Transcript Implementation of the Mental Health Act 2007

Implementation of the
Mental Health Act 2007
Core Module
Session 1
Goals and Objectives
Domestics
•
•
•
•
•
Emergency procedures
Expected finish times
Refreshment breaks
Lunch arrangements
Venue facilities.
Role of Facilitator
•
•
•
•
•
Guide you through the course
Maximise your participation
Challenge / support / advise
Provide information
Collate feedback / outcomes.
Ground Rules
•
•
•
•
•
Commitment
Courtesy
Honesty
Responsibility
Time keeping.
Objectives
This workshop will enable you to:
• Explain the background to and purpose of the Mental
Health Act 2007 including the role of the Regulations
• Outline the key changes to the Mental Health Act 1983
• Outline the key content of the Mental Health Act 1983
Code of Practice for Wales (the Code)
• Identify and describe the guiding principles in the Code
• Outline the changes to the Mental Capacity Act 2005
• Outline the principal changes to the Domestic Violence,
Crime and Victims Act 2004.
Timetable
Start 9.15
• Goals and objectives
• Mental Health Act 2007 and Code of Practice
Coffee 10.50
• Criteria for detention
• Supervised community treatment
• MHRT for Wales and IMHA
• Provision for young people
• ECT
• Power to take and convey and places of safety
Lunch 12.15
• Deprivation of liberty safeguards
• Domestic Violence, Crime and Victims Act
• Review and evaluation
Close 15.00
Session 2
Mental Health Act 2007
Why was this review necessary?
• To help ensure that people with serious mental
disorders receive treatment necessary to protect
them and the public from harm
• To simplify and modernise the definition of
mental disorder and the criteria for detention
• To bring mental health legislation into line with
modern service provisions
• To strengthen patient safeguards and tackle
human rights incompatibilities.
The Mental Health Act 1983
• Reception, care and treatment of mentally
disordered people
• The circumstances for detention for treatment
without consent
• Sets out the processes and the safeguards for
patients
• Main purpose is to ensure that people with
serious mental disorders can be treated
irrespective of their consent where it is
necessary to prevent them from harming
themselves or others.
The Mental Health Act 2007
Introduced amendments to several earlier
Acts:
• The Mental Health Act 1983
• The Mental Capacity Act 2005
• The Domestic Violence, Crime and Victims
Act 2004.
Activity
Changes to the Mental Health Act
In pairs, using the information in your
participant pack:
• identify the significant changes to the Act,
and
• the impact of these changes on your role
Session 3
Mental Health Act 1983 Code of
Practice for Wales
Guiding principles
Guiding principles grouped under three
broad headings:
•The empowerment principles
•The equity principles
•The effectiveness and efficiency principles
Activity
In small groups discuss …
What you would need to consider to ensure
these principles are applied in practice?
Empowerment principles
1.Patient well-being and safety should be at the heart of
decision-making
2.Retaining the independence, wherever practicable, and
promoting the recovery of the patient should be central
to all interventions under the Act
3.Patients should be involved in the planning,
development and delivery of their care and treatment to
the fullest extent possible
4.Practitioners performing functions under the Act should
pay particular attention to ensuring the maintenance of
the rights and dignity of patients, and their carers and
families, while also ensuring their safety and that of
others
Equity principles
5. Practitioners must respect the diverse needs, values
and circumstances of each patient
6. The views, needs and wishes of patients’ carers and
families should be taken into account in assessing and
delivering care and treatment
7. Practitioners should ensure that effective
communication takes place between themselves,
patients and others
Effectiveness and efficiency
principles
8.Any person made subject to compulsion under the Act
should be provided with evidence based treatment and
care, the purpose of which should be to alleviate, or
prevent a worsening of, that person's mental disorder,
or any of its symptoms or manifestations.
9.Practitioners should ensure that the services they
provide are in line with the Welsh Assembly
Government’s strategies for mental health and learning
disability
Session 4
Criteria for detention
Criteria for detention
•
•
•
•
The criteria remain generally much as
before
Also apply to the new provisions for
supervised community treatment (SCT)
Addition that 'appropriate medical
treatment' must be available for the
patient
'Treatability test' has been removed.
