Implementation of the Mental Health Act 2007

1. Implementation of theMental Health Act 2007 Core Module

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 This workshop will enable you to: • Explain the background to and purpose of the Mental Health Act 2007 including the role of the Regulations • Outline the key changes to the Mental Health Act 1983 • Outline the key content of the Mental Health Act 1983 Code of Practice for Wales (the Code) • Identify and describe the guiding principles in the Code • Outline the changes to the Mental Capacity Act 2005 • Outline the principal changes to the Domestic Violence, Crime and Victims Act 2004.

7. Timetable Start 9.15 • Goals and objectives • Mental Health Act 2007 and Code of Practice Coffee 10.50 • Criteria for detention • Supervised community treatment • MHRT for Wales and IMHA • Provision for young people • ECT • Power to take and convey and places of safety Lunch 12.15 • Deprivation of liberty safeguards • Domestic Violence, Crime and Victims Act • Review and evaluation Close 15.00

8. Session 2 Mental Health Act 2007

9. 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.

10. 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.

11. The Mental Health 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.

12. Activity Changes to the Mental Health Act • identify the significant changes to the Act, and • the impact of these changes on your role In pairs, using the information in your participant pack:

13. Session 3 Mental Health Act 1983 Code of Practice for Wales

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

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

16. Empowerment principles • Patient well-being and safety should be at the heart of decision-making • Retaining the independence, wherever practicable, and promoting the recovery of the patient should be central to all interventions under the Act • Patients should be involved in the planning, development and delivery of their care and treatment to the fullest extent possible • Practitioners performing functions under the Act should pay particular attention to ensuring the maintenance of the rights and dignity of patients, and their carers and families, while also ensuring their safety and that of others

17. Equity principles 5.Practitioners must respect the diverse needs, values and circumstances of each patient 6. The views, needs and wishes of patients’ carers and families should be taken into account in assessing and delivering care and treatment 7. Practitioners should ensure that effective communication takes place between themselves, patients and others

18. Effectiveness and efficiency principles 8. Any person made subject to compulsion under the Act should be provided with evidence based treatment and care, the purpose of which should be to alleviate, or prevent a worsening of, that person's mental disorder, or any of its symptoms or manifestations. 9. Practitioners should ensure that the services they provide are in line with the Welsh Assembly Government’s strategies for mental health and learning disability

19. Session 4 Criteria for detention

20. Criteria for detention • The criteria remain generally much as before • Also apply to the new provisions for supervised community treatment (SCT) • Addition that 'appropriate medical treatment' must be available for the patient • 'Treatability test' has been removed.

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

22. Medical 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 new rules also stipulate that the purpose of medical treatment, “is to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations”.

23. Activity • In your groups, read through the cases for Maggie, Morgan and Jim and then decide whether in your view: • the person has a mental disorder • whether detention under the 1983 Act would be possible. • Please give reasons for your answers

24. Appropriate treatment test When does the appropriate treatment test apply? • Section 3 • criteria for detention under section 3 of the 1983 Act • Related sections of Part 3 and corresponding criteria for renewal and discharge • section 36 - remand for treatment • section 48 - transfer of unsentenced prisoners • section 51(6) - hospital orders where it is impractical or inappropriate to bring a detainee before the court.

25. Appropriate treatment test • When does the appropriate treatment test apply? • Section 17A - as part of the criteria for community treatment orders. • 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).

26. Session 5 Supervised community treatment

27. 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.

28. Activity In groups, read through the case study and answer the questions using the information in your participant pack.

29. Patients 16 or over • Those with capacity to consent to treatment can only be treated if they consent • Those who lack the capacity to consent to treatment can be treated without their consent • Force cannot be used to administer treatment if the patient objects to it, except in emergencies • Force is permissible if the patient does not object to treatment • If the treatment cannot be given to the patient if it conflicts with a valid and applicable advance decision made under the Mental Capacity Act.

30. Children aged under 16 • Children aged under 16 can be made subject to a CTO • A child with capacity to consent to treatment can only be treated if they consent • A child who lacks the capacity to consent to treatment can be treated without their consent • Advance decision should not arise though, since these cannot in general be made by children under 16.

31. Emergency treatment for patients lacking capacity Force can be used to give treatment only if: • it is immediately necessary • it needs to be given to prevent harm to the patient, and • it is a proportionate response to the likelihood of the patient suffering harm and to the seriousness of the harm.

