Policy and Procedures for the Administration of the Mental Health Act 1983, as Amended by the Mental Health Act 2007

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Trust Policy

Policy and Procedures for the Administration of the Mental Health Act 1983, as Amended by the Mental Health Act 2007

WAHT-CG-664 Page 1 of 33 Version 3

Policy and Procedures for the

Administration of the Mental Health

Act 1983, as Amended by the Mental

Health Act 2007

Department / Service:

Nursing

Originator:

Suzanne Hardy, Lead Nurse – Safeguarding Adults

Key contact:

Safeguarding lead

Accountable Director:

Lisa Miruszenko, Deputy Chief Nursing Officer

Approved by:

Key Document Approval Group

Date of approval:

24

th

February 2016

First Revision Due:

24

th

February 2018

Target Organisation(s)

Worcestershire Acute Hospitals NHS Trust

Target Departments

All departments

Target staff categories

All staff involved in the care of patients detained under

the Mental Health Act within the Acute Hospital setting

Policy Overview:

The purpose of this policy is ensure that the Trust has procedures by which the staff

are aware of and abide by the Mental Health Act, 1983.

It provides assistance to the Trust’s employees when involved in the admission,

care, treatment, transfer and discharge of patients with mental health conditions

who may be detained under the Mental Health Act, 1983.

Latest Amendments to this policy:

Revision of flow charts following feedback of use in practice

Clarification of storage of section papers following legal advice

Clarification of the submission of the annual KP90 data set related to Mental Health

Act detentions

Defining who can be the nominated deputy

Strengthening monitoring arrangements

Clarification around responsibility of review of detentions prior to expiry

Strengthen to address Revised Code of Practice 2015

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Contents page:

1. Introduction

2. Scope of this document

3. Definitions

4. Abbreviations

5. Responsibility and duties

6. Policy detail

6.1 Guiding principles

6.2 Defining the detaining authority

6.3 Consent to treatment

6.4 Medical and administrative scrutiny and storage of section

documents

6.5 Electronic record of an individual’s Mental Health Act activity

6.6 Information about patients’ rights

6.7 Procedures

7. Implementation of key document

7.1 Plan for implementation

7.2 Dissemination

7.3 Training and awareness

8. Monitoring and compliance

9. Policy review

10. References

11. Background

11.1 Consultation process

11.2 Approval process

11.3 Equality requirements

11.4 Financial risk assessment

11.5 Version control

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Appendices

Appendix 1 Detention Document Checklist

Appendix 2 Key actions for Managing all Detained Patients

Appendix 3 Section 5(2) Holding Power

Appendix 4 Section 2 Admission for Assessment

Appendix 5 Section 3 Admission for Treatment

Appendix 6 Section 19 Transfer (internal and external)

Appendix 7 Section 17 Leave of Absence

Appendix 8 Section 18 Absent without Leave

Appendix 9 Section 136 Police Removal Power

Appendix 10 Expiry of or Revoking of a Section

Appendix 11 Flow Chart of Consent to Treatment under the Mental

Health Act

Appendix 12 Conveyance

Appendix 13 Discharge – Mental Health Tribunal

Appendix 14 Discharge – Hospital Manager’s Review Meetings and

Appeal hearings

Appendix 15 Changing Responsible Clinician

Appendix 16 Death of a Detained Patient

Appendix 17 Section 29 Displacement of the Nearest Relative

Appendix 18 Associated Documentation

Supporting Documents

Supporting Document 1

Equality Impact Assessment

Supporting Document 2

Financial Risk Assessment

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1. Introduction

The Worcestershire Acute Hospitals NHS Trust (WAHT) has a statutory obligation to ensure that its service users, who become subject to the Mental Health Act 1983; as amended by the Mental Health Act 2007 (here after referred to in this document as the Act); are treated lawfully.

The main purpose of the Act is to allow compulsory action to be taken, where necessary, to make sure that people with mental disorders get the care and treatment they need for their own health or safety, or for the protection of other people. It sets out the criteria that must be met before

compulsory measures can be taken, along with protections and safeguards for patients.

Part 2 of the Act sets out the civil procedures under which people can be detained in hospital for assessment or treatment of mental disorder. Detention under these procedures normally requires a formal application by either an Approved Mental Health Professional (AMHP) or the patient’s nearest relative, as described in the Act. An application is founded on two medical recommendations made by two qualified medical practitioners, one of whom must be approved for the purpose under the Act. Different procedures apply in the case of emergencies.

The registration process for health and adult social care requires that any hospital using the MHA to detain patients must be specifically registered to do so. The Act’s Code of Practice identifies

standards that mental health service providers should meet when they perform their responsibilities under the Act. Although the Code of Practice is not legally enforceable, failure to follow it might be referred to in evidence in legal proceedings.

2. Scope of this document

This policy sets out guidance on the use of the Act within WAHT. It covers the role of Worcestershire Acute Hospitals NHS Trust and the staff employed within it when caring for patients under the MHA 1983. It covers what staff should know, admission, transfer, discharge and review. Further

information is available in the Mental Health Act 1983 – Code of Practice (accessible through the trust intranet).