Appropriate treatment test
The criteria cannot be met unless
medical treatment:
• is available to the patient which is
appropriate
• it considers the nature and degree of the
patient’s mental disorder
• takes account of all other circumstances of
the patient’s case.
Medical Treatment
What is meant by 'medical treatment'?
The definition of medical treatment has been amended
to read:
“Medical treatment includes nursing, psychological
intervention and specialist mental health habilitation,
rehabilitation and care”.
The new rules also stipulate that the purpose of
medical treatment,
“is to alleviate, or prevent a worsening of, the disorder
or one or more of its symptoms or manifestations”.
Activity
•
In your groups, read through the cases
for Maggie, Morgan and Jim and then
decide whether in your view:
– the person has a mental disorder
– whether detention under the 1983 Act would
be possible.
•
Please give reasons for your answers
Appropriate treatment test
When does the appropriate treatment test apply?
• Section 3
– criteria for detention under section 3 of the 1983 Act
• Related sections of Part 3 and corresponding criteria
for renewal and discharge
– section 36 - remand for treatment
– section 48 - transfer of unsentenced prisoners
– section 51(6) - hospital orders where it is impractical
or inappropriate to bring a detainee before the court.
Appropriate treatment test
• When does the appropriate treatment test apply?
– Section 17A - as part of the criteria for community
treatment orders.
• When does the appropriate treatment test not
apply?
– The test does not apply to section 2 or section 4
of the 1983 Act (admission for assessment).
Session 5
Supervised community treatment
Supervised community treatment
(SCT)
SCT provides for some patients to live in the
community while still being subject to
powers under the 1983 Act to ensure they
continue with the medical treatment that
they need.
The aim of SCT to break the cycle in which
some patients leave hospital and do not
continue with their treatment.
SCT replaces after-care under supervision.
Activity
In groups, read through the case study and
answer the questions using the information
in your participant pack.
Patients 16 or over
• Those with capacity to consent to treatment can
only be treated if they consent
• Those who lack the capacity to consent to
treatment can be treated without their consent
• Force cannot be used to administer treatment if
the patient objects to it, except in emergencies
• Force is permissible if the patient does not
object to treatment
• If the treatment cannot be given to the patient if
it conflicts with a valid and applicable advance
decision made under the Mental Capacity Act.
Children aged under 16
• Children aged under 16 can be made subject to
a CTO
• A child with capacity to consent to treatment can
only be treated if they consent
• A child who lacks the capacity to consent to
treatment can be treated without their consent
• Advance decision should not arise though, since
these cannot in general be made by children
under 16.
Emergency treatment for patients
lacking capacity
Force can be used to give treatment only if:
• it is immediately necessary
• it needs to be given to prevent harm to the
patient, and
• it is a proportionate response to the
likelihood of the patient suffering harm and
to the seriousness of the harm.
Emergency treatment
• Treatment can be classed as immediately
necessary if it is intended to:
–
–
–
–
save the patients life, or
prevent a serious deterioration of their condition, or
alleviate serious suffering by the patient, or
prevent the patient from behaving violently or being a
danger to himself or others and represents the
minimum interference necessary.
Note provisos
Session 6
Mental Health Review Tribunal for
Wales and
Independent mental health
advocates
Referrals
• Patients for whom hospital managers must make
a referral:
– patients admitted to a hospital in pursuance of
an application for admission for assessment
– patients admitted to a hospital in pursuance of
an application for admission for treatment
– community patients
– patients whose CTO is revoked
– patients transferred from guardianship to a
hospital.
Referrals
Periods after which hospital managers must make
a referral:
•Six months after detention from the day on which:
– the patient was first detained for assessment (under
section 2) or for treatment (under section 3), or
– the patient is admitted following revocation of a CTO,
or
– the patient was detained in hospital following a
transfer from guardianship.
