Transcript New ways of Working for Everyone: The continuing story

“Assisting and supporting you on the
road to service improvement and delivery”
Changes to the 1983 Mental Health Act
Gained Royal Assent on 19th July 2007
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Amends:
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Mental Health Act 1983
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Domestic Violence, Crime & Victims Act 2004
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Mental Capacity Act 2005
Changes to the Mental Health Act 1983
The main changes to the 1983 Act are:
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Definition of mental disorder
Criteria for detention
Professional roles
Nearest relative
Supervised Community Treatment
Mental Health Review Tribunals
Age-appropriate services
Advocacy
Electro-convulsive therapy
Other changes to the MHA 1983
Changes to the Mental Capacity Act 2005
New Roles
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The Act introduces to new roles:
- the Approved Mental Health Professional
- Approved Clinicians (which includes Responsible Clinicians)
The Minister for Wales has agreed to the permissive introduction of the roles in Wales. However,
the intention is that the introduction of the new roles is a flexibility rather than a mandatory
requirements.
Approved Mental Health Professional
AMHP will replace the ASW:
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The main change here is that whilst in the main the roles and responsibilities currently carried out
by Approved Social Works remains largely unchanged, other non social work professionals will be
able to train and be approved as AMHPs. The professional groups include:
- social workers
- psychologists
- occupational therapists
- mental health nurses
A doctor cannot be an AMHP
Approved Clinicians
RMO replaced by Approved Clinicians (including Responsible clinicians):
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The RC is the lead clinician responsible for the care and treatment of patients once subject to
compulsion
Powers to renew section, discharge, grant leave, responsibilities under Community treatment
Orders, power of recall to hospital for treatment
Responsible Clinicians can be:
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Doctors
Nurses
Social workers
Psychologists
Occupational therapists
FUTURE ACTIONS
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Local Authorities will have to prepare for the introduction of the AMHP
- panels
-nomination criteria for non – social work applicants
- governance arrangements between NHS and Local Authorities
- access to appropriate legal advice for all AMHPs
-access to training
-access and provision of practice supervisors
-funding to support non social work AMHP
-joined up workforce planning
-internal management, supervision
Commencement
Majority of provisions to be commenced in October 2008:
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Early commencement:
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NHS Foundation Trusts
Amendments to MCA
Approval of courses for AMHPs
& amendment to CSA 2000
Cross border arrangements
Restriction orders and clarification
on CD and limitation directions
Clarification on LHBs
Civil partners as nearest relatives
Informal admission of 16/17 year olds
Deprivation of Liberty Spring
24/07/07
01/10/07
01/10/07
01/10/07
01/10/07
01/10/07
01/12/07
01/01/08
Spring 09
Towards Implementation of changes to the MH Act 1983
Tasks facing LA Social Services Authorities:
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Use existing partnership structures to consider implementation with wider local mental health
community
Plan for the financial impact of the changes that will need to occur before and after the enactment
Revise and update the governance arrangements (risk plans, audit programmes, staffing plans)
Plan and implement the transition of ASW’s to AMHP’s
- training
- ensure sufficiency of AMHP’s to meet needs of MH service
Develop approval and re-approval of AMHP’s acting on behalf of LSSA’s
Ensure training is planned for the workforce across all related MH services/guidance
Review and develop policies and procedures for the operation of the MHA e.g. nearest relative,
guardianship
Establish & maintain register of AMHP’s working on
behalf of LA’s
MCA Deprivation of Liberty Safeguards
Key provisions:
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Provides a procedure for the authorisation of the deprivation of liberty of persons resident in
hospital or care home, who lack capacity (for decision to reside there), and who are not subject to
mental health legislation safeguards
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Aim is to provide legal safeguards to prevent arbitrary decisions to deprive a person of liberty and
gives rights of appeal
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A ‘Managing Authority’ (a hospital or care home) seeks authorisation from a ‘Supervisory
Body’ (LHB or LA) in order to be able to deprive ‘P’ of their liberty;
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P must have a mental disorder and lack capacity to consent P can only be deprived of his/her
liberty if:
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It is in his/her best interests
There is no less restrictive alternative
When should it be used and what does it look like?
Used when a resident or patient needs to go in to or remain in the
registered care home or hospital in order to receive the care or treatment
that is necessary to prevent harm to themselves.
