The New Mental Health Act

1. The �New� Mental Health Act Dr Owen Samuels Consultant Forensic Psychiatrist Robin Pinto Unit 8 October 2008

3. � � the Bill is not the step forward for people with mental health problems that we all wanted, it is not the Bill that we needed and it will not be the legislation that we need� . Baroness Barker House of Lords 2 July 2007

4. Riding the crest of the wave

5. �Every barrier that gets in the way of getting treatment to people with serious mental health problems puts both patients and the public at risk� Rosie Winterton MP Health Minister 1 March 2007

6. Lines of battle were drawn

7. Scottish Mental Health (Care and Treatment) Act 2003

9. 9 Key changes to MHA 1983 Single definition for mental disorder Criteria for the use of compulsion Age appropriate services Professional Groups Nearest Relative Independent mental health advocacy service Patients and ECT Supervised community treatment Referral to the MHRT

10. Key Change 1 � Mental Disorder Four forms of Mental Disorder in the 1983 Act - replaced by a single definition of Mental Disorder �Mental Disorder� means any disorder or disability of mind Amendments remove the exclusions in s. 1(3) of the 1983 Act namely immorality, promiscuity and sexual deviancy � leaving only �dependence on alcohol or drugs� Extends compulsory powers to people with developmental disorders and those with learning disabilities in exactly the same way as the unamended Act Leaves some confusion with the overlap with the Mental Capacity Act

11. Key Change 2 � Criteria for Compulsion May be detained under s. 3 whether or not they have a disorder which fits into one of those current four categories Treatability test abolished and replaced by appropriate medical treatment test �Medical Treatment� includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care

12. Medical treatment which is for the purpose of alleviating or preventing a worsening of a disorder, symptom or manifestation Purpose is not the same as likelihood Does not have to be the most appropriate treatment Does not have to address every aspect of the person�s disorder Must be available not theoretically be provided

13. In summary S. 3 An application for admission for treatment may be made in respect of a patient on the grounds that: He is suffering from mental disorder of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital; and� Repealed [�treatability test�] It is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and it cannot be provided unless he is detained under this section; and (d) Appropriate medical treatment is available to him

14. Section 37 The court is satisfied on the written or oral evidence of two registered medical practitioners, that the offender is suffering from mental disorder and � the mental disorder from which the offender is suffering is of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital; and Appropriate medical treatment is available to him

15. Key Change 3 � Supervised Community Treatment AGAINST More patients subjected to compulsory powers Increased meds Disproportionately impact on BEM Inadequate community services FOR More flexible Community-based service delivery Shorter hospital stays Revolving door patients

16. Revolving door patients

17. Churchill et al 2007 � International Experience of Using CTO No evidence of change in outcomes of : Hospital admissions Hospital bed days Compliance with treatment Violence Symptoms Offences resulting in arrests Social functioning Quality of life, care or satisfaction Perceived coercion

18. Problems with CTOs AMHP and RC from same team � unlikely to disagree Discharge safety net for those risk averse Difficult being discharged by Tribunals

19. The Process S. 25A repealed S. 17A introduced Only for those detained for treatment (not s. 2 or s. 136) AMHP Appropriate Conditions are necessary and appropriate Subsequent conditions do not need AMHP

20. Criteria for RC and AMHP to agree Mental disorder of nature or degree for medical treatment Necessary for health or safety or protection of others Rx can be provided without patient being detained in hospital RC should be able to recall Appropriate medical treatment is available

21. Conditions At least two conditions: Patient must be available for examination for extension of CTO Patient must be available for examination for Part 4A certificate

22. Key Change 4 � Professional Groups AMHPs: Widens pool of professionals Nurses, psychologists, OTs Must be able to demonstrate �social perspective� and independence ACs: Medical Practitioners, Chartered Psychologists, �First Level� Nurses, Ots, Social Workers Relevant Competencies � Schedule 2 Mental Health (Approved Clinician) Direction 2008

23. RCs: Is an AC with overall responsibility for the patient May change over time Another professional can carry out roles that the RC cannot do e.g. prescribing NB changes to renewal (s. 20)

24. Other Changes Key Change 5 � Nearest Relative Key Change 6 � IMHA Key Change 7 � ECT Key Change 8 � Changes to Tribunals

25. The Guiding Principles The purpose principle The least restrictive principle

26. Respect principle Participation principle Effectiveness, efficiency and equity principle

27. Don�t worry you are not the only ones battling to understand it all!