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Module 5.1

Completing Statutory Forms lawfully

Completing Section Papers

  • When detaining someone under the Mental Health Act (MHA) a set of statutory papers must be completed. There is a set way in which this must be done.
  • Form A4
    • When detaining someone under Section 2 of the MHA you need to complete a medical recommendation that is form A4.
    • Click here to view form A4.
  • Form A3
    • You could decide to make your medical recommendation jointly alongside another doctor in which case you would use form A3.
    • Click here to view form A3.
  • Form A8
    • When detaining someone under Section 3 of the MHA you need to complete a medical recommendation that is form A8.
    • Click here to view form A8.
  • Form A7
    • Again, you could decide to make your medical recommendation jointly alongside another doctor in which case you would use form A7.
    • Click here to view form A7.

Module 7.1

CAMHS (Child & Adolescent MH Service)
Authors: Dr Dan Hayes, Consultant Psychiatrist & Lead Panel member – London s12/AC Approvals Panel
Denista Wincey, Approvals Lead – London s12/AC Approvals Panel

Introduction

The application to those under 18 is different. Different considerations apply to those who are sixteen and over (‘young persons’) and to those under 16 (‘children’).

When an under 18 year old requires treatment, it may be necessary to consider their capacity/ competence to consent to treatment in the context of their age and maturity, as well as the effect of any illness or disability on their understanding. It is also necessary to consider the role of someone with parental responsibility under the Children Act 1989, or the Court. There may be a number of different people who can consent to treatment/ admission if appropriate to do so. You may visit the guidance in relation to treatment of children is given in chapter 19 of the MHA 1983 Code (2015) and also at para 24.31-24.34.

Module 4.2

Tribunal and Managers powers

Author: Arthur de Frisching, Hospital Manager

Tribunals and Managers’ Reviews

Role and Purpose

Module 2.4

Nearest relative powers

Establish Nearest Relative (NR) for a patient

  • Wherever possible, Approved Mental Health Professional should identify who is patient’s Nearest Relative (NR) at the time of sectioning.
  • This is not always possible as in some cases patients do not have an NR.

Module 2.2

Renewal under Section 20

Renewal of section 3, 37 and 47

Responsible Clinician (RC) or Approved Clinician (AC) must personally examine the patient and decide within the two months leading up to the expiry of the patient’s detention whether:

  • The criteria for renewing detention under Section 20 of the act are met or discharge is appropriate.
  • The person is suffering from a mental disorder of a nature or degree which makes it appropriate for them to receive medical treatment in hospital.

It is necessary for the health and safety of the person or for the protection of other persons that they should receive such treatment and it cannot be provided unless the patient is detained under this section and appropriate medical treatment is available.

Module 2.3

Discharge under Section 23 and Section 117

Discharge of patients under Section 23

Module 2.1

Powers under MHA

Compulsion in the community
Author: Nick Dorling, Trust Mental Health Law Training Officer

S17, CTO & Guardianship

S17 leave of absence

Patients detained in hospital can leave lawfully only if they are given leave of absence by their Responsible Clinician (RC) under s17 of the Mental Health Act 1983 (MHA CoP 27.3)

S17 leave cannot be given to patients detained under s5(2), s35, s36 and s38. Leave can only be given to restricted patients with the approval of the Ministry of Justice (unless they need emergency leave e.g. for urgent medical treatment)

In the absence of the usual RC, s17 leave can be granted only by the AC who is acting as the patient’s RC (CoP 27.8)

S17 leave should normally be of short duration and not normally for more than 7 days.

If a patient is detained under s3 or s37 and is given leave for more than 7 days, the RC must consider discharge under a Community Treatment Order (CTO).

If treatment needs to be administered without the patient’s consent, the RC should consider recalling the patient to hospital.

The RC’s responsibilities for their patients remain the same while their patients are on leave (CoP 27.24)

The RC may revoke their patient’s leave at any time if they consider it necessary in the interests of the patient’s health or safety or for the protection of others (CoP 27.32)

The RC can extend leave without the patient having to return to hospital.

The RC can renew a patient’s detention while they are on leave if the criteria under s20 are met (CoP 27.32)

NHS Trust v X (In the matter of X (A Child) (No 2)) [2021] EWHC 65 (Fam)


NHS Trust v X (In the matter of X (A Child) (No 2)) [2021] EWHC 65 (Fam)

“This case is about whether [X], a young woman declared to be Gillick competent and “mature and wise beyond her years”, should be afforded the exclusive right to decide her own medical care in the same way as her peers aged 18 years and older’. ‘She is a baptised Jehovah’s Witness…Unhappily, she suffers from serious sickle cell syndrome.’ The ‘conventional wisdom’ prevails: a refusal to consent to medical treatment by a Gillick competent minor is not determinative.

High Court’s Inherent Jurisdiction And Children


High Court’s Inherent Jurisdiction And Children

It is important to note, in relation to anyone under 18, the role played by the High Court. A decision by a parent to consent or to refuse to consent to treatment may be overridden by the Court in exceptional circumstances. In cases where a child or young person cannot be admitted and/or treated informally, and the criteria for detention under the Act are not met, legal advice should be obtained on whether to seek the assistance of the High Court. The court’s authorisation may be sought by way of an order or declaration, under its inherent jurisdiction, or for a section 8 order under the Children Act 1989. Whether the court is prepared to assist will depend on the facts of the particular case. It should also be noted that the Court of Protection can make a deprivation of liberty order in respect of young people aged 16 and 17. (Code of Practice19.52)

‘There is now ample authority for the proposition that the inherent powers of the court under its parents patriae jurisdiction are theoretically limitless and they certainly extend beyond the powers of the natural parent. The court does have the power to override the refusal of a minor, whether over or under 16, and even if ‘Gillick competent.’ Per Lord Donaldson.

The High Court took the unusual course of invoking the parents patriae jurisdiction to make A a ward of Court in Re An NHS Trust v A [2014] EWHC 920 (Fam) and made declarations that it was in her best interests to have a nasojejunal tube inserted through which she would receive fluids, nutrition and medication. The child and her mother both refused the proposed treatment. A was 15 year old who, weighed less than 6 stone and had suffered dramatic weight loss as a result of persistent vomiting. She was found not to have capacity to participate in treatment decisions. Her strongly expressed resistance to the proposed treatment was given great weight but was not determinative. The treatment was urgent and her best interests required declarations in relation to medical treatment.