Referrals
•
After 3 years without review
–
–
Hospital managers were only under a duty to make
a referral to the MHRT upon the renewal of patient's
detention
The requirement to refer a patient aged under 18
years after one year represents an extension to the
previous age limit of 16 years
Referrals
• On revocation of a CTO
– Statutory duty to refer to MHRT for Wales as
soon as possible after the order is revoked.
– Note this is in addition to the duty to refer six
months after the patient’s admittance
following revocation of the CTO
Qualifying Patients
• Patients who qualify for advocacy support are
essentially those who are:
– liable to be detained under the Act, or
– subject to guardianship, or
– a community patient.
• Qualifying patients must be informed that they are
eligible for the services provided by an IMHA as
soon as is practicable.
• An IMHA will meet with a patient on the request of
the patient, the nearest relative, the responsible
clinician or an AMHP.
Independent mental health advocates
How does the IMHA help the patient?
• Includes help in obtaining information about and
understanding:
– the patient’s rights under the Act
– the provisions of the Act under which the patient
qualifies for an IMHA
– any conditions or restrictions which affect the patient
– the medical treatment the patient is receiving or is
being proposed or discussed
– why it is given, proposed or discussed
– the legal authority for providing the treatment
– the requirements of the Act which apply to treatment.
Independent mental health advocates
How does the IMHA support the patient?
The IMHA may also give:
• help in obtaining information about and
understanding any rights which may be
exercised, and
• help (by way of representation or otherwise) in
exercising those rights.
Independent mental health advocates
• IMHA has a right to:
– access and inspect any hospital or local authority
records relating to the patient (with patient
consent)
– meet patients in private and to visit and interview
anyone professionally concerned with the
patient’s medical treatment.
• It is important to note also that hospital managers
cannot withhold correspondence between patients
and their advocates.
Session 7
Provisions for young people
Provisions for young people
Informal admission of patients aged 16 or 17 with the
capacity of consent
• Decisions cannot be overridden by a person with parental
responsibility for them.
• This means that:
– If the patient consents, they can be admitted to hospital
and their consent cannot be overridden by a person with
parental responsibility
– If the patient does not consent, they cannot be informally
admitted on the basis of consent from a person with
parental responsibility
• The young person could nevertheless be admitted to hospital
for compulsory treatment if they meet the relevant criteria.
Provisions for young people
Accommodation for patients aged under 18
• Hospital Managers are under a duty to:
– Ensure that, subject to their needs, patients under 18 are
accommodated in an environment that is suitable for their
age.
• The decision should be taken on the basis of:
– What is suitable for a patient of this age?
– Is there something about this patient or the circumstances
that suggests the use of an environment that would not
normally be suitable for a patient of this age?
– Consult a suitable person with experience in child and
adolescent mental health services cases.
Session 8
Electro-convulsive therapy
New safeguards
New safeguards for patients introduced:
• Abolition of the power to impose ECT on a
detained patient who has the capacity to
consent, other than in an emergency situation
• ECT can only be given when the patient gives
consent, or is incapable of giving consent.
Consent to ECT
Patients capable of consent
• Detained adult patient:
– consent must be certified by either the AC in
charge of their treatment or by a SOAD.
• Detained or informal patient not subject to a CTO
under 18 years of age:
– a SOAD must certify their consent and that it is
appropriate for the treatment to be given.
Consent to ECT
Patients incapable of consent
• The SOAD must certify that:
– the patient is not capable of understanding the nature,
purpose and likely effects of the treatment, and
– it is appropriate for the patient to receive the
treatment.
• These provisions apply to all detained patients
(adults and children) and informal child patients
not subject to a CTO.
Consultation by SOAD
• Before issuing a certificate, the SOAD must first
consult two other persons:
– A nurse concerned with the patient's medical
treatment, and
– Another person professionally concerned with the
patient’s medical treatment who is neither a nurse nor
a doctor.
• The patient’s RC and the person in charge of
their treatment (if they are not the RC) are
specifically excluded from being a person the
SOAD must consult.
