Westminster Homeless Health Co-ordination project 02/02/2016 Joint Homelessness Team Mental Health Act 1983 Kathryn Andrews & Andy Knight Westminster Homeless Health Co-ordination project 02/02/2016

Mental Health Act 1983 - Guiding Principles Least restrictive option and maximising independence Empowerment and involvement Respect and dignity Purpose and effectiveness Efficiency and equity

Statutory Roles under the Mental Health Act 1983 Approved Mental Health Professional (AMHP) Registered Medical Practitioner – Doctor Approved Clinician/Responsible Clinician Psychiatric Nurse Police constable

Mental Health Act 1983 - Section Two Application for admission for assessment Up to 28 days Assessment may be followed by treatment For admission the person must suffer from a mental disorder And the patient ought to be detained in the interests of the person’s own health or safety or for the protection of other people The section will involve an approved mental health professional and two doctors

Mental Health Act 1983 - Section Three Admission for treatment For up to 6 months Must be suffering from a mental disorder and Such treatment is necessary in the interests of the patient’s health or safety or for the protection of others and Appropriate medical treatment is available Application by Approved Mental Health Professional and two registered doctors Can be renewed for further six months and then yearly Only includes learning disability if associated with abnormally aggressive or seriously irresponsible conduct

Mental Health Act 1983 - Section 136 Empowers a constable to remove a person from a PUBLIC place to a place of safety in the interests of that person or for the protection of others if it is considered that the person appears to be a) suffering from a mental disorder AND b) in immediate need of care and control To be assessed for care or treatment A person may be detained for up to 72 hours

Section 135(1) - a warrant to search for and remove a person If there is reasonable cause to suspect that a person believed to be suffering from mental disorder “Has been, or is being, ill-treated, neglected or kept otherwise than under proper control, in any place, or being unable to care for himself, is living alone in any such place” A warrant may be issued by a magistrate on information given by an ASW which allows entry by a policeman, if need be, to enter, by force, any premises in which the person is believed to be and remove him to a place of safety where they can be detained for up to 72 hours in which time an assessment can take place. The policeman must be accompanied by an AMHP and doctor

Mental Health Act 1983 - Section 117 Applies to people detained under sections 3, 37, 47, and 48 of the Act Patients are entitled to a discharge meeting to establish a care plan The patient, health and social service representatives must attend and other parties e.g. housing, carer etc A 117 worker (care co-ordinator) will be appointed to ensure the care plan is implemented in the community All services provided are free of charge The 117 continues until health and social services agree that it should end

Community Treatment Order For high risk and “revolving door” patients who have been on a section 3. Must be suffering from a mental disorder for which they require treatment and Treatment is necessary in the interests of the patient’s health or safety or for the protection of others and The treatment can be provided in the community and It is necessary for the RC to have the power to recall the patient to hospital appropriate medical treatment is available Application by Responsible Clinician must have agreement of AMHP Can be renewed for further six months and then yearly

Community Treatment Order Conditions Conditions are attached to a CTO Mandatory conditions – must be available to see the RC to consider extension of CTO and to be seen by the second opinion doctor. Other conditions typically relate to where someone lives, the treatment they receive and engaging with support services. Breaching conditions does not lead to recall but may indicate need for recall.

Section 7 - Guardianship Order Guardianship orders are made where “ it is necessary in the interests of the welfare of the patient or the protection of other persons.” The guardian has three powers a) to require the patient to reside at a place specified b) to attend at places for medical treatment, occupation or training and c) to require the patient to give access to them

Approved Mental Health Professional - AMHP To receive and process requests for assessment under the Mental Health Act To co-ordinate the mental health assessment e.g. arrange times, liaise with the doctors, police, ambulance To interview the person in “a suitable manner”. To ensure communication is possible with the aid of an interpreter or signer To satisfy themselves that having taken into account all the circumstances of the case that admission to hospital is the most appropriate way of providing the person with care and medical treatment To make an application for compulsory admission under the act if they are satisfied that the criteria is met and there is no other alternative

Rights for Patients under MHA Nearest Relative – their identity is clearly prescribed in MHA - usually a close family member. They have certain rights e.g. they can request discharge & object to section 3. Independent Mental Health Advocate IMHA - provide additional safeguard for those under the MHA, to help patients exercise their rights and participate in decisions about their care and treatment. Tribunal – independent panel decides whether detention should continue on the evidence of the patient and various professionals involved. Takes place as soon as possible during section 2 detention. Patient receives free legal advice. Hospital managers hearing – similar to tribunal

Planning for MHA Assessment Making referrals – record facts, observations and concerns clearly Refer to Mental Health Service Interventions for Rough Sleepers Tools and Guidance http://www.scie-socialcareonline.org.uk/mental-health-service-interventions-for-rough-sleepers-tools-and-guidance/r/a11G000000Avk3fIAB MHA assessment on homeless people are usually complex and AMHP is likely to need assistance – locating and identifying, carrying out assessment safely, managing practicalities On-going support during and after admission – hospital visits, discharge planning, accommodation and support options

Further information/contacts http://www.mind.org.uk/ https://www.rethink.org/ Joint Homelessness Team – 0202 7854 4206 andy.knight@nhs.net