MENTAL HEALTH ACT POLICY FOR ADULTS AGED 18 YEARS AND OVER
Version / 2Name of responsible (ratifying) committee / Mental Health and Learning Disabilities Committee
Date ratified / 24 August 2017
Document Manager (job title) / Associate Director of Quality and Governance
Date issued / 31 August 2017
Review date / 30 August 2019
Electronic location / Clinical Policies
Related Procedural Documents / -
Key Words (to aid with searching) / Mental Health, Learning Disability, Mental Health Act
Version Tracking
Version / Date Ratified / Brief Summary of Changes / Author2 / 24.08.2017 / Quick reference guide updated. Introduction updated to reflect current legislation. Approved Mental Health Practitioner section updated. Duty Hospital Managers section updated and now includes reference to the MHA Administration Service Level Agreement with SHFT. Process section updated. MH Administration section updated with current provision. In-patient psychiatry provision section updated to reflect current provision. Risk assessment and Care Planning statement added. Treatment under the MHA section completely updated with additional information. Responsible Clinician and Section 4 sections updated to reflect current practice. Section 5 updated to reflect current practice. Police powers section updated to reflect current position. Section 17 leave and Process of Transfer sections updated with additional information. Receipt and Scrutiny of section papers section updated to reflect current process. Patient’s right to appeal section updated. Monitoring of compliance table updated
Appendix 1 replaced to new flow chart regarding process for receiving detention paperwork. Addition of Appendix 2 showing Scheme of Delegation.
Moved from Management Policies to Clinical Policies on Trust website. / F. McNeight
1 / 25.08.2015 / New Policy / F McNeight
Mental Health Act Policy for Adults 18 and over
Version: 2
Issue Date: 31 August 2017
Review Date: 30 August 2019 (unless changes to legislation)Page 1 of 20
CONTENTS
QUICK REFERENCE GUIDE
1.INTRODUCTION
2.PURPOSE
3.SCOPE
4.DEFINITIONS I have left this in as this is our policy format
5.DUTIES AND RESPONSIBILITIES
6.PROCESS
7.TRAINING REQUIREMENTS
8.REFERENCES AND ASSOCIATED DOCUMENTATION
9.EQUALITY IMPACT STATEMENT
10.MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
APPENDIX 1: Process for receiving detention paperwork
APPENDIX 2: Scheme of delegation
EQUALITY IMPACT SCREENING TOOL
Mental Health Act Policy for Adults 18 and over
Version: 2
Issue Date: 31 August 2017
Review Date: 30 August 2019 (unless changes to legislation)Page 1 of 20
QUICK REFERENCE GUIDE
For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.
Mental Health Act Policy for Adults 18 and over
Version: 2
Issue Date: 31 August 2017
Review Date: 30 August 2019 (unless changes to legislation)Page 1 of 20
1.INTRODUCTION
Mental health law is about balancing the need to detain people in order to protect them or other people from harm and the need to respect peoples’ human rights and autonomy. The Mental Health Act (MHA) 1983 (which was substantially amended in 2007) is the law in England and Wales that allows people with mental health problems to be admitted to hospital, detained and treated without their consent; either for their own health and safety, or for the protection of other people. People can be admitted, detained and treated under different sections of the MHA depending on the circumstances and may be referred to as detained or formal patients. The individual must be considered to have a ‘mental disorder’; the definition of this term was broadened as a result of the 2007 Act which became ‘any disorder or disability of the mind’. Patients who are not detained under the MHA but receive treatment in psychiatric units are often referred to as informal or voluntary patients. The MHA (The Act) provides a framework for the compulsory admission to hospital and subsequent treatment of patients with a mental disorder.
The Mental Health Act 1983 Code Of Practice sets out requirements for detaining authorities to have policies in place to cover a number of areas. This policy sets out these requirements and meets them or states how they are met by other Portsmouth Hospitals NHS Trust Policies.The Code of Practice is statutory for doctors, nurses and AMHP and Trust staff must be familiar with its contents and principles.
The policy includes a delegation of a number of roles under the Mental Health Act to employees of Portsmouth Hospitals NHS Trust.
The following are the guiding principles outlined in the Code of Practice that all professionals should have regard for and should underpin all aspects of clinical practice and inform decision making.All guiding principles are of equal importance.
Least restrictive, legal and safe
Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. Wherever possible, a patient’s independence should be encouraged and supported with a focus on promoting recovery.
Empowerment and involvement
Patients should be fully involved in decisions about care, support and treatment. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this.
Respect and dignity
Patients, their families and carers should be treated with respect and dignity and listened to by professionals.
