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Discharge – Section 23


Discharge – Section 23

Only RC (not AC) can discharge from detention, guardianship or CTO

Hospital managers/NR have this authority as well (LSSA usually for Guardianship)

NR cannot order discharge for Section 37 Hospital or Section 37 Guardianship Order

This power does not apply to patient’s subject to section’s 41 and 49 (Restricted patients)

It also does not apply to Sections 35, 36 and 38 (Courts have the power)

Renew Detention – Section 20


Renew Detention – Section 20

Responsible Clinician (Medic vs Non-Medic)

Examination has to happen within 2 months preceding expiry of detention
Must consult and obtain written statement from another professional involved in patient’s care
Statutory conditions must be met
Written report must be submitted

Important cases to read – Winterwerp v Netherland (1979) EHRR 387/ Varbanov v Bulgaria (2000) MHLR 263 (issues with the term ‘Medical expertise’)

Absence Without Leave – S 18 / 21 / 21A + B


Absence Without Leave – S 18 / 21 / 21A + B

  • AWOL Section 18
  • Patient leaves hospital without S17 Leave (18(1)a)
  • Patient fails to return from escorted / unescorted leave (18(1)b)
  • Patient fails to return on being recalled to hospital (18(2A))
  • Patient fails to reside at an agreed address (18(1)c / 18(3))
  • If patient returns or taken into custody within 28 days of going AWOL (Section 3, 37, CTO & Guardianship)
  • RC renews order – simple
  • If patient returns or taken into custody after 28 days of going AWOL (Section 3, 37, CTO & Guardianship)
  • RC must examine within 7 days; Consult an AMHP and one more professional to reinstate order (order extended by 6 or 12 months from the date of going AWOL)
  • If Original Order (3,37,CTO & Guardianship) expires on the day or patient returns within 7 days preceding that day – order extended by 7 days / For CTO Recall Period (S 17F) – extended by 72 Hours
  • No liability for detention after expiry of Sections 2 / 5(2) / 5(4)
  • No Restriction on detention of Restricted patients (41 & 49)

Leave – Section 17


Leave – Section 17

  • RC only (or AC acting as RC)
  • Indefinite or specified occasions
  • Could be conditional
  • Should consider SCT if leave > 7 days (consecutive)
  • Risk assessment to be carried out and care plan implemented
  • Recording system has to be in place
  • Leave can be in custody
  • Recall – anytime if considered necessary by RC
  • Copy of leave should be shared with patient, carers, escort

Roles of Responsible Clinician (RC)


Roles of Responsible Clinician (RC)

Leave for detained patients (Section 17)

Absent Without Official Leave (AWOL) and return to hospital procedures (Section 18)

Community Treatment Order (CTO)
1.Recommendation
2.Renewal

Renew hospital detention (Section 20)

Discharge from section (Section 23)

Bar discharge following request by Nearest Relative (NR)
(Section 25)

Extend remand (Sections 36 & 38)

Report to Ministry of Justice (Section 41 & 49)

Assure court of bed availability (Section 37 & 38) (hospital managers can also do this)

Other Roles of Approved Clinician (AC)


Other Roles of Approved Clinician (AC)

  • Detention under section 5(2)
  • Examine Detained patients following referral by Secretary of State under:
    • Section 67 (Re: Section 37 Hospital Order / Guardianship/ CTO)
    • Section 76 (Re: Section 37 & Section 41)
  • Give evidence in court (Section 35 – 36)
  • Extend remand (Section 35)
  • Assure court of bed availability (Section 35 – 36) (hospital managers can also do this)

Reporting Responsibilities of Approved Clinician (AC)


Reporting Responsibilities of Approved Clinician (AC)

  • An Approved Clinician (AC) must:
    • Submit periodic reports under section 61 to the Mental Health Act Commission regarding treatment under section 57.
    • Submit periodic reports under section 61 to the Mental Health Act Commission regarding medication and ECT supported by a SOAD certificate under section 58 or 58A.
    • Submit reports to MHAC as required on treatment given to SCT patients on the basis of a SOAD’s “Part 4A certificate” (62A).
  • An Approved Clinician (AC) can sign a certificate under section 58 or 58A of the Act certifying that the patient has consented to medication or ECT (respectively).