NI Mental Capacity and Mental Health Legislation –topics for consideration

1. NI Mental Capacity and Mental Health Legislation –topics for consideration Genevieve Smyth and Kate Lesslar College of Occupational Therapists 8th December 2009

2. Current proposals under consideration • Principles based legislation • Test for mental capacity • Age range for legislation • Deprivation of Liberty Safeguards • Substitute decision making • Advance decisions/statements • Increase of assessment period • Compulsory community treatment • Extension of role of Mental Health Review Tribunal • Nominated persons • Advocacy • Additional protections for children

3. Definition of mental illness and exclusions • “A state of mind which effects a person’s thinking, perceiving, emotion or judgement to the extent that he requires care or medical treatment in his own interests or the interests of other person’s” • Current exclusions of personality disorder, addictions, sexual deviancy

4. Treatment for disorder • Interventions to treat mental disorder can only happen if appropriate medical treatment is available • Symptoms and manifestations

5. Definition of medical treatment • Change in definition of “medical treatment” from “medical treatment includes nursing, care, habilitation and rehabilitation under medical supervision” to “..includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care”

6. Family and friends • Recognition of civil partnerships • Service user application for the displacement of a nearest relative

7. ECT • Do we need tighter restrictions about giving ECT?

8. Extension of roles –Bamford view • “Nursing and other professionals are becoming increasingly skilled at mental state and risk assessment. The Framework envisages that, in addition to GPs, other appropriately trained clinicians (including nurses and clinical psychologists) –referred to as Approved Clinicians – could complete a recommendation for compulsory admission to an approved facility for assessment and that on arrival, the person should immediately be examined by a medical doctor. It is also envisaged that the separate and distinct role of the Approved Social worker as applicant for compulsory assessment should continue.” p 85

9. Current views of DHSSPS • “..changes to these roles should not be included in the single bill and that an enabling powers should be provided to allow a widening of the professional base at a later date to take account of professional development and development of alternative treatments.”

10. Extension of roles in England and Wales • ASW now Approved Mental Health Professional (AMHP) –now open to OTs, nurses and psychologists • RMO now Approved/Responsible Clinician (AC/RC)- now open to OTs, nurses and psychologists • No such roles exist in Scotland

11. Why did COT support this? • Career opportunity • The best person for the job • Competence based practiced • Permissive legislation • ASW – social model of disability • AC – allocation based on occupational need • Nurses, OTs and psychologists represent 85% of the mental health workforce

12. Approved Mental Health Professional (AMHP) • Function is exactly the same as ASWs • Training now open to the other professional groups • Training based role

13. AMHPs cont. • HEIs offering training • Must be nominated by local employer • Release for training, job description, supervision, insurance

14. Principles for selection for entry to AMHP training: • Experience of working with people with mental disorders • Experience of community settings • Basic understanding of key aspects of mental health law, mental capacity and consent, human rights, children and adults safeguards, codes of practice • Understanding of the social perspective of mental disorder and ability to view people holistically

15. Principles for selection for AMHP training cont. • An ability to work assertively and make independent decisions • An ability to work in an anti-discriminatory manner

16. Approved/Responsible Clinician (AC/RC) • Functions practically identically to the RMO role • Application to become a AC now open to other professional groups • Competence based role not training based

17. AC/RC • Potential applicants for AC approval will be very experienced, well qualified professional who given the additional training and development opportunities should be able to demonstrate the full range of competencies for the AC role. • Applicants need to be nominated by their employer and submit a portfolio of evidence to an approval panel.

18. AC/RC cont. • Acceptance by the approval panel to act as a AC –2 days training to be able to act as a RC • Allocation of RC based on needs of service user e.g. if needs primarily occupational rehabilitation, OT may be the most appropriate person • Extension of care –coordinator role • Limitations of role e.g. medication

19. Competencies of the RC • Legal and policy framework • Assessment -An ability to identify the presence and severity of mental disorder, whether severity warrants compulsion, the ability to undertake MH assessment incorporating biological, psychological, cultural and social perspectives, ability to assess risk

20. Competencies of RC cont • Treatment -Understanding of MH treatments including physical, psychological and social interventions, understanding the applicability to to different service users, ability to determine whether person has capacity, ability to formulate, review and lead on treatment appropriate to skills • Care planning

21. Competencies of RC cont. • Ability to effectively to lead an MDT, assimilate diverse views and make decisions ain complex cases • Equality and diversity –up to date knowledge • The ability to communicate effectively

22. Evidence of competence for RC role • A summary of experience relevant to the RC role • Minimum of 2 case studies relating to involvement in the care of a detained service user. This should reflect on MH legislation, assessment. Treatment, care planning, leadership, equality and diversity • 2 testimonies from senior professionals –one from different professional background • 360 degree appraisal to include service user and carer feedback

23. Compulsory Community Treatment –similar to Scotland • An alternative to hospital treatment rather than following hospital treatment • Tribunal approval required • Inclusion of conditions which allow for recall to hospital should conditions be breached or if the service users condition deteriorates • Provision of adequate and appropriate resourses before introduction of community based treatment

24. Possible conditions • Requiring that the service user receives a specific treatment • The service user attends specified care services • The service user lives at a particular place • The service user allows access to care professionals

25. Contact details • Genevieve.Smyth@cot.co.uk • 0207 450 5220