Responsibilities of Approved Clinician (AC) (in charge of treatment)

Progression of Roles

AC → AC in charge of treatment → RC

Change of RC Possible?

• As the needs of the patient change over time, it is important that the appropriateness of an RC is kept under review by hospital managers.
• It would be appropriate for patient’s RC to change during a period of care and treatment if such a change enables the needs of a patient to be met more effectively.
• This might, of course, also apply if the patient was moved to another treatment centre. (Mental Health Act, 2007. New Roles; NIMHE 2008).

Differentiation Between Approved Clinician (AC) and Responsible Clinician (RC)

• All RC’s are AC’s but not all AC’s are RC’s
• Specific functions under the Act may be carried out by an AC who is not patient’s RC
• RC’s are able to delegate to AC’s in respect of treatment under the Act
• Renewal of detention / placing patient on SCT is done only by an RC

Definitions of Approved Clinician (AC) and Responsible Clinician (RC)

Part 1

History of the Mental Health Act 1983

Acid Test

The ‘acid test’ is to see whether a person is being deprived of their liberty, you must consider two questions during this process:

• Is the person subject to continuous supervision and control?
• Is the person free to leave?

Here the focus must not be on whether a person seems to be wanting to leave, but on how those who support him/her would react.

How to identify an NR

1 ) A patient’s NR is usually different from a next of kin. But it is prescribed by law that a next of kin can be nominated as an NR.

2 ) A patient’s NR is identified on a hierarchy basis. Below is the structure how we identify an NR. An NR can be patient’s:

3 ) If more persons are eligible to become an NR, it will always be the eldest person.

Note: To perform the role of an NR a person must be 18 years of age or older. If someone who is identified as an NR is not 18 years of age, you must move down the list until an NR is found.

People involved in the renewal of section 3, 37 and 47

• The Responsible Clinician (RC) or AC Approved Clinician (AC) – The Responsible Clinician (RC) or AC Approved Clinician (AC) must discuss the decision of the renewal of section 3, 37 and 47 with the patient.
• The Hospital Managers – Where RC is satisfied that the criteria for renewing the patient’s detention are met, they must submit a report to that effect to the hospital managers.
• The second professional – The Responsible Clinician (RC) is required to obtain the written agreement of another professional (‘the second professional’) that the following criteria are met.
  • This second professional must be professionally concerned with the patient’s treatment and must not belong to the same profession as the RC.
  • The second professionals should be identified and recorded before examining the patient for the purposes of renewal. They should ensure they have sufficient information on which to make the decision and be given enough notice to be able to interview or examine the patient if appropriate.

Note: Unless there are exceptional circumstances the decision of the second professional should be accepted, even if the RC does not agree with it.