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The New Mental Health Act


Lines of battle were drawn. Scottish Mental Health (Care and Treatment) Act 2003 ... Don't worry you are not the only ones battling to understand it all! ... – PowerPoint PPT presentation

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Title: The New Mental Health Act

The New Mental Health Act
  • Dr Owen Samuels
  • Consultant Forensic Psychiatrist
  • Robin Pinto Unit
  • 8 October 2008

(No Transcript)
  • … the Bill is not the step forward for people
    with mental health problems that we all wanted,
    it is not the Bill that we needed and it will not
    be the legislation that we need .
  • Baroness Barker
  • House of Lords
  • 2 July 2007

Riding the crest of the wave
  • Every barrier that gets in the way of getting
    treatment to people with serious mental health
    problems puts both patients and the public at
  • Rosie Winterton MP
  • Health Minister
  • 1 March 2007

Lines of battle were drawn
Scottish Mental Health (Care and Treatment) Act
(No Transcript)
9 Key changes to MHA 1983
  • Single definition for mental disorder
  • Criteria for the use of compulsion
  • Age appropriate services
  • Professional Groups
  • Nearest Relative
  • Independent mental health advocacy service
  • Patients and ECT
  • Supervised community treatment
  • Referral to the MHRT

Key Change 1 Mental Disorder
  • Four forms of Mental Disorder in the 1983 Act -
    replaced by a single definition of Mental
  • Mental Disorder means any disorder or
    disability of mind
  • Amendments remove the exclusions in s. 1(3) of
    the 1983 Act namely immorality, promiscuity and
    sexual deviancy leaving only dependence on
    alcohol or drugs
  • Extends compulsory powers to people with
    developmental disorders and those with learning
    disabilities in exactly the same way as the
    unamended Act
  • Leaves some confusion with the overlap with the
    Mental Capacity Act

Key Change 2 Criteria for Compulsion
  • May be detained under s. 3 whether or not they
    have a disorder which fits into one of those
    current four categories
  • Treatability test abolished and replaced by
    appropriate medical treatment test
  • Medical Treatment includes nursing,
    psychological intervention and specialist mental
    health habilitation, rehabilitation and care

  • Medical treatment which is for the purpose of
    alleviating or preventing a worsening of a
    disorder, symptom or manifestation
  • Purpose is not the same as likelihood
  • Does not have to be the most appropriate
  • Does not have to address every aspect of the
    persons disorder
  • Must be available not theoretically be provided

In summary S. 3
  • An application for admission for treatment may be
    made in respect of a patient on the grounds that
  • He is suffering from mental disorder of a nature
    or degree which makes it appropriate for him to
    receive medical treatment in a hospital and 
  • Repealed treatability test
  • It is necessary for the health or safety of the
    patient or for the protection of other persons
    that he should receive such treatment and it
    cannot be provided unless he is detained under
    this section and
  • (d) Appropriate medical treatment is available to

Section 37
  • The court is satisfied on the written or oral
    evidence of two registered medical practitioners,
    that the offender is suffering from mental
    disorder and …
  • the mental disorder from which the offender is
    suffering is of a nature or degree which makes it
    appropriate for him to receive medical treatment
    in a hospital and
  • Appropriate medical treatment is available to him

Key Change 3 Supervised Community Treatment
  • More patients subjected to compulsory powers
  • Increased meds
  • Disproportionately impact on BEM
  • Inadequate community services
  • FOR
  • More flexible
  • Community-based service delivery
  • Shorter hospital stays
  • Revolving door patients

Revolving door patients
Churchill et al 2007 International Experience
of Using CTO
  • No evidence of change in outcomes of
  • Hospital admissions
  • Hospital bed days
  • Compliance with treatment
  • Violence
  • Symptoms
  • Offences resulting in arrests
  • Social functioning
  • Quality of life, care or satisfaction
  • Perceived coercion

Problems with CTOs
  • AMHP and RC from same team unlikely to disagree
  • Discharge safety net for those risk averse
  • Difficult being discharged by Tribunals

The Process
  • S. 25A repealed
  • S. 17A introduced
  • Only for those detained for treatment (not s. 2
    or s. 136)
  • AMHP
  • Appropriate
  • Conditions are necessary and appropriate
  • Subsequent conditions do not need AMHP

Criteria for RC and AMHP to agree
  • Mental disorder of nature or degree for medical
  • Necessary for health or safety or protection of
  • Rx can be provided without patient being detained
    in hospital
  • RC should be able to recall
  • Appropriate medical treatment is available

  • At least two conditions
  • Patient must be available for examination for
    extension of CTO
  • Patient must be available for examination for
    Part 4A certificate

Key Change 4 Professional Groups
  • AMHPs
  • Widens pool of professionals
  • Nurses, psychologists, OTs
  • Must be able to demonstrate social perspective
    and independence
  • ACs
  • Medical Practitioners, Chartered Psychologists,
    First Level Nurses, Ots, Social Workers
  • Relevant Competencies Schedule 2 Mental Health
    (Approved Clinician) Direction 2008

  • RCs
  • Is an AC with overall responsibility for the
  • May change over time
  • Another professional can carry out roles that the
    RC cannot do e.g. prescribing
  • NB changes to renewal (s. 20)

Other Changes
  • Key Change 5 Nearest Relative
  • Key Change 6 IMHA
  • Key Change 7 ECT
  • Key Change 8 Changes to Tribunals

The Guiding Principles
  • The purpose principle
  • The least restrictive principle

Respect principle
  • Participation principle
  • Effectiveness, efficiency and equity principle

Dont worry you are not the only ones battling to
understand it all!