1. Intervention or Interference?
Statutory Framework

2. Mental Health (Care and Treatment) (Scotland) Act 2003
Almost 90% of hospital admissions are voluntary (McManus and Thomson 2005)
Emergency, short term and compulsory treatment orders (hospital based or community).
Short term detention can commence immediately without an initial emergency certificate – preferred course of action as no appeal for emergency detention.

3. Principles Participation Respect for Carers Informal Care Benefit
Non discrimination
Respect for Diversity
Least restrictive
Reciprocity
Child Welfare
Equality

4. S36 (1) Emergency Detention
Allows patient to be detained in hospital for 72 hours for the purposes of assessment :-
Likely that patient has mental disorder
Likely that ability to make decisions about treatment is significantly impaired because of mental disorder
It is necessary as a matter of urgency to detain the patient in hospital for assessment
If not detained significant risk to health safety and welfare (the patient and others)
There would be an undesirable delay in making arrangements for short term detention

5. S36(1) Emergency detention
Code of Practice
Medical exam plus MHO consent and completed certificate (grounds of detention met with reasons)
Certificate to hospital managers
Hospital managers arrange for s22 doctor
MHO – onerous list of responsibilities. Huge expertise – get their advice!
Case study example

6. Short Term Detention
It is likely that the patient has a mental disorder
It is likely that the patients ability to make decisions about the provision of medical treatment is significantly impaired because of mental disorder
It is necessary to detain the patient for the purpose of determining what medical treatment should be given to the patient; or giving medical treatment to the patient

7. Short Term Detention
If the patient is not detained in hospital there would be a significant risk to his/her health, safety or welfare; or the safety of any other person
The granting of a short term certificate is necessary

8. S44 Short Term Detention
Allows detention for 28 days and permits treatment
Examination by AMP – three days to grant certificate
Consent of MHO
Hospital manager – inform MWC and Tribunal
MHO Complete social Circumstances Report in 21 days
Appeal to Tribunal
Can be extended by three days
Case study example

9. CTO Tribunal can grant an interim CTO for up to 28 days
CTO application needs to be made before expiry of short term detention
Designed to be tailor made
Community based or hospital
Can last for 6 months

10. CTO The patient has a mental disorder
Medical treatment would be likely to prevent the mental disorder worsening; or alleviate any of the symptoms, or effects of the disorder; and that such treatment was available
Without such medical treatment there would be a significant risk to the health, safety or welfare of the patient; or to the safety of others

11. CTO
The mental disorder significantly imairs the patient’s ability to make decisions about the provision of such medical treatment
The making of a compulsory treatment order is necessary
2medical reports/MHO report
Specify the measures that should be authorised by the CTO
Case study example

12. What is mental disorder?
‘any mental illness, personality disorder or learning disability however caused or manifested’
A person is not mentally disordered only on account of sexual orientation, sexual deviancy, transexualism, transvestism, dependence on or use of alcohol or drugs, behaviour that causes or is likely to cause, harassment, alarm or distress to another person; or acting as no prudent person would act.
Shared understanding is still a challenge

13. Link between major mental illness and violence-
Swanson et al (1990) USA Schizophrenia and comorbid schizophrenia and substance misuse
Eronen et al (1996) Finnish ASPD – alcohol and dug misuse, schizophrenia
Hodgins et al (1996) Danish cohort
Wessely (1997) UK
Steadman et al (1998)
But also...
Bartlett, Thomson and Johnstone (2001) Over 80% 0f prisoners in Barlinnie have personality disorder

14. Human Right Act 1998 Can raise issues in sheriff court
Art 6 Right to a Fair hearing – independent and impartial tribunal.
Art 8 – Respect for Private and Family Life
Art 3 Freedom from torture, inhuman and degrading treatment – successful challenge to seclusion procedures at Broadmoor. Unsuccessful challenge to be handcuffed to bed.
Art 14 Prohibition of Discrimination – Cannot raise this on its own.

15. High Water Mark
UK law protects the right of person of sound mind to refuse treatment
St George’s Healthcare NHS Trust v S
Mental Welfare Commission Reports
Warrants
Get advice from MHO’s

16. Adults With Incapacity (Scotland) Act
Presumption in favour of capacity
Falls to be determined in relation to each and every decision an adult makes
Incapax – previously all or nothing
Don’t assume it is fixed
Relapsing medical disorder/ acquired brain injury
Developmental disorder causing learning disability/ degenerative disorder – dementia

17. AWI - Exercise There may be ways to maximise decision making capacity
Communication
Inter agency/disciplinary working
Information sharing
Non discriminatory practice – Is this good enough for someone in my family?
Respect for autonomy

18. AWI Principles Benefit Minimum intervention Wishes of the Adult
Consultation with relevant others
Encouraging the adult to exercise residual capacity

19. Assessing capacity incapacity means:-
Acting; or
Making decisions; or
Communicating decisions; or
Understanding decisions; or
Retaining the memory of decisions
By reason of mental disorder or of ability to communicate because of physical disability

20. AWI incapacity does not mean:-
lack or deficiency in the faculty of communication if that lack or deficiency can be made good by human or mechanical aid (whether of an interpretative nature of otherwise)

21. AWI Codes of Practice Continuing POA and Welfare POA
Accounts and funds- intromission with funds
Management of Residents Finances
Intervention Orders
Guardianship Orders

22. Office of the Public Guardian
Supervision of guardians and persons authorised under intervention orders
Maintaining Registers
Investigations
Advice for guardians, attorneys, withdrawers etc
Consultation with MWC and any LA where there is a common interest

23. Local Authority Local procedures Role of MHO Last resort Cheshire West
Court process

24. SSSI Report Inspection of Scottish Borders, April 2004
‘A recurring theme throughout the history of this case and one that persists into 2002, is the view that if an allegation is withdrawn or does not result in a criminal charge or conviction that social work has no locus to act.’

25. Do we learn from our mistakes?
Be clear/confident about the distinction between opinion and fact
Use evidence based practice – research based
Confidence to challenge other professionals no matter who they are.
Rising threshold increases poor outcomes (see DoE 2012 (Research Report DFE-RR226); Daniel, Burgess and Scott 2012; Ofsted 2012.
Understand civil standard of proof – balance of probabilities.
How often do we hear ? ‘there was no corroboration/proof’; ‘we had suspicions but no proof’; ‘it was hearsay’.
Do we share best practice?
Lots of good practice around!

26. Adult Support and Protection (Scotland) Act 2007
Section 3 Adults at risk:
Unable to safeguard their own wellbeing, property rights or other interests are at risk of harm and because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected

27. ASP
At risk of harm if :-
Another person’s conduct is causing (or is likely to cause) the adult to be harmed or
The adult is engaging (or is likely to engage) in conduct which causes (or is likely to cause) self harm

28. ASP Section 4 – duty to make inquiries Section5 – co-operation
Section 6 – duty to consider advocacy
Section 7 – 10 investigations, visits, interviews, medical examination, examination of records
Warrants are available
Case Study

29. ASP Assessment Orders Removal Orders Banning Orders Powers of arrest
Needs consent of Adult at risk
Codes of Practice
Offences – individuals and corporate bodies- obstruction

30. ASP Think outside the box Interface with other legislation
Peer review/supervision

31. Final thoughts 3 main point relation to: 1) training
2) Service Delivery
3) Multi- disciplinary working
4)Other
WWW/EBI