Certification not possible
• The SOAD may not give the certificate if giving
the treatment would conflict with:
– a valid and applicable advance decision of the patient
not to receive the treatment
– a decision made by a deputy or done as defined by
the Mental Capacity Act 2005
– an order of the Court of Protection.
Urgent treatment
• Emergency ECT has been extended to patients
who are not consenting.
• The conditions that must be met before ECT
may be given in an exceptional emergency are
that the treatment:
– is immediately necessary to save the patient’s life, or
– is immediately necessary to prevent a serious
deterioration of his or her condition and is not
irreversible.
Electro-convulsive therapy
Conditions that may not be used for
authorising ECT
• These are that the treatment (not being
irreversible or hazardous):
– is immediately necessary to alleviate serious suffering
by the patient, or
– is immediately necessary and represents the
minimum interference necessary to prevent the
patient from behaving violently or being a danger to
himself or to others.
Session 9
Power to take and convey
Power to take and convey
• A patient who is liable to be detained can be
taken into custody and returned to the place
where they are required to reside, as named in
their care plan.
• Changes:
– Extended to Community patients
– Patient being “returned” to a place can be taken there
for the first time
– Extends powers to include new guardianship patients
– Not confined to being returned after absconding or
failing to return voluntarily.
Power to take and convey
Who can exercise this power?
• an AMHP
• an officer on the staff of the hospital
• a constable (in effect any police officer)
• anyone authorised in writing by the RC or the
hospital managers.
Session 10
Places of safety
Existing powers
• Under section 135(1), the police can, on the
authority of a magistrate, enter premises and
remove to a place of safety a person who:
– is thought to have a mental disorder, and
– has been or is being ill-treated or neglected, or
– if living alone, is unable to care for himself.
• A place of safety includes a hospital, a care
home and a police station.
Places of safety
• Under section 136, the police can remove from a
public place to a place of safety a person who:
– appears to have a mental disorder, and
– appears to need immediate help.
• Under either section, the person can be
detained at the place of safety for up to 72
hours.
New power to transfer
• The 2007 Act has amended both section135 and
section 136 so as to enable a person detained at
a place of safety to be transferred to another
place of safety
• Their detention remains subject to the overall
time limit of 72 hours.
Session 11
Changes to the
Mental Capacity Act 2005
and introduction of
Deprivation of liberty safeguards
Mental Capacity Act 2005
• The Mental Capacity Act 2005 has been
amended to:
– provide additional safeguards for people who lack
capacity to consent, and
– whose care or treatment necessarily involves a
deprivation of liberty, but
– who either are not, or cannot be, detained under the
Mental Health Act 1983.
• These safeguards are referred to as deprivation
of liberty safeguards.
Deprivation of liberty safeguards
Definition of deprivation of liberty
• Defined in the legislation as having the same
meaning as in Article 5(1) of the ECHR.
– What is meant by deprivation of liberty in that
context?
– How can we decide whether a particular set of
circumstances amounts to actual deprivation of
someone's liberty or whether it is just a restriction of
liberty?
Deprivation of liberty safeguards
• The difference between restriction or deprivation
of liberty is one of degree or intensity rather than
of nature or substance
• No simple definition can be produced that would
apply in every case
• Every case must be assessed on its own terms.
Deprivation of liberty safeguards
Case law
• Based on existing case law, the following factors
might well be considered:
– The person is not allowed to leave the facility
– The person has no, or very limited, choice about
their life within the care home or hospital
– The person is prevented from maintaining contact
with the world outside the care home or hospital.
Activity
In small groups, using the information in the
participant pack, analyse the case study and
discuss responses to questions.
Procedures – requesting authorisation
• A request for authorisation must be made if a person:
– meets or is likely to meet all of the qualifying
requirements
– is, or is likely to be, detained as a resident in that
hospital or care home in circumstances which amount
to deprivation of their liberty.
• Assessments must be made as soon as possible after
application
• Regulations may specify the time period for completion
• Existing equivalent assessments may be used if carried
out within the last year.