32. Emergency treatment • Treatment can be classed as immediately necessary if it is intended to: • save the patients life, or • prevent a serious deterioration of their condition, or • alleviate serious suffering by the patient, or • prevent the patient from behaving violently or being a danger to himself or others and represents the minimum interference necessary. Note provisos

33. Session 6 Mental Health Review Tribunal for Wales and Independent mental health advocates

34. Referrals • Patients for whom hospital managers must make a referral: • patients admitted to a hospital in pursuance of an application for admission for assessment • patients admitted to a hospital in pursuance of an application for admission for treatment • community patients • patients whose CTO is revoked • patients transferred from guardianship to a hospital.

35. Referrals Periods after which hospital managers must make a referral: • Six months after detention from the day on which: • the patient was first detained for assessment (under section 2) or for treatment (under section 3), or • the patient is admitted following revocation of a CTO, or • the patient was detained in hospital following a transfer from guardianship.

36. Referrals • After 3 years without review • Hospital managers were only under a duty to make a referral to the MHRT upon the renewal of patient's detention • The requirement to refer a patient aged under 18 years after one year represents an extension to the previous age limit of 16 years

37. Referrals • On revocation of a CTO • Statutory duty to refer to MHRT for Wales as soon as possible after the order is revoked. • Note this is in addition to the duty to refer six months after the patient’s admittance following revocation of the CTO

38. Qualifying Patients • Patients who qualify for advocacy support are essentially those who are: • liable to be detained under the Act, or • subject to guardianship, or • a community patient. • Qualifying patients must be informed that they are eligible for the services provided by an IMHA as soon as is practicable. • An IMHA will meet with a patient on the request of the patient, the nearest relative, the responsible clinician or an AMHP.

39. Independent mental health advocates How does the IMHA help the patient? • Includes help in obtaining information about and understanding: • the patient’s rights under the Act • the provisions of the Act under which the patient qualifies for an IMHA • any conditions or restrictions which affect the patient • the medical treatment the patient is receiving or is being proposed or discussed • why it is given, proposed or discussed • the legal authority for providing the treatment • the requirements of the Act which apply to treatment.

40. Independent mental health advocates How does the IMHA support the patient? The IMHA may also give: • help in obtaining information about and understanding any rights which may be exercised, and • help (by way of representation or otherwise) in exercising those rights.

41. Independent mental health advocates • IMHA has a right to: • access and inspect any hospital or local authority records relating to the patient (with patient consent) • meet patients in private and to visit and interview anyone professionally concerned with the patient’s medical treatment. • It is important to note also that hospital managers cannot withhold correspondence between patients and their advocates.

42. Session 7 Provisions for young people

43. Provisions for young people Informal admission of patients aged 16 or 17 with the capacity of consent • Decisions cannot be overridden by a person with parental responsibility for them. • This means that: • If the patient consents, they can be admitted to hospital and their consent cannot be overridden by a person with parental responsibility • If the patient does not consent, they 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 criteria.

44. Provisions for young people Accommodation for patients aged under 18 • Hospital Managers are under a duty to: • Ensure that, subject to their needs, patients under 18 are accommodated in an environment that is suitable for their age. • The decision should be taken on the basis of: • What is suitable for a patient of this age? • Is there something about this patient or the circumstances that suggests the use of an environment that would not normally be suitable for a patient of this age? • Consult a suitable person with experience in child and adolescent mental health services cases.

45. Session 8 Electro-convulsive therapy

46. New safeguards New safeguards for patients introduced: • Abolition of the power to impose ECT on a detained patient who has the capacity to consent, other than in an emergency situation • ECT can only be given when the patient gives consent, or is incapable of giving consent.

47. Consent to ECT Patients capable of consent • Detained adult patient: • consent must be certified by either the AC in charge of their treatment or by a SOAD. • Detained or informal patient not subject to a CTO under 18 years of age: • a SOAD must certify their consent and that it is appropriate for the treatment to be given.

48. Consent to ECT Patients incapable of consent • The SOAD must certify that: • the patient is not capable of understanding the nature, purpose and likely effects of the treatment, and • it is appropriate for the patient to receive the treatment. • These provisions apply to all detained patients (adults and children) and informal child patients not subject to a CTO.

49. Consultation by SOAD • Before issuing a certificate, the SOAD must first consult two other persons: • A nurse concerned with the patient's medical treatment, and • Another person professionally concerned with the patient’s medical treatment who is neither a nurse nor a doctor. • The patient’s RC and the person in charge of their treatment (if they are not the RC) are specifically excluded from being a person the SOAD must consult.

50. Certification not possible • The SOAD may not give the certificate if giving the treatment would conflict with: • a valid and applicable advance decision of the patient not to receive the treatment • a decision made by a deputy or done as defined by the Mental Capacity Act 2005 • an order of the Court of Protection.