1. 1

2. 2 Learning Outcomes Gain awareness and understanding of the definition of mental disorder contained within the MHA; Understand the criteria for detention and appropriate treatment as defined in the MHA; Be able to apply the Guiding Principles in relation to appropriate treatment; Understand how the age appropriate admission criteria will work

3. 3 3 key changes 1.A simplified definition of mental disorder 2.The ‘appropriate treatment’ test 3.Age appropriate accommodation

4. 4 Definition of Mental Disorder Section 1 (1) “mental disorder” means any disorder or disability of the mind; and “mentally disordered” shall be construed accordingly: Simplified definition of ‘mental disorder’ The 4 ‘categories’ of mental disorder disappear

5. 5 The effect…. This simplified definition now applies to all sections of the MHA (not just assessment sections, as was previous the case) This will have little effect on assessment sections (s2, s4, s135/136) except with regard to the exclusions

6. 6 Exclusions from the definitions of Mental Disorder Section 1 (3) Dependence on alcohol or drugs is not considered to be a disorder or disability of the mind However previous exclusions on the basis of ‘immoral conduct’ or ‘sexual promiscuity’ have been removed

7. 7 The effect…. Although dependence on alcohol or drugs alone cannot be seen as a mental disorder, it is possible to detain a person who is dependent on alcohol or drugs if he or she is also suffering from a mental disorder, or if the use of drugs or alcohol gives rise to a mental disorder.

8. 8 The effect….. In the case of people diagnoses as having a personality disorder, their long term detention no longer requires the existence of a ‘persistent disorder or disability of mind that results in abnormally aggressive or seriously irresponsible conduct.’

9. 9 The effect…. promiscuity or sexual deviancy have been removed. The need to protect children from the abuse, the media and public Previous exclusions on the basis of immorality, attention to paedophilia both influenced the government to abolish these exclusions

10. 10 The Learning Disability Qualification Section 1 (2A) a person with learning disability shall not be considered to be suffering from mental disorder unless that disorder is associate with abnormally aggressive or seriously irresponsible conduct on his part Section 1(4) In subsection (2A) above, “learning disability” means a state of arrested or incomplete development of the mind which includes significant impairment of intelligence and social functioning

11. 11 The effect…. This applies to longer term forms of compulsion like section 3, SCT, Guardianship and forensic treatment sections This means that people who have a learning disability can only be detained for treatment or guardianship if their learning disability is ‘associated with abnormally aggressive or seriously irresponsible conduct.’

12. 12 The effect….. However, because a learning disability is defined as being a developmental condition associated with BOTH an impairment of intelligence and social functioning, some conditions previously excluded (such as the effects of head injury and those with Aspergers Syndrome) CAN now be included

13. 13 Issues that should not influence assessment of mental disorder COP 3.6 Difference should not be confused with disorder. No-one may be considered to be mentally disordered solely because of their political, religious or cultural beliefs, values or opinions, unless there are proper clinical grounds to believe that they are the symptoms or manifestations of a disability or disorder of the mind……

14. 14 COP 3.7 A person’s sexual orientation towards people of the same gender (or both the same and the other gender) is not a mental disorder for any purpose. Issues that should not influence assessment of mental disorder

15. 15 Activity 1 Definition of Mental Disorder

16. 16 Criteria: The ‘appropriate medical treatment test’ S3:2(d) ‘appropriate medical treatment is available for him.’ S3:4 ‘appropriate medical treatment’ means ‘medical treatment which is appropriate in his case, taking into account the nature and degree of the mental disorder and all other circumstances of the case.’

17. 17 Who this applies to S3, SCT & forensic treatment sections

18. 18 The purpose of the test… ‘The purpose of the appropriate medical treatment test is to ensure that no-one is detained (or remains detained) for treatment, or is an SCT patient, unless they are actually to be offered medical treatment for their mental disorder.’ COP 6.7

19. 19 What does ‘medical treatment’ mean? Section 145 ‘medical treatment’ includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care Section 145 (4) ‘Any Reference in this Act to medical treatment, in relation to mental disorder, shall be construed as a reference to medical treatment the purpose of which is to alleviate or prevent a worsening of the disorder or one or more of its symptoms or manifestations’

20. 20 The issue of purpose…. ‘Purpose is not the same as likelihood. Medical treatment may be for the purpose of alleviating, or preventing a worsening of, a mental disorder even though it cannot be shown in advance that any particular effect is likely to be achieved.’ COP 6.4

21. 21 Nature or Degree Treatment should be appropriate for the Nature or Degree of the patient’s mental disorder

22. 22 All the circumstances of the case When considering ‘all the circumstances of the case’ guidance is given in the code 6.11. Additionally, the Guiding Principles have to be applied to support decision making in individual circumstances. This will also help the clinician to prioritise different aspects of treatment whilst someone is subject to compulsion – e.g. protection over therapy.

23. 23 Does it have to be the ‘perfect’ treatment? No, there needs to be a balance between the ‘purpose’ of the intervention, and other issues.

24. 24 Actual availability…. ‘Medical treatment must actually be available to the patient. It is not sufficient that appropriate treatment could theoretically be provided’ COP 6.13

25. 25 Appropriate Treatment Activity 2 (p 62)

26. 26 Age Appropriate Accommodation & protections From 2010, the expectation is that accommodation suitable to the needs of young people will be available Hospital Managers will have a responsibility to ensure that young people are admitted to accommodation ‘suitable to their age (subject to their needs’) section 131A This applies to both detained and informal patients under the age of 18yrs

27. 27 In an emergency… Section 140 has been amended giving a duty to PCTs to provide information on: (b) or the provision of accommodation or facilities designed so as to be specially suitable for patients who have not attained the age of 18 years.

28. 28 What makes accommodation ‘suitable’ for young people? 36.68 This means that children and young people should have: appropriate physical facilities; staff with the right training, skills and knowledge to understand and address their specific needs as children and young people; a hospital routine that will allow their personal, social and educational development to continue as normally as possible; and equal access to educational opportunities as their peers, in so far as that is consistent with their ability to make use of them, considering their mental state.

29. 29 Activity 3 (p 65) Continuing Eddie’s Story