1. Dr Ruth Yates GP ST2 in Psychiatry

2. Aims and Objectives To learn about the Mental Health Act 1983 and different sections of it To learn how to detain people under the act, who is involved and how

3. Overview Introduction Terminology Who’s who Definition of mental disorder Sections of the MHA (including 2, 3, 4, 5, 135, 136) Summary Quiz

4. Introduction Informal patients – In hospital voluntarily – Same rights as those being treated for physical illness Formal patients – 25% of mental hospital inpatients – Compulsorily detained under a section of MHA 1983 – Lose some rights available to informal patients

5. Some Terminology Community Treatment Order (CTO) Legal order that allows patient to be discharged from formal detention onto supervised community treatment Supervised Community Treatment (SCT) Patient is discharged from detention under MHA Required to comply with conditions set out in a CTO If fail to do so, may be recalled to hospital for tx

6. Who’s who Approved mental health professional (AMHP) Social workers, nurses, OTs or psychologists Approved by local services authority Carry out certain functions under MHA 1983 to give them power to make an application for admission to hospital under a section of the Act where necessary and proper. Must interview patient to check detention appropriate

7. Who’s who Approved clinician Mental health professional who has been approved, for the purposes of the MHA, by the Secretary of State (England) or Welsh Ministers (Wales). Doctors, psychologists, nurses, occupational therapists, social workers

8. Who’s who Responsible clinician Approved clinician with overall responsibility for patient’s care and treatment Are only ones who can make certain decisions E.g. Placing detained patient on SCT All responsible clinicians must be approved clinicians

9. Who’s who A person’s nearest relative can apply for their relative to be formally detained under a section of the Act

10. Who’s who Mental Health Tribunal (MHT) Independent panels that decide whether a formal patient should be discharged or not

11. Definition of mental disorder Any disorder or disability of mind Note A person with a learning disability is not considered to be suffering from a mental disorder for most purposes under the Act; or to require treatment in hospital, unless that disability is associated with abnormally aggressive or seriously irresponsible conduct.

12. Section 2 Compulsory admission to hospital or guardianship for patients not involved in criminal proceedings Admission for assessment 28 days maximum Application by AMHP or patient’s nearest relative

13. Section 2 cont... Procedure: 2 doctors must confirm that.... a) patient has mental disorder of a nature/degree that warrants detention in hospital for assessment (or assessment followed by medical treatment) for at least a limited period; AND Patient ought to be detained in interests of his/her own safety, or with a view to the protection of others

14. Section 2 cont... Discharge by Responsible clinician Hospital managers Nearest relative, who must give 72 hours’ notice The responsible clinician can prevent him/her discharging a patient by making a report to the hospital managers MHT – the patient can apply to a tribunal within the first 14 days of detention

15. Section 3 Admission for treatment Duriation: Up to 6/12 Renewable for a further 6/12 Then renewable for one year at a time Application for admission: By nearest relative or AMHP

16. Section 3 cont... Procedure: 2 doctors must confirm that... – a) the patient is suffering from a mental disorder of a nature/degree that makes it appropriate for him/her to receive medical tx in hospital; AND – b) appropriate medical tx is available for him/her; AND – c) it is necessary for his or her own health or safety, or for protection of others that he/she receives such treatment and it cannot be provided unless he/she is detained under this section

17. Section 3 cont... Renewal: under section 20 Responsible clinician can renew section 3 if: Original criteria still apply Appropriate medical treatment is available for patient’s condition Responsible clinician must consult another person of a different profession who has been professionally concerned with the patient’s treatment.

18. Section 3 cont... Discharge by: – Responsible clinician – Hospital managers – Nearest relative (must give 72 hours’ notice). If the responsible clinician prevents this, by making a report to the hospital managers, the nearest relative can apply to an MHT within 28 days – MHT. A patient can apply to a tribunal: Once during first 6 months of detention Once during 2 nd 6 months of detention Then once during each period of one year

19. Section 4 Admission for assessment in cases of emergency Duration of detention: 72 hours max Application by AMHP or nearest relative – Applicant must have seen patient within the previous 24 hours Procedure: 1 doctor must confirm that: – a) urgent necessity for admission and detainment under section 2 – b) waiting for 2 nd doctor to confirm the need for an admission under section 2 would cause ‘undesirable delay’

20. Section 5 Compulsory detention of informal patients already in hospital A doctor or other approved clinician in charge of informal patient’s treatment (inc. physica problem) can detain a patient for up to 72 hours by reporting to hospital managers that an application for compulsory admission ‘ought to be made’ A nurse working in mental illness or learning disabilities can detain an informal patient who is receiving treatment for a mental disorder for up to 6 hours until a doctor/clinican can detain them

21. Section 135 Warrant to search for and remove patients Duration: 72 hours max Procedure: if there is reasonable cause to suspect a person suffering from mental disorder AND – a) is being ill-treated/neglected/not kept under proper control – b) is unable to care for themselves and lives alone....a magistrate can issue a warrant authorising a police officer (with a doctor and AMHP) to enter any premises where person is believed to be and remove them to place of safety

22. Section 136 Mentally disordered persons found in public Duration: 72 hours max. Procedure: – Person suffering from mental disorder – Is in immediate need of care or control – Police officer can take to ‘place of safety’ Hospital or police station – Person then examined by a doctor and interviewed by an AMHP and ‘any necessary arrangements’ made of their treatment or care

23. Summary Many sections of MHA 1983 Section 2 – assessment Section 3 – treatment Section 4 – emergency detainment while awaiting 2 nd doctor for section 2 Section 5 – detainment of patients in hospital informally Section 135 – search premises and remove person to place of safety Section 136 – remove person from public place to place of safety

24. Quiz

25. Any Questions?