The five overarching principles are

Mental Health Act Code of Practice 2015 Guiding Principles

We will look into more details of this on the next slide.

Consent to treatment under the Mental Health Act
Author: Nick Dorling, Trust Mental Health Law Training Officer

Introduction

Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination.
This must be done on the basis of an explanation by a clinician
Consent from a patient is needed regardless of the procedure, whether it’s a physical examination, organ donation or something else.
The principle of consent is an important part of medical ethics and international human rights law.

What’s going to be covered in this module:

• Treatment under the Mental Health Act
• Who can prescribe medication
• Patients consent and capacity around treatment
• What sections are used to lawfully treat.

What is the aim of Section 117 aftercare?

• The aim of Section 117 aftercare is to provide services to prevent further admissions to a hospital.
• No-one is legally obliged to accept all or any of the aftercare services offered.
• If someone still needs aftercare they are still eligible for it until a formal assessment identifies that specific services are no longer needed or that there are no further needs under s117 and the person is discharged from s117.

Section 117 aftercare

Section 117 aftercare is a legal duty that is placed on health and social services to provide after care services for individuals who have been detained under Section 3, Section 37, Section 47, Section 48 and Section 45A.  It is the duty that comes in effect once the person has been discharged from the hospital.

Note: The law that gives this right is section 117 of the MHA. It is often referred to as ‘section 117 aftercare’.

MHA (1983) Guiding Principles

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).