Managing Authority
Hospital/Care Home
Supervisory Body
PCT/LA
Managing Authority
Supervisory Body
Decide if it is necessary to
apply for authorisation
from Supervisory Body to
deprive someone of their
liberty in their best
interests
Assess each individual
case and provide or refuse
authorisation for DOL as
appropriate
Review cases to determine
if DOL is still necessary
and remove where no
longer appropriate
A) Hospital or care home managers
identify those at risk of deprivation of liberty
& request authorisation from supervisory
body
B) Assessment commissioned
by supervisory body. IMCA
appointed for unbefriended
Age
assessment
Mental health
assessment
Authorisation expires
and Managing authority
requests further
authorisation
No Refusals
assessment
Mental
capacity
assessment
Best interest
assessment
Eligibility
assessment
All assessments
support
authorisation
Any
assessment
says no
C) Request for
authorisation
declined
In an emergency
hospital or care
home can issue
an urgent
authorisation for 7
days while
obtaining
authorisation
D) Best interest
assessor recommends
period
F) Authorisation is granted and
persons representative
appointed
E) Best interest
assessor
recommends
person to be
appointed as
representative
G) Authorisation implemented
by managing authority
Managing authority
requests review
because circumstances
change
Person or their
representative requests
review
H) Review
Person or their
representative
appeals to Court
of Protection
which has
powers to
terminate
authorisation or
vary conditions
Responsibilities in Deprivation of Liberty
Managing Authority
Hospital or Care Home
Supervisory Body
PCT or LA
Responsible for care and requesting an
assessment of deprivation of liberty
Responsible for assessing the need for
and authorising deprivation of liberty
Relevant Person
Assessors
Person being deprived of liberty
Family/Friends/Carers
Carry out assessments
Representative
Providing independent support
Consulted, involved and provided
with all information
IMCA
Court of Protection
Person in need of care to
prevent harm to themselves
Is it necessary to deprive
them of their liberty?
Now?
Grant urgent authorisation
Yes
DoL Process
Purpose: To
prevent unlawful
deprivation of
liberty
Apply to SB for standard authorisation
Is application
appropriate?
No
Reject application
Yes
Conduct assessments
Do all assessments
support DoL?
Yes
Grant authorisation
Appoint a representative
Monitor and Review DoL
No
Reject application
MCA Deprivation of Liberty Safeguards
Key Provisions:
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PCT or LA responsible for assessing the need for an authorising Deprivation of Liberty
MCA Deprivation of Liberty Safeguards
Tasks facing LA Social Services Authorities:
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Develop arrangements & processes to perform the function of supervisory body within the
requirements of DOLs – responsibilities to assess individual cases and provide or refuse
authorisation for DOL as appropriate
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Review cases to determine if DOL is necessary or remove if no longer appropriate
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Provision for a person who needs to go into or remain in the registered care home or hospital in
order to receive the care or treatment that is necessary to prevent harm to themselves
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Ensure local authority care homes are familiar with DOLs & local arrangements for applying the
standard and urgent authorisations
MCA Deprivation of Liberty Safeguards
Tasks facing LA Social Services Authorities:
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LA’s, PCT’s, Hospitals, Care Homes and other key stakeholder organisations need to work in
partnership to deliver DOL safeguards and reduce the numbers referred unnecessarily for
assessment
Availability of trained Best interest assessors, AMHPs, social workers – taking into account the
rules relating to conflict of interest
Capacity issues – Regulatory Impact Assessment estimated 21,000 people requiring assessment
within the first year – 80% burden on LA and 20% on NHS
Training
– all those with formal role within DOLS ,best interest and mental health assessors
- “brief” those with an admin/managerial role in care homes, hospitals and PCT’s and LA’s
- awareness of all others affected more indirectly i.e. staff who provide day to day care and
treatment but not involved in the statutory process
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Towards Implementation
Support Mechanisms:
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Local Implementation groups established across Wales – funding bids to WAG to support project
plans, now approved to support implementation
WAG implementation support and programme – ongoing.
WAG commissioned training materials to be available in Spring 08:
Core module on MHA 2007 (approx ½ day) and shorter specialist modules (approx 2-3
hours):
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AMHPs
ACs and RCs
Section 12 doctors
Hospital Managers
Registered care homes
“Other settings”
Voluntary organisations
Will be piloted
Slides, handouts, case studies, facilitator’s packs, workbooks
Towards Implementation
Support Mechanisms:
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NLIAH implementation project:
- self assessment tool produced
- training report developed and distributed
- support to local joint implementation groups
- employers guidance document Spring 08
- training support
Chris Merchant DS Ltd
NLIAH Mental Health Act Implementation Project
E mail: [email protected]
Tel: 07879401178