Deprivation of liberty safeguards
• If the person does not meet the eligibility
requirements for an authorisation to be issued:
– The supervisory body must turn down the request
for authorisation
– The assessment process will be discontinued.
Procedures – After authorisation
is granted
Representative is appointed who will:
• maintain contact with the relevant person
• support and represent them in matters
concerning the authorisation, including
requesting a review or applying to the Court of
Protection on their behalf.
Urgent authorisation
• The need is so urgent that it is appropriate to
begin before the request is made, or
• The need has become so urgent that it is
appropriate to begin before the request is dealt
with.
• An urgent authorisation can never be issued
without a request for a standard
authorisation being made.
Urgent authorisation
How long does an urgent authorisation last?
• Maximum of 7 days
• In exceptional circumstances it is extended to 14
days
• Can be extended by up to a further 7 days if
there are exceptional reasons
• At the end of the period specified or earlier.
Methods of appeal and review
• The supervisory body may review a standard
authorisation at any time and must do so if
requested to by any of:
– the relevant person (the patient)
– the relevant person's representative
– the managing authority of the care home or
hospital.
Methods of appeal and review
The qualifying requirements are reviewable if:
• the relevant person does not meet one or more
of the qualifying requirements, or
• the reason that they meet one of the qualifying
requirements is not the reason stated in the
authorisation, or
• there has been a change in the relevant
person's case (this applies to the best interests
requirement only).
Methods of appeal and review
• The supervisory body must decide if any of the
qualifying requirements appear to be reviewable.
– If one or more of the age, mental health, mental
capacity, objections element of eligibility or no
refusals requirements are reviewable, the supervisory
body must commission a review assessment
– If the best interests assessment appears to be
reviewable the supervisory body must obtain a best
interests review assessment.
Methods of appeal and review
• When the review is complete, the supervisory
body must inform
– the managing authority of the hospital or care
home
– the relevant person, and
– their representative.
Session 12
Domestic Violence, Crime and
Victims Act 2004
Domestic Violence, Crime and Victims
Act 2004
Will apply where:
• the offender is made subject to a hospital order
without restrictions, or
• the offender is made subject to a hospital and
limitation direction and the limitation direction
subsequently ceases to have effect, or
• the offender is transferred from prison to hospital
under a transfer direction without a restriction
direction, or where the restriction direction is
removed.
Victim’s rights
Right to make representations and receive information
• The local probation board must establish whether the
victim wishes:
– to make representations as to whether the patient
should be subject to conditions in the event of
discharge from hospital
– to receive information about those conditions in the
event of the patient’s discharge
– inform the hospital managers of the victim’s wishes.
Domestic Violence, Crime and Victims
Act 2004
The hospital managers must:
• forward representations to the relevant people
for making decisions on discharge or community
treatment orders.
• pass any information received from them to the
victim
• inform the victim if the offender is being
considered for discharge or is to be discharged
• inform the victim whether the patient is to be
subject to a CTO including any conditions.
Responsibilities
Hospital managers must be informed by:
• the RC and the MHRT if the patient is to be
discharged
• the RCs whether they are to make a community
treatment order
• the RCs about information regarding any
conditions and when the order will end.
Session 13
Review, Action Planning and
Evaluation
Review and Action Planning
• Review of your issues and goals
• Review of course objectives.
Course objectives
Do you now feel able to:
• Explain the background to and purpose of the Mental
Health Act 2007 including the role of the Regulations
• Outline the key changes to the Mental Health Act 1983
• Outline the key content of the Mental Health Act 1983
Code of Practice for Wales (the Code)
• Identify and describe the guiding principles in the Code
• Outline the changes to the Mental Capacity Act 2005
• Outline the principal changes to the Domestic Violence,
Crime and Victims Act 2004.
Review and Action Planning
Complete the action plan
Sources of further study
Sources of further information and study:
• Specific modules.
Evaluation
Please complete the course evaluation form
Thank you