least 18 yrs old)
Form T4
Certificate of Consent to Treatment & 2nd Opinion (patient under 18)
Form T5
Certificate of 2nd Opinion
Form T6
The Mental Health Act in Practice
Following the Patient’s 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.
The Mental Health Act in Practice
Following the Patient’s 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
The Mental Health Act in Practice
Following the Patient’s 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.
The Mental Health Act in Practice
Following the Patient’s 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 patient’s 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.
The Mental Health Act in Practice
Following the Patient’s 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!
THANK YOU FOR
ATTENDING
ALISON WHEELTON
SENIOR MHA ADMINISTRATOR
JAG BARHA
DEPUTY SENIOR MHA ADMINISTRATOR