Purpose and effectiveness
Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines.
Efficiency and equity
Providers, commissioners and other relevant organisations, should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. All relevant services should work together to facilitate timely, safe and supportive discharge from detention.
2.PURPOSE
The purpose of this document is:
- To ensure staff have access to appropriate procedures and have the appropriate knowledge to ensure patients are managed in accordance with the requirements of the Mental Health Act and Code of Practice.
- To protect the safety and well-being of the detained person, staff members and other patients/visitors.
3.SCOPE
This policy is intended for all clinical and non-clinical staff who are involved in the care of adult patients with specialist mental health needs.
4.DEFINITIONS I have left this in as this is our policy format
Approved Clinician (AC): An approved clinician is a doctor, a psychologist, a mental health nurse, an occupational therapist or a social worker who has been trained and approved to carry out certain duties under the Act. Only approved clinicians can take overall responsibility for the case of someone who has been detained in hospital– be their 'responsible clinician’.
Responsible clinician (RC): People who are detained under the Mental Health Act in hospital must be under the care of a 'responsible clinician'. He or she has overall responsibility for an individual's care.A doctor who is 'approved' under section 12 of the Act is approved on behalf of the Secretary of State because they have special expertise in the diagnosis and treatment of 'mental disorders'. Doctors who are approved clinicians are automatically also approved under section 12. Section 12 approved doctors have a role in deciding whether someone should be detained in hospital under section 2 and section 3 of the Mental Health Act.
A responsible clinician need not be a psychiatrist, though at present almost all of them are doctors. All responsible clinicians have applied for, and been given, 'approved clinician' status.
Approved mental health professionals (AMHPs):AMHPs are social workers who have trained in Mental Health law to carry out the role of making an application under the Act. Only an AMHP can make an application under the Act.The AMHP must gather information about the previous history and the current situation and must take the views of the patients nearest relative in to account prior to an assessment taking place. They are also required to adhere to the code of practice which states (amongst other things) that the AMHP must consider the best time (usually during the day when there is access to services) to complete the assessment, whether they are able to interview the patient in a suitable manner and the availability of a doctor with previous acquaintance unless the situation is an emergency.
Other points to note:
- Normally, if a person is consenting to their admission and treatment for a mental disorder then a mental health act assessment is not necessary.
- An AMHP cannot use the Act ifa less restrictive option is available
- The MHA cannot be used by any person for people only experiencing issues with drugs and alcohol.However, consideration for the use of the MHA or MCA can be had for an intoxicated person, depending on their presentation.
Independent Mental Health Act Advocate (IMHA): Each detained patient has the right to support from an IMHA. They are independent of the Trust and their role is to support the patient through the processes of accessing their rights and representing the patient’s view, or supporting the patient to represent their own view. If a patient wishes to be allocated an IMHA, you must contact the Duty Hospital Manager.
Mental Capacity Act 2005 (MCA): The statute in relation to matters concerning mental capacity including determining if a person is unable to make a specific decision at a specific time and the powers and duties others have to them.
Nearest Relative (NR): A specific role of an identified relative in relation to detained patients, persons where the making of an application under the Act is being considered and persons who are likely to have an application under the Act considered. Who the NR is, is determined by very specific rules set out in in s26 of the MHA. It is not the same as ‘next of kin’. The law says the ‘nearest relative’ is someone’s husband, wife, civil partner or unmarried partner, if they have been living together for more than six months (unmarried partners). If someone does not have a spouse or partner, the ‘nearest relative’ is their child, if they are over 18. If someone does not have a child, or their child is under 18, their nearest relative is then one of their parents.If their parents are not alive, their nearest relative is the first relevant person in the following order who is aged over 18: a brother or sister; a grandparent; a grandchild; an uncle or aunt; a nephew or niece; somebody who is not related but with whom the person has been living for more than five years.If a person lives with, or cares for the person then they move to the top of the list in respect of nearest relative priority. It is usually the role of the AMHP to determine who the nearest relative is and to contact them.
5.DUTIES AND RESPONSIBILITIES
Chief Executive:The Chief Executive has overall responsibility for the strategic and operational management of the Trust including ensuring that there are processes in place for seeing that the requirements of the Mental Health Act are followed. In particular, they must ensure that patients are detained only as the Act allows, that their treatment and care accord fully with its provisions, and that they are fully informed of, and are supported in exercising, their statutory rights.
