Mental Health Act Introduction 2016

1. Mental Health Act Introduction 2016 For non qualified staff Approx. 20 mins START

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6. Mental Health Act Introduction 2016 Navigation Toolbar

7. Objectives This course aims to introduce you to the following elements of the Mental Health Act: Section 2 Section 3 Section 5(2) Section 5 (4) Section 17 leave Section 132 Consent to treatment ECT Section 37 By the end of the course you should have an understanding of each element in relation to your role. Navigation Toolbar

8. Which one of these people has a mental disorder? (Click on a picture) Navigation Toolbar

9. ANSWER It is impossible to tell which one has a mental disorder Navigation Toolbar

10. Section 2 This section allows for the compulsory admission and detention for assessment of someone with a mental disorder. This assessment may lead to treatment which can occur while under Section 2. I • Criteria • The patient is suffering from a mental disorder of a nature and/or degree which warrants the detention of the person in a hospital for assessment or for assessment followed by medical treatment for at least a limited period’, and • Detention is in the interests of the person’s own health or safety or with a view to the protection of other persons’. Navigation Toolbar

11. Section 2 cont… Duration of Section 2 Section 2 is up to 28 days, it can’t be renewed nor is it good practice for one Section 2 to be followed by another Section 2. A patient that has already been admitted informally can be placed onto a section 2. Treatment Section 2 patients are subject to consent to treatment rules. This is explained later in the training. Section 17 Leave of Absence The Responsible Clinician (referred to as the RC) may grant a patient leave. Appeals by the Patient The patient can appeal to the Hospital Managers and the Mental Health Tribunal. There is a different process for these applications and a different appeal document is used for each one. Navigation Toolbar

12. Question What is the maximum length of time a section 2 order can last? 48 hours 7 days 28 days 14 days CONTINUE Navigation Toolbar

13. Section 3 This section provides for the compulsory admission and detention for treatment of someone with a mental disorder. A patient that has been admitted informally can be placed on a section 3. The patient does not have to be placed on a section 2 for a section 3 to be used. I • Criteria • The patient is suffering from a mental illness and the mental illness is of a nature and/or degree which makes it appropriate for the patient to receive treatment in hospital, and • It is necessary for the health or safety of the person or for the protection of other persons that they should receive such treatment, and • Such treatment cannot be provided unless they are detained under this section, and • Appropriate medical treatment is available to them (meaning that the place you are admitting the patient onto is named on the section papers). Navigation Toolbar

14. Section 3 cont… Duration of Section 3 The initial duration is for up to six months which can be renewed if the criteria are still met for a further six months and then for subsequent renewals yearly. Treatment Section 3 patients are subject to consent to treatment rules.This is explained later in the training. Section 17 Leave of Absence The RC may grant a patient leave from the ward or unit, explained later in the training. Appeals by the Patient The patient can appeal to the Mental Health Tribunal against their detention once in the first six months of the section 3 and then on each renewal period. Navigation Toolbar

15. Section 5(2) This section provides for the detention ofinformal in-patients for up to 72hrs. It is designed to be used as an emergency holding power to give time for the medical and social care workers to complete an assessment for a Section 2 or 3. Treatment Patients detained under Section 5(2) are not subject to consent to treatment provisions of the Act. Medication could be given if the patient consents to the medication or if the patient lacks capacity under the Mental Capacity Act. Section 17 Leave of Absence Section 17 does not apply to this section. Who can discharge the section Only the RC can discharge the patient. Appeal Rights There are no appeal rights to either the Mental Health Tribunal (MHT) orHospital Managers against detention under section 5(2). Navigation Toolbar

16. Section 5(4) This section allows a registered mental health / learning disabilities nurse to hold an informal patient, who is already an inpatient for up to six hours. It may be used if the nurse believes the patient is suffering from a mental illness to a degree that makes it necessary for their health or safety or for the protection of others, for them to be immediately stopped from leaving hospital. It can only be used if the patient is indicating either verbally or otherwise that he/she wishes to leave the hospital. Who can discharge the section The power will end after six hours or earlier if a doctor who is entitled to make a report under Section 5(2) arrives. It cannot be used concurrently if the six hours has lapsed. No medication No transfer to another area No right of appeal Navigation Toolbar

17. Section 132 Rights A Section 132 Rights Form needs to be completed when the patient is first detained. This should be as soon as is practicable dependant on the circumstance. All attempts to explain the rights must be documented even if the patient doesn’t appear to understand. The 132 Rights form should also be completed on each occasion that the patient is given information regarding their rights. Trust policy states that this should be at least on a monthlybasis (for section3, not section 2). Navigation Toolbar

18. Section 132 Rights cont… The patient can verbally instruct you to appeal on their behalf. A patient that is not able to understand information about detention at first presentation and this incapacity is likely to be transient or short term; staff must show an ongoing commitment to offering both oral and written information. This will entail regular discussions and meetings with the patient. Each attempt must be recorded on the appropriate form and should be re-presented regularly. If a patient has a long-term lack of capacity a mental capacity assessment will need to be completed to evidence that the patient lacks capacity to understand their rights and the patient’s nearest relative/next of kin/ careers has been given information about the rights that the patient has. A statement should be written on the Section 132 form to state the patient has a long term lack of capacity and a mental capacity assessment has been completed. A copy of the capacity assessment must be attached to the Section 132 form. The patient should also be referred to the IMHA service. Navigation Toolbar

19. Section 132 Rights cont… • Information given to the patients: • The section they are detained under and why • The length of section and possible outcomes • Information about the IMHA service • The name of the RC and named nurse • Right of appeal to the MHT/Managers and solicitors which is free of charge • Consent to Treatment • About the role of the Care Quality Commission Navigation Toolbar

