Longer-term s17 leave of absence or a CTO?

Criteria for Guardianship

• The patient is suffering from a mental disorder of a nature of degree which warrants his reception into Guardianship and;
• It is necessary, in the interests of the welfare of the patient or for the protection of others, that the patient be so received (CoP 30.8).

So, unlike a CTO, the purpose of Guardianship is primarily to ensure the patient receives care and protection rather medical treatment.

Two medical recommendation forms + an AMHP application. NR can object (like s3). Patient can be transferred from s3 to Guardianship (form G6).

Papers received by the local authority not hospital. Local authority has the responsibility of authorising an AC to be the patient’s RC (CoP 30.16).

A Guardianship Order can last for six months. It can be extended for another six months and, thereafter, on an annual basis, if necessary.

In the final two months of the first and each subsequent period of Guardianship, the RC must examine the patient in order to decide whether they meet the criteria for extending the order (similar to a CTO). NR can discharge without notice and cannot be barred!

S7 Guardianship

The purpose of Guardianship is to provide care for a small number of people with mental disorder who do not require treatment in hospital but who need close supervision and some control in the community, and this cannot be provided without compulsory powers (CoP 30.2).

A Guardian is likely to be the local authority or an individual approved by the local authority (a ‘private guardian’ e.g. a relative). Private Guardians are rare.

Guardians have 3 specific powers:

• They have the exclusive right to decide where a patient should live
• They can require the patient to attend for treatment, work, training or education at specific times and places but they cannot use force to take the patient there
• They can demand that a doctor, AMHP or another relevant person has access to the patient at the place where the patient lives

RECALL

CTO patients can be recalled to hospital if their RC decides that they need to receive medical treatment for their mental disorder in a hospital or, if they were not recalled to hospital to receive treatment, there would be a risk of harm to their health or safety, or to other people (CoP 29.46).

Failure to comply with a condition (apart from the two mandatory conditions above) does not in itself trigger recall (CoP 29.49).

CTO Conditions

All CTOs must include conditions requiring patients to make themselves available for examination so that:
(a) The RC can decide whether to make a report extending the CTO under S20a and
(b) A SOAD can decide whether to give a certificate authorising certain kinds of treatment for the patient

The CTO may include other conditions which the RC (with the AMHP’s consent) think are necessary or appropriate for one or more of the following reasons:

• Ensuring that the patient receives medical treatment
• Preventing harm to the patient’s health or safety
• Protecting other people

The conditions (with the exception of the two mandatory conditions above) are not directly enforceable.
The RC and AMHP should ensure the conditions of a CTO :

• Be kept to a minimum consistent with achieving their purpose
• Restrict the patient’s liberty as little as possible while being consistent with their care plan and recovery goal
• Be clearly and precisely expressed, so that the patient can readily understand what is expected (CoP 29.31)

CTO Criteria

• The patient is suffering from a mental disorder of a nature or degree which makes it appropriate for the patient to receive medical treatment
• It is necessary for the patient’s health and safety, or for the protection of others that the patient should receive such treatment
• Subject to the patient being liable to be recalled, such treatment can be provided without the patient continuing to be detained in hospital
• It is necessary that the RC should be able to exercise the power to recall the patient
• Appropriate medical treatment is available

An AMHP needs to endorse the RC’s opinion that all the above criteria are met and agree that it is appropriate for the patient to be subject to a CTO.

S17a Community Treatment Order

• The purpose of a CTO is to allow suitable patients to be safely treated in the community rather than under detention in hospital, and to provide a way to help prevent relapse and any harm – to the patient and others – that this might cause. It is intended to help patients maintain stable mental health outside hospital and promote recovery (CoP 29.5)
• The Guiding Principles of the MHA 1983, in particular, treating patients using the least restrictive option and maximising their independence, and purpose and effectiveness should always be considered when deciding if a CTO is necessary.
• A CTO does not bring an admission for treatment to an end. It merely suspends the hospital power to detain the patient for as long as the CTO is in force.
• Patients detained under s3 and s37 can be considered for discharge under a CTO.

Privacy Notice

This notice has been prepared to comply with the General Data Protection Regulation.

• The London Approvals Panel is one of four regional panels that are appointed by the Department of Health and Social Care to manage the application and approval process for clinicians wishing to act as Section 12 doctors or Approved Clinicians under the Mental Health Act 1983.
• Where Section 12 or Approved Clinician status is granted by the Approval Panel to a clinician, certain personal data, including name, employment address and telephone numbers, grade and re-approval date are added to the Mental Health Act 1989 approvals database and stored electronically.  The Data Protection Act 1998 and General Data Protection Regulation (GDPR 2018) apply.
• Information on the approvals database may be shared with certain professionals and organisations that have a routine need to ascertain that clinicians have the appropriate approval under the Mental Health Act 1983. Primarily this will include local authorities and Approved Mental Health Professionals, and will also include police, NHS Trusts and Foundation Trusts, Clinical Commissioning Groups, courts, and prisons. By way of example, your information may be retrieved by a user searching for Section 12 doctors working in a particular geographical area. 
• This is therefore a public task under the GDPR. The processing is necessary for the Department and its Approval panels to perform a task in the public interest or for official functions, and the task or function has a clear basis in law.
• Access and use of the MHA Database is subject to current Data Protection legislation and regulation. This includes The Data Protection Act 1998 and the GDPR, as well as related legislation including the Computer Misuse Act 1990. Only personnel authorised by the Department of Health and Social Care, or by the four regional Approval Panels, can access and use the Database. Such personnel are obliged to sign an agreement recognising that it is an offence to replicate and disseminate information contained on the database.
• On expiry of a clinician’s approval, or after a request to be removed from the database, personal data may be retained in an archive for a period of ten years. This is to allow for a timely reactivation of your approval status as well as to provide evidence of a clinician’s previous approval status.
• The Approval Panel will also keep personal data pertaining to a clinician’s application for approval as is necessary to perform its function of considering such applications and granting approval.

Under the GDPR, you have the following rights:

• The right to be informed;
• The right of access;
• The right to rectification;
• The right to erasure;
• The right to restrict processing;
• The right to data portability;
• The right to object;
• The right not to be subject to automated decision-making including profiling.
• You are asked to consent to these arrangements on the Applicant’s Declaration.

You are asked to consent to these arrangements on the Applicant’s Declaration.

Medical Indemnity

You should be aware that medical indemnity by the NHS does not usually cover section 12(2) assessments made beyond Trust premises with the exception of domiciliary visits.

You should personally arrange for appropriate medical indemnity cover.

General Conditions of Approval

You must stop acting as an AC or S12(2) approved doctor and inform the Region Panel immediately if you no longer hold a valid GMC Licence

You must stop acting as an AC and inform the Region Panel immediately if you no longer possess all of the professional competencies set out in Schedule 2 of the Secretary of State’s Instructions 2014

You must stop acting as an AC and inform the Region Panel immediately if you are suspended from the professional register relevant to your professional registration.

You must inform the Region Panel immediately if a period of suspension from your professional register ends so the Panel can re-instate the approval for the remaining period.

You must inform the Region Panel if you are bound over, cautioned, become the subject of criminal proceedings which might lead to conviction, or if fitness to practice proceedings are being undertaken by an appropriate licensing or regulatory body in the UK or another country.