Implementation of the Mental Health Act 2007

1. Implementation of theMental Health Act 2007 Hospital Managers

2. Session 1 Goals and Objectives

3. Domestics • Emergency procedures • Expected finish times • Refreshment breaks • Lunch arrangements • 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: • Define the processes and good practice that should be adopted when considering whether to exercise the power of discharge • Explain the new simplified single definition of mental disorder and the revised criteria for detention for treatment • Explain the provisions of supervised community treatment and the hospital manager's role in considering a patient’s discharge from supervised community treatment

7. Objectives (2) • Explain the role of the independent mental health advocate, and how this might impact of the running on hearings • Explain the changes in professional roles and the impact for evidence-giving in these roles • Explain the impact of the new duties in relation to Domestic Violence, Crime and Victims Act 2004 for evidence-giving and hearings.

8. Timetable Start 9.15 • Goals and objectives • Mental Health Act 2007 • Discharge of patients • Coffee 10.50 • Supervised community treatment (SCT) • Professional roles • Referrals to the MRHT for Wales • Provisions for young people • Independent mental health advocacy • Domestic Violence, Crime and Victims Act 2004 • Review and evaluation Close 13.00

9. Session 2 Mental Health Act 2007

10. Why was this review necessary? • To help ensure that people with serious mental disorders receive treatment necessary to protect them and the public from harm • To simplify and modernise the definition of mental disorder and the criteria for detention • To bring mental health legislation into line with modern service provisions • To strengthen patient safeguards and tackle human rights incompatibilities.

11. The Mental Health Act 1983 • Reception, care and treatment of mentally disordered people • The circumstances for detention for treatment without consent • Sets out the processes and the safeguards for patients • Main purpose is to ensure that people with serious mental disorders can be treated irrespective of their consent where it is necessary to prevent them from harming themselves or others.

12. The Mental Heath Act 2007 Introduced amendments to several earlier Acts: • The Mental Health Act 1983 • The Mental Capacity Act 2005 • The Domestic Violence, Crime and Victims Act 2004.

13. Activity – Changes to the Mental Health Act 1983 In pairs using the information in your participant pack: • identify the significant changes to the 1983 Act, and • the impact these changes will have on your role.

14. Mental Health Act 1983 Code of Practice for Wales • Is designed to guide practitioners in discharging their powers and duties under the Mental Health Act • Chapter 27 deals with the hospital manager’s power of discharge under section 23 of the 1983 Act.

15. Guiding principles Guiding principles grouped under three broad headings: • The empowerment principles • The equity principles • The effectiveness and efficiency principles

16. Activity In small groups discuss … What you would need to consider to ensure these principles are applied in practice.

17. Session 3 Discharge of Patients

18. Discharge of patients Under the 1983 Act the hospital managers are part of the group (along with RC, the nearest relative and the MHRT for Wales) with the power of discharge. The amendments brought in by the 2007 Act: • do not change the exercise of this power • extends the power to cover a new group of patients.

19. Discharge of patients The Act: • Covers the discharge of community patients – those who have been discharged onto SCT under a community treatment order.

20. Discharge of patients Review Panels • Must have three or more members • The Act does not define either the criteria or the procedure for reviewing a patient's detention • Hospital managers should consider whether the criteria for admission or continued detention under the Act are satisfied.

21. Criteria for detention • The person must be suffering from a mental disorderof a nature or degree which makes it appropriate for them to receive medical treatment in hospital, and • It is necessary for their own health or safetyor for the protection of other persons that he or she should receive such treatment and it cannot be provided unless the person is detained, and • Appropriate medical treatment is available for the person.

22. Criteria for detention Main changes • Definition of mental disorder • Appropriate medical treatment.

23. Definition of mental disorder • The definition of mental disorder has been changed to 'any disorder or disability of the mind' • Replaces the previous wording of 'mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind' • Abolishes the four categories of mental disorder that were previously used • This new definition provides a single, simple definition rather than specifying categories of disorder.

24. Definition of mental disorder • Includes clinically recognised mental illnesses • Encompasses forms of personality disorder • 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 • The overall effect of this then is to widen the application of the provisions to all mental disorders.

25. Learning disability • In general does come under the definition of mental disorder • A person can only be detained for treatment (or discharged on to SCT) where it is associated withabnormally aggressive or seriously irresponsible conduct • No change to the previous position.

26. Exclusions The 1983 Act formerly provided that: “the definition of mental disorder should not be construed as implying that a person may be dealt with as suffering from mental disorder by reason only of promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs”. Replaced with a single exclusion stating that 'dependence on alcohol or drugs is not considered to be a disorder or disability of the mind'.

27. Appropriate medical treatment test Needs to cover the question of: • whether proposed medical treatment is clinically appropriate for the nature and degree of the patient’s mental disorder, and • all other factors relating to the patient’s circumstances.

28. Appropriate medical treatment test Other factors to take into account: • implications for the patient's family and social relationships • the patient's gender, gender-identity, and sexual orientation • their culture and ethnicity • the patient’s physical health • the consequences of not providing treatment • any implications for the patient’s education or work.

29. Appropriate medical treatment test The criteria cannot be met unless medical treatment: • is available to the patient in question • and is appropriate given the nature and degree of the patient’s mental disorder • and takes account of all other circumstances of the case.

