Mental health act

Framework

• Mental Health Act 1983

  • Mental Capacity Act 2005

• Mental Health Act 2007

  • • Primarily amendments

Section 2

• • Assessment order

    • Lasts up to 28 days

    • Cannot be renewed

  • It can be instituted following an assessment under the Act by two doctors and an AMHP

  • At least one of these doctors must be a Section 12 approved doctor

    • The other must either have had previous acquaintance with the person under assessment, or also be a Section 12 approved doctor

      • This latter rule can be broken in an emergency situation

        • Where the person is not known to any available doctors and two Section 12 approved doctors cannot be found

    • In any case, the two doctors must not be employed in the same service, to ensure independence

    • Commonly, in order to satisfy this requirement, a psychiatrist will perform a joint assessment with a general practitioner (GP)

  • A Mental Health Act assessment can take place anywhere, but commonly occurs in a hospital, at a police station, or in a person’s home.

Section 3

• • Treatment order

  • Can initially last up to six months

    • If renewed, the next order lasts up to six months and each subsequent order lasts up to one year

  • It is instituted in the same manner as Section 2, following an assessment by two doctors and an AMHP

  • One major difference, however, is that for Section 3 treatment orders:

    • the doctors must be clear about the diagnosis and proposed treatment plan

    • and be confident that “appropriate medical treatment” is available for the patient

    • The definition of “appropriate medical treatment” is wide and may constitute basic nursing care alone.

  • Most treatments for mental disorder can be given under Section 3 treatment orders

    • Including injections of psychotropic medication such as antipsychotics

  • However, after three months of detention, either:

    • the person has to consent to their treatment

    • or an independent doctor has to give a second opinion to confirm that the treatment being given remains in the person’s best interests

  • A similar safeguard is used for electroconvulsive therapy (ECT)

    • However the RC can authorise two ECT treatments in an emergency situation for people detained under Section 3 treatment orders

    • ECT:

      • may not be given to a refusing patient who has the capacity to refuse it

      • may only be given to an incapacitated patient where it does not conflict with any advance directive, decision of a donor or deputy, or decision of the Court of Protection

Section 4

• Emergency order that lasts up to 72 hours

• Implemented by just one doctor and an AMHP, in an emergency

  • Where there is not time to summon a second suitable doctor in order to implement a Section 2 assessment order or Section 3 treatment order

• Once in hospital, a further medical recommendation from a second doctor would convert the order from a Section 4 emergency order to a Section 2 assessment order.

• Section 4 emergency orders are not commonly used.

Section 12 approved doctors

• • Medically qualified doctor who has been recognised under section 12(2) of the Act

  • They have specific expertise in mental disorder and have additionally received training in the application of the Act

  • They are usually psychiatrists, although some are general practitioners (GPs) who have a special interest in psychiatry

AMHP

• • Can be anyone

    • Social worker

    • Nurse

    • Doctor

    • OT

  • Coordinating role

  • Trained under section 12

    • Takes ~1 year

  • Approved by local authority

  • Aim for community assessment and least restrictive level of care

SOAD

• • Second opinion appointed doctor

  • Safeguard patient's best needs