20. Question A Section 132 Rights Form needs to be completed when the patient is first detained and should also be completed on each occasion that the patient is given information regarding their rights. TRUE FALSE CONTINUE Navigation Toolbar

21. Section 17 Leave Only the current RC can authorise leave. The RC must record the dates and times, restrictions, terms and conditions and whether the leave is escorted or unescorted on the patient’s Section 17 leave form. Escorted leave can only be undertaken by staff of the hospital, family members cannot escort a patient but the leave could specify that the patient is accompanied by family/carer. Section 17 Leave is at the discretion of the nurse in charge who should assess the risks on the current presentation of the patient at the time that the leave to be taken. Navigation Toolbar

22. Section 17 Leave cont… In the absence of the RC (e.g. he/she is on annual leave) leave can only be granted by an Approved Clinician who is acting as the RC. This can also be approved out of hours by the on call consultant. The patient should be given a copy of the leave form, as should the carer. The form should be ticked to show a copy has been given. Old forms should be struck through to avoid confusion. • All staff undertaking section 17 leave with a patient must check the following: • The form is dated • The form is signed • Whether there is any time limitations • Are the conditions stated being adhered to? ie. number of staff, places to visit. Navigation Toolbar

23. Consent to Treatment Patients on long-term sections can be treated for mentaldisorder during the first three months of their detention withor without their consent. This is for treatment for their mental illness only. After three months the patient’s consent and agreement must be sought. If the patient does not consent or is unable to give consent the Care Quality Commission must be contacted to arrange for a Second Opinion Approved Doctor (SOAD) to authorise the treatment. The SOAD doctor will visit the patient on the ward and discuss the care proposed with the patient, medical staff and another professional involved in the patients care. This could be a nurse, therapist or occupational therapist. I • Patient is consenting – Form T2 • RC will complete a Form T2 • Patient and RC will complete the Capacity to Consent Form • A copy of the T2 should be kept with the drug chart • A copy of the T2 and Capacity to Consent Form should be scanned tothe patients electronic file • Originals are sent to the Mental Health Act Office Navigation Toolbar

24. Consent to Treatment Not consenting or incapable – Form T3 RC needs to complete the online Second Opinion Approved doctor (referred to as SOAD) request form. SOAD will contact the ward to arrange to visit the patient, this can take some time to arrange. Treatment can be given by way off Section 62 emergency treatment until the SOAD visits and completes a T3. A copy of the section 62 should be kept on the drug chart until the T3 has been completed.  The T3 should then replace the section 62 on the drug chart. The originals need to be kept in a safe place until collected by the Mental Health Act Office. Navigation Toolbar

25. ECT Any patient who has capacity but who refuses ECT can not be given this treatment, even if detained under the Mental Health Act. Any patient without capacity, but with a valid advanced decision refusing ECT can not be given this treatment. Any patient without capacity, with no advanced decision can only be given ECT if a SOAD agrees the patient does not have capacity and that ECT treatment would be appropriate. Navigation Toolbar

26. Section 37 This section enables an offender to be admittedto a hospital. It can be instigated by either aCrown Court or a Magistrate’ Court. Once the Court implements a Section 37 it has no further involvement and does not have to be informed if the patient is discharged. Once in hospital it is treated like a Section 3 in all ways except for appeal rights. No appeal during first six months. The only appeal during this time has to go back to the court. I Criteria The offender is suffering from mental disorder which is of a nature or degree which makes it appropriate for them to be detained in hospital for treatment. The court also needs to believe that in all the circumstances of the case that the most suitable disposal is to use a Section 37. Duration of Section 37 The initial duration is for up to six months which can be renewed if the criteriaare still met for a further six months and then for subsequent renewals yearly. Navigation Toolbar

27. Section 37/41 When a Hospital Order (Section 37) is made,an order restricting discharge may be madeunder Section 41; hence a Hospital Order withan accompanying Restriction Order will be recorded as 37/41. Restriction Orders are applied for more serious persistent offenders. It means the Ministry of Justice become responsible for granting leave and allowing discharge, apart from a MHT discharge. Only a Crown Court can make a Restriction Order. Changes in ward cannot be undertaken without Ministry of Justice permission. This includes movement within a hospital unit. I Criteria A Restriction Order is ‘for the protection of the public from serious harm’. The Court should take into account the nature of the offence and the risk of him committing further offences if not detained in hospital. Appeals by the patient They are the same as for a Section 37. If the patient appeals to the Hospital Managers they can’t discharge without the authority of the Secretary of State.SEPT have a specific process for this. Navigation Toolbar

28. Remember, if you want to find more information / evidence about this subject or anything else which is relevant to your work or study, join your local healthcare library. For staff in Essex contact Basildon Healthcare Library. www.btuheks.nhs.uk library@btuh.nhs.uk 01268 524900 EX3594 It may be that you work in a different area, for example Luton. Details of all the Health Libraries in the East of England can be found at this site… You are welcome to join any of these. www.eel.nhs.uk Navigation Toolbar

29. Use a computer? Make sure you use I.T. well! IT Training IT training is available in: Word Excel PowerPoint Publisher Outlook Explorer General skills For information on locations, dates, times, availability and for any other questions please contact: Jay Thornton : james.thornton@sept.nhs.uk : 01268 568068 Navigation Toolbar

30. Review of Objective(s) Before completing the test, please ensure you have acquired the relevant knowledge against the modules objective(s) below: If not, please take this opportunity to revisit the presentation content. This course aims to introduce you to the following elements of the Mental Health Act: Section 2 Section 3 Section 5(2) Section 5 (4) Section 17 leave Section 132 Consent to treatment ECT Section 37 By the end of the course you should have an understanding of each element in relation to your role. Navigation Toolbar

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