30. 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 Act now 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”.

31. When does the appropriate treatment test apply? • Under section 3 of the 1983 Act, and related sections of Part 3 • As part of the criteria for CTOs, which are covered by a new section (section 17A) of the Act • Used as part of the corresponding grounds for renewal and discharge.

32. When does the appropriate treatment test not apply? The test does not apply to: • Section 2 or section 4 of the 1983 Act (admission for assessment).

33. Other criteria – Patients own health and safety Admission to hospital under section 3 Typical factors that may be taken into account when making such an assessment. These include: • Any evidence suggesting that the patient’s mental health will deteriorate without treatment • The views of the patient on the likely course of the disorder and the possibility of it improving • The possible impact of any future deterioration or lack of improvement on carers, close friends, or family - especially those living with the patient • Whether there are other methods of coping with an expected deterioration or lack of improvement.

34. Other criteria – Protection of other persons There are two separate issues to consider: • The nature of the potential risks • The likelihood of such harm occurring Need to arrive at a balanced view of the acceptability of the risks.

35. Discharge by hospital managers The Hospital Managers: • may undertake a review at any time at their discretion • must review a patient's detention when the RC submits a report under section 20(3) renewing detention • must consider holding a review when they receive a request from a patient • must consider holding a review when the RC makes a report under section 25(1) barring a nearest relative’s application for the patient's discharge.

36. Discharge by hospital managers When reviewing the case of a patient detained in hospital for treatment (section 3 or 37), the review panel should consider the following questions: • Is the patient still suffering from mental disorder? • If so, is the disorder of a nature or degree which makes treatment in a hospital appropriate? • Is detention in hospital for treatment still necessary in the interests of the patient's health or safety, or for the protection of other people? • Is appropriate medical treatment available for the patient?

37. Discharge by hospital managers Where the RC has made a report under section 25(1) barring a nearest relative’s application for the patient's discharge, the review panel should also ask: • Would the patient, if discharged, be likely to act in a manner dangerous to other persons or to him or herself?

38. Discharge by hospital managers N.B. • These questions should be asked in the order given • The panel must order the discharge of the patient unless they are satisfied, on the basis of all the questions asked, that continued detention is appropriate.

39. Activity In your groups read through the case study about Jane and answer the questions. Use the Code of Practice and information in your participant pack for reference.

40. Session 4 Supervised Community Treatment

41. Supervised community treatment (SCT) • SCT provides for some patients to live in the community while still being subject to powers under the 1983 Act to ensure they continue with the medical treatment that they need • The aim of SCT to break the cycle in which some patients leave hospital and do not continue with their treatment • SCT replaces after-care under supervision.

42. Supervised community treatment • An individual may be discharged onto SCT, this is achieved by way of a CTO • Only those patients who are detained in hospital for treatment (under section 3 or an unrestricted order under Part 3 of the Act) can be discharged onto SCT • In order for a patient to be eligible for SCT, various criteria need to be met.

43. Supervised community treatment Patients who are discharged onto SCT will be subject to conditions whilst living in the community • Most conditions will depend on individual circumstances but must be for the purpose of ensuring the patient receives medical treatment, or to prevent risk of harm to the patient or others • The conditions will form part of the patient's CTO which is made by their RC.

44. Supervised community treatment • May be recalled to hospital for treatment should this become necessary (either in-patient or out-patient care) • May resume living in the community or, • If they need to be treated as an in-patient again, their RC may revoke the CTO • After-care under supervisionhas now been abolished.

45. Making a community treatment order The RC and AMHP must be satisfied that the following five criteria are met: • Must be suffering from mental disorder which makes medical treatment appropriate • Need medical treatment for their mental disorder either for their own health or safety, or for the protection of others • Must be possible to receive the treatment needed without having to be detained in hospital • Have the power for the patient to be recalled to hospital for treatment should this become appropriate • Appropriate medical treatment is available.

46. Making a community treatment order • When making decisions, the RC must consider the risk that the patient’s condition will deteriorate after discharge from hospital • In considering that risk, the RC must have regard to the patient’s history of mental disorder and any other relevant factors • If the RC and the AMHP cannot come to an agreement, then the CTO cannot be made.

47. Conditions of the CTO There are two conditions that must appear in all CTOs: • Patient’s must make themselves available for medical examinations as required for the purposes of determining whether the CTO should be extended • They must make themselves available for medical examinations to allow a SOAD to make a Part 4A certificate.

48. Conditions of the CTO Further conditions will be set as required with the intention of: • ensuring that the patient receives medical treatment, and/or • preventing risk of harm to the patient’s health or safety, and/or • protecting other persons.

49. Conditions of the CTO • The RC and an AMHP must agree the conditions • The RC may subsequently vary the conditions, or suspend any of them without the agreement of an AMHP.

50. Community treatment order How long does the CTO last for? • May initially last for up to six months from the date when the order was made • Can then be extended for a further six months and, following that, it can be extended for periods of one year at a time • To be extended, the RC must examine the patient and provide a report to the hospital managers confirming that the necessary criteria are met • An AMHP must agree that the criteria for extension of the CTO are satisfied, and that it is appropriate to extend the CTO, before the report can be made.