1. Implementation of the Mental Health Act 2007 Section 12(2) Approved Doctors

2. Session 1 Goals and Objectives

3. Domestics Emergency procedures Expected finish times Refreshment breaks Venue facilities.

4. Role of Facilitator Guide you through the course Maximise your participation Challenge / support / advise Provide information Collate feedback / outcomes.

5. Ground Rules Commitment Courtesy Honesty Responsibility Time keeping.

6. Objectives (1) This workshop will enable you to: Outline the statutory roles and responsibilities of section 12(2) approved doctors Explain what is meant by ‘appropriate treatment’ for the patient and what should be taken into account when considering making a medical recommendation Determine the grounds for detention taking into account relevant factors Identify circumstances of potential conflicts of interest that might compromise the process of undertaking an assessment

7. Objectives (2) Outline the roles and responsibilities of approved mental health professionals in the assessment process Identify factors to be taken into account when applications are made under sections 2, 3 and 4 of the Act Explain the changes to rules governing admission for 16 and 17 year olds in relation to those with parental responsibility Explain about new powers to ‘take and convey’ under guardianship Explain that persons will be able to be transfer between places of safety, and consider implications for assessment process.

8. Timetable Start 9.15 Goals and Objectives Role and Responsibilities Provision of Medical Recommendations Conflicts of Interest Places of Safety Admission of 16 or 17 year olds Quiz, Review and Evaluation Close 11.30

9. Session 2 Roles and Responsibilities

10. Role of the approved doctor Remains broadly the same Medical recommendations continue to be required in support of an application for a patient's admission to hospital or an application for guardianship under Part 2 of the Mental Health Act 1983.

11. Duties of the approved doctor under section 12 Section 2 Admissions for Assessment Section 3 Admission for treatment Section 7 Guardianship.

12. Duties of the approved doctor under section 12 an application must be founded on the written recommendations of two registered medical practitioners including in each case, a statement that in the opinion of the practitioner the relevant conditions for the proposed action are complied with.

13. Duties of the approved doctor under section 12 For the purposes of any such application: one must be given by a practitioner who has special experience in the diagnosis or treatment of mental disorder, and one must be given by a practitioner who has previous acquaintance with the patient.

14. Session 3 Provision of Medical Recommendations

15. Admission for Assessment An application for admission for assessment or for treatment may be made by either: –the patient’s nearest relative, or –an Approved Mental Health Professional (AMHP).

16. Admission for Assessment The basic process when the AMHP makes the application remains much as before. –Appointment of AMHP –AMHP assessment –Medical recommendations –AMHP application.

17. Activity In groups, read through the case study about Alun and answer the questions about the assessment process Use the Code of Practice and information in your participant pack for reference.

18. Admission for Assessment The AMHP who is assessing a patient for possible admission has overall responsibility for: –co-ordinating the process of assessment, and –where he or she decides to make an application, for implementing that decision.

19. Admission for Assessment The AMHP must: identify him/herself to other parties interview the patient in a suitable manner identify the patient’s nearest relative consult with others who have been involved with the patient’s care make an independent decision on whether to apply for compulsory admission.

20. Grounds for detention Main changes to 1983 Act made by the 2007 Act are: –Definition of mental disorder –Grounds for detention –'Treatability test' no longer applies.

21. Grounds for detention Before a person can be detained for assessment and treatment the RC and the AMHP must be sure that all the following criteria are met: –The patient must be suffering from mental disorder which makes medical treatment appropriate –They need medical treatment for their mental disorder either for their own health or safety, or for the protection of others –Appropriate medical treatment is available.

22. Grounds for detention So what does qualify as mental disorder? –clinically recognised mental illnesses such as schizophrenia, bipolar disorder, anxiety or depression –personality disorders, eating disorders, autistic spectrum disorders and learning disabilities –forms of personality disorder which would not be considered legally to be 'mental illness'

23. Grounds for detention Disabilities of the brain would not be classified as mental disorders unless they give rise to a disability or disorder of the mind as well.

