Presentation on theme: "THE MENTAL HEALTH ACT 2007 Implications for the medical treatment of patients in the community Richard Jones Consultant in Mental Health and Community."— Presentation transcript:
1 THE MENTAL HEALTH ACT 2007Implications for the medical treatment of patients in the communityRichard JonesConsultant in Mental Health and Community Care LawMorgan Cole, Solicitors
2 MHA Community Powers Guardianship Long term s.17 leave Supervised Community Treatment
3 GuardianshipA new power to take the person to the place where he or she is required to beReasonable force can be used during conveyance (s.137). More than “closing a loophole”Authority to treat under common law or MCA 2005
4 Long Term s.17 LeaveLonger term s.17 leave (7 days +) cannot be granted unless CTO “considered” by RCEffect of the decisions of the High Court in cases involving the use of s.17Is hospital treatment a “significant component” of the patient’s treatment planAuthority to treat under Part IV of the Act
5 Community Treatment Orders Supervised discharge provisions repealed and replaced by supervised community treatmentTransitional regulations have been madeSCT will only apply to those who would be a risk to their own health or safety or that of others if they do not continue to receive their treatment when discharged from hospital – the “revolving door” patient
6 CTO ApplicationsPatient (of any age) must have been assessed and treated in hospital first whilst under s.3 or a Part III power without restrictionsPatient can be on s.17 leaveCriteria similar to those in section 3 + it is necessary that the RC should be able to exercise the power to recall the patientDE case.
7 CTO Applications (2)The four specific categories of mental disorder have been replaced by a single definition – “any disorder of disability of the mind”The “treatability” test has been replaced by an appropriate treatment testThe RC applicant must obtain the written agreement of an AMHP that criteria met and CTO appropriate
8 Effect of ApplicationWhen it comes into effect, the application suspends –The authority to detain the patient in hospital – no need to renew sectionThe operation of Part IV of the Act in respect of the patient
9 CTO ConditionsPackage of after-care services (NHS and LA) must be in place before the patient leaves hospital (s.117)Patient subject to mandatory conditions to make himself available to SOADs (for Part IVA certificates) and to RCs (for renewals)Mandatory: p make himself available for examination for renewal and for Part 4A certificates.Mandatory. P available for examination for renewals and Part 4A certificatesMandatory – p available for examinations for renewals and Pert 4A certificates (failure - RECALL). Discretionary – ensure p receives medical t., prevent risk of harm to p., protecting other persons (CONSIDER RECALL).
10 CTO Conditions (2)Wide discretion for additional conditions – “necessary or appropriate” to ensure that treatment received and/or patient or others protectedRC must agree conditions with AMHPRC may subsequently vary or suspend conditions without the agreement of an AMHPMandatory: p make himself available for examination for renewal and for Part 4A certificates.Mandatory. P available for examination for renewals and Part 4A certificatesMandatory – p available for examinations for renewals and Pert 4A certificates (failure - RECALL). Discretionary – ensure p receives medical t., prevent risk of harm to p., protecting other persons (CONSIDER RECALL).
11 CTO Conditions (3)“Conditions might include stipulating where the patient might live, the arrangements for receiving treatment in the community and may cover matters such as avoiding the use of illegal drugs, non-prescription drugs and/or alcohol where their use has lead to relapse in their mental disorder” (Code of Practice, para.30.33)
12 CTO Recall to HospitalRC may recall patient by written notice if (1) he needs treatment and there is a risk to him or others if he is not recalled (even if complying with conditions) or (2) where patient fails to comply with a mandatory conditionRecall need not be to the “responsible hospital” and can be for out-patient treatment in a hospital clinicEffect of recall – reinstatement of s.3 regimeRecall is for a maximum of 72 hoursRecalled patient can be treated under either Part 4 or 4A
13 CTO Options on RecallThe patient’s RC has the following options on a patient’s recall:Revoke CTO if criteria for detention under s.3 satisfied (with AMHP’s agreement) – automatic referral to MHRTRelease patient from detention – the patient continues to be subject to the CTOTransfer to another hospital
14 Community Treatment of CTO patients Patient subject to new Part 4A (medication and ECT) while in the community (or in hospital informally)Mentally capable patients must consent (SOAD certificate required). Power of recall can be used if treatment refusedIncapacitated patients can be treated if either a donee or deputy consents or a SOAD certifiesIncapacitated patient cannot be treated contrary to a valid and applicable advance decision or if donee or deputy objects
15 Community Treatment of CTO patients (2) Provision for emergency treatment to be given to an objecting incapable patient in order to prevent harm to the patient, using proportionate force if necessary (no equivalent for capacitated patients)Certificate not required for medication within one month of making of CTO, or three months from when medication first given, whichever is laterSOAD may attach conditions to certificateSeparate provision for children under the age of 16
16 Treatment on Recall (s.62A) Patient may be given treatment which would otherwise require a s.58 or 58A certificate on the basis of a certificate given under Part 4A if the certificate specifies that the treatment can be given on recall, and giving the treatment would not be contrary to any condition in the certificateOtherwise Part IV applies and existing certificates are resurrected. Treatment can continue, pending compliance with Part IV, if its discontinuance would cause serious suffering
17 CTO – Renewals and MHRT rights Renewal periods and procedure as for s.3RC reports to Hospital Managers that criteria are satisfied + risk assessment completed with respect of need for recall powerAMHP’s agreement needed + consultation with another professionalSame rights of access to MHRT as for s.3 (MHRT can recommend CTO for s.3 patient)No right to challenge conditions at MHRT
18 Ending of CTOCTO, (and, apart from revocation, the underlying authority for detention) ends if:Period runs out and CTO not extendedDischarged under s.23 or by MHRTRC revokes CTO following patient’s recallPatient received into guardianship
19 Criteria for Discharge of CTO Is the patient suffering from a mental disorder disorder of a nature or degree which makes it appropriate for the patient to receive medical treatment?Is it necessary in the interests of the patient’s health or safety or for the protection of others that he should receive such treatment?
20 Criteria for Discharge of CTO (2) Is it necessary that the RC should be able to exercise the power to recall the patient to hospital?Is appropriate treatment available for the patient?If the patient has been discharge by his NR (Part 2 patients only), would the patient be likely to act in a manner dangerous to other persons or to himself?
21 Advantages of s.17 Leave Familiarity Contains similar powers to SCT Far less bureaucraticMore acceptable to patients?
22 Disadvantages of s.17 Leave No automatic MHRT referral on a recallLess structured than SCTDoes not provide for the protection of AMHP involvement