Medical Director:The Medical Director has Executive responsibility for ensuring that appropriate standards for detention, treatment and care of patients under the MHA 1983 are followed. The Director of Nursing will support the Medical Director in this Executive responsibility. The Medical Director is responsible for ensuring that the Clinical Service Centre Chief of Service and Heads of Nursing take clinical ownership of this policy and ensure that all staff comply with this policy.
Chief of Service and Heads of Nursing:
Responsibilities include:
- Manage implementation of this policy ensuring all staff are aware of the policy requirements.
- Ensure that adequate resources are in place to allow for the safe and effective care of patients detained under the MHA.
- Support staff in any corrective action or interventions if an incident occurs.
- To ensure staff training needs are met in relation to this policy.
All staff involved in the care of patients under the MHA: All staff must be familiar with the requirements of this policy and act in accordance with the guiding principles of the MHA Code of Practice. For patients requiring detention under the MHA, staff must inform the Duty Hospital Managers immediately.
Duty Hospital Managers: Duty Hospital Managers are responsible for the receipt and scrutiny of detention papers and for maintaining the log of all detained patients, including the on-going monitoring of status for each patient. In addition, responsible for ensuring that patients are read their rights in accordance with the requirements of the MHA.The Duty Hospitals Managers are responsible for informing the Consultant Psychiatrist in the MHLT of any patients placed under section as soon as is reasonably possible.The Duty Hospital Managers must be informed if any patient wants to appeal their detention as they will liaise with Southern Health Mental Health Administrators who will organise this on behalf of the Trust. The Duty Hospital Managers will also support the ward staff in arranging an IMHA should the patient request an advocate.
Southern Health Foundation Trust provide the Mental Health Act administration function via a Service Level Agreement to ensure compliance with legislative requirements which includes the responsibility for processing appeals and arranging hearings in relation to Mental Health Tribunals and Hospital Managers Reviews
6.PROCESS
The following outlines the process to be followed when detaining patients under the MHA and relationships with other Acts of Parliament and provides guidance to comply with the requirements of the MHA.
The Trust Board have ultimate responsibility for the powers and duties carried out on its behalf under the Mental Health Act 1983. This policy sets out the delegation and governance of those duties. The main duties and powers and their delegation are summarised in Appendix 2.
The Mental Health Act and the Mental Capacity Act
The Mental Capacity Act 2005 (MCA) was designed to protect and empower individuals who may lack the mental capacity to make their own decisions about their care and treatment. The MCA 2005 provides a statutory framework for individuals aged 16 and over.The Mental Capacity Act was amended by the Mental Health Act 2007 by the introduction of deprivation of liberty safeguards (DoLS); these amendments came into force in April 2009. DoLS cannot be used in the presence of detention under the MHA.
Where a person lacks capacity and is being deprived of their liberty, a legal framework is ALWAYS required.
DoLS orders are applied for by the responsible hospital and are authorized (or not) by the responsible supervisory body (local authorities). The safeguards are intended to ensure that people are only deprived of their liberty when it is in their best interests.
Hospital Managers
The Mental Health Act sets out duties and powers that detaining authorities have in regard to detained patients. In doing so it places these duties and powers with ‘hospital managers’. For NHS Trusts this term means the organisation itself. For Portsmouth Hospitals NHS Trust (PHT) these are the ultimate responsibility of the Board who are responsible for what happens to people who are detained and treated under the Mental Health Act within that particular hospital; for making sure the law is used properly within the hospital; and for ensuring that patients who are detained and treated under the Act are fully informed of their rights.
Hospital managers (The Trust) has delegated a number of roles to members of PHT staff and sometimes other people. These will be outlined within this policy.
Associate Hospital Managers are not employees of the Trust and are not the sameas the Hospital Managers noted above that delegate functions. These managers hear appeals from patients who disagree with a decision to detain or treat them compulsorily. Southern Health Foundation Trust have taken over this responsibility as part of the Service Level Agreement. They have the power to discharge patients who have been detained under the Act
MHA Administration function
The effective and efficient administration of the MHA is crucial in ensuring compliance with the law. This function currently sits with the Duty Hospital Managers (DHM). For any patient admitted or existing in-patients requiring detention under the MHA, the DHM must be informed. The DHM will take receipt and provide scrutiny of all Section papers when a patient is first admitted or detained under the MHA. The Trust has outsourced its Mental Health Act administration function to Southern Health and the Duty Hospital Managers will forward copies of all section papers and relevant documents to the Mental Health Act administrator for further scrutiny in accordance with the MHA, and to ensurethat there is appropriate medical scrutiny and allow amendment of correctable errors. The MHA administrator is located within the MHLT within the Trust. There is a Service Level Agreement in place which specifies responsibilities.