1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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

13. 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

14. Planning for MHA Assessment
Making referrals – record facts, observations and concerns clearly
Refer to Mental Health Service Interventions for Rough Sleepers Tools and Guidance
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

15. Further information/contacts
Joint Homelessness Team –