24. Grounds for detention Exclusions Learning disability Drug or alcohol dependence.

25. Appropriate medical treatment The patient must be suffering from mental disorder which makes medical treatment appropriate They need medical treatment for their mental disorder either for their own health and safety or for the protection of others Appropriate treatment is available.

26. Appropriate treatment What is meant by appropriate? Takes into account the nature and degree of the mental disorder, and Takes into account all other circumstances of his case.

27. Appropriate treatment What is meant by 'medical treatment'? The definition of medical treatment has been amended to read: “Medical treatment includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care”. The legislation also stipulates that medical treatment: “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”.

28. Appropriate treatment What is meant by available? The appropriate treatment is actually available for the patient and doesn’t just exist in theory.

29. Session 4 Conflicts of Interest

30. Conflicts of interest Section 12(3) specifies quite clearly that: "No medical recommendation shall be given for the purposes of an application... if the circumstances are such that there would be a potential conflict of interest for the purposes of regulations under section 12A".

31. Conflicts of interest Work relationships Financial reasons Related individuals Other circumstances.

32. Session 5 Places of safety

33. Places of safety – Powers to remove Section 135: Warrant to search for and remove patients Powers of entry may be exercise by a warrant, and are used by a police officer when the AMHP believes it is necessary to gain access to a mentally disordered person who is not in a public place and, if necessary, remove them to a place of safety The police officer must be accompanied by an AMHP and a doctor Where the warrant is for a patient who is liable to detention or recall, the police officer may be accompanied by a doctor and/or by any authorised person to take or retake the patient.

34. Places of Safety – Powers to remove Applies to any person found in a public place, who appears to a police officer to be suffering from mental disorder and to be in immediate need of care or control Removal to a place of safety may take place if the police officer believes it necessary in the interests of that person, or for the protection of others. Section 136: Mentally disordered persons found in public places

35. Places of safety What is an appropriate place of safety? Preferable to be detained in a hospital Exceptional cases a police station.

36. Places of safety Transfer The Act allows for the patient to be taken to one or more places of safety before the end of the 72-hour period The person may be taken to the second or subsequent places of safety by a police officer, an AMHP or a person authorised by either the police officer or the AMHP.

37. Power to ‘take and convey’ for guardianship A new subsection (7) of section 18 Patient being “returned” to a place can be taken there for the first time Covers all patients under the 1983 Act, including those subject to guardianship.

38. Session 6 Informal Admission of Patients Aged 16 or 17 with the Capacity to Consent

39. Informal admission of patients aged 16 or 17 Decisions cannot be overridden by a person with parental responsibility for them. This means that: –If the patient consents, he/she can be admitted to hospital and their consent cannot be overridden by a person with parental responsibility –If the patient does not consent, he/she cannot be informally admitted on the basis of consent from a person with parental responsibility –The young person could nevertheless be admitted to hospital for compulsory treatment if they meet the relevant grounds.

40. Session 7 Quiz, Review, Action Planning and Evaluation

41. Review and Action Planning Review of your issues and goals Review of course objectives.

42. Course Objectives (1) Do you now feel able to: Outline the statutory roles and responsibilities of section 12(2) approved doctors Explain what is meant by ‘appropriate treatment’ for the patient and what should be taken into account when considering making a medical recommendation Determine the grounds for detention taking into account relevant factors Identify circumstances of potential conflicts of interest that might compromise the process of undertaking an assessment

43. Course Objectives (2) Outline the roles and responsibilities of approved mental health professionals in the assessment process Identify factors to be taken into account when applications are made under Sec 2, 3 and 4 of the Act Explain the changes to rules governing admission for 16 and 17 year olds in relation to those with parental responsibility Explain about new powers to ‘take and convey’ under guardianship Explain that persons will be able to be transfer between places of safety, and consider implications for assessment process.

44. Review and Action Planning Complete the action plan at the end of your participant pack.

45. Sources of Further Study Sources of further information and study: Specific modules.

46. Evaluation Please complete the course evaluation form. Thank you.