This policy applies to all staff working in the Acute Trust who may be involved in the care of patients detained under a section of the Mental Health Act and the management of the documentation related to their detention.

This policy applies to patients who are detained under any section of the MHA 1983 and are receiving care in the Acute Trust.

3. Definitions

The Act

Mental Health Act 1983, as amended by the Mental Health Act 2007

Approved Clinician

A mental health professional approved by the Secretary of State under Section 12, to act as an approved clinician for the purposes of the Act. Some decisions under the Act can only be taken by people who are approved clinicians. All responsible clinicians must be approved clinicians.

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Approved Mental Health Professional

A social worker or other professional approved by the local social services authority to carry out a variety of functions under the Act.

Capacity

The ability to take a decision about a particular matter at the time the decision needs to be made. Some people may lack capacity to take a particular decision because they cannot understand, retain, use or weigh the information relevant to the decision. A legal definition of lack of capacity for people aged 16 and over is set out in Section 2 of the Mental Capacity Act 2005.

Consent

‘Agreeing to allow someone else to do something to or for you’, particularly consent to treatment. Valid consent requires that the person has the capacity to make the decision (or the competency to consent, if a child) and they are given the information they need to make the decision and that they are not under any duress or inappropriate pressure.

Hospital Managers

The Organisation that is responsible for the operation of the Mental Health Act in a particular hospital.

Independent Mental Health Advocate (IMHA)

An advocate available to offer help the service user under arrangements which are specifically required to be made under the Act.

Mental Capacity Act

The Mental Capacity Act 2005, which governs decision making on behalf of people who lack capacity.

Mental Disorder

Any disorder or disability of the mind. As well as mental illnesses, it includes conditions like

personality disorders, autistic spectrum disorders and learning disabilities but excludes dependence on drugs/alcohol and immoral conduct.

Mental Health Review Tribunal

The first-tier Tribunal (Mental Health) hears applications and references for people detained under the Act. The main purpose is to review the cases of patients detained under the Act and to direct the discharge of any patients where the statutory criteria for detention are not met.

Nearest Relative

A person defined by Section 26 of the Act who has certain rights and powers under the Act in respect of a service user for whom they are the nearest relative.

Nominated Deputy

The consultant in charge of an in-patient’s treatment can nominate a deputy to exercise section 5(2) powers in their absence. Only a doctor also on the staff of WAHT can be a nominated deputy. Only one deputy can be authorised at any one time.

Responsible Clinician

The person in overall charge of the care of an individual who is subject to the Act. This must be an Approved Clinician, this will be a consultant psychiatrist who will work closely with the consultant in charge of the physical treatment of the patient.

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Section

A specific piece of legislation within the Act, which pertains to the type of detention an individual is subject to.

4. Abbreviations

AC - Approved clinician Admin - Administrator

ADRT - Advanced decision to refuse treatment AMHP - Approved mental health professional ASAP - As soon as possible

AWOL - Absent without leave CQC - Care Quality Commission DDN - Divisional Director of Nursing ECT - Electro-convulsive therapy GP - General practitioner HM - Hospital managers

IMHA - Independent mental health advocate LPA - Lasting power of attorney

MHA - Mental Health Act MHT - Mental health tribunal NED - Non executive director NIC - Nurse in charge NR - Nearest relative OOH - Out of hours

RC - Responsible clinician

WAHT - Worcestershire Acute Hospitals Trust WHCT - Worcestershire Health and Care Trust

5. Responsibility and Duties

Trust Board – for the purpose of the Act is the “Hospital Managers” and have important statutory

powers, responsibilities and duties concerning detained patients.

The following functions are delegated:

 To ensure that the grounds for admitting the patient are valid and that all relevant documents are in order

 To ensure that those formally delegated to receive documents, and those who are required to scrutinise them, have a thorough knowledge of the Act.

 To review each patient’s detention

 To ensure that any patient who wishes to apply to a Mental Health Review Tribunal is given the necessary assistance

 To authorise the transfer of certain patients to the care of another hospital or set of ‘hospital managers’

 To consent to the rectification of certain kinds of error in statutory documents.

Associate Hospital Managers – for the purpose of the Act exercise the function of “Hospital Managers” to discharging patients/renewing detention orders, They are responsible for managing a hearing when a request for such a review of their detention has been made by a patient. They must also undertake a review following the renewal/extension of a detention. This must be undertaken with other associate hospital managers who are not employed by the Trust – this service is commissioned from Worcestershire Health and Care Trust when required.

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Divisional Manager – are responsible for:-

 ensuring that a RC is appointed and this is clearly documented

 ensuring all detained patients are being reviewed on a daily basis.

Matron, Ward/Unit Manager or Deputy – are responsible for:-

 discharging the delegated power of accepting the section papers by the Trust

 checking all documents related to the section and completing the form to accept receipt of patient or to initiate transfer

 discharge the delegated power of ensuring patient and nearest relative receives all appropriate information

 that documents are stored in accordance to the policy

 that the Hospital Managers are aware of all patients detained under the Mental Health Act

 investigation of any incidents or complaints related to the use of the policy.

Patient Safety Team - is responsible for:-

 completing statutory notification to CQC of death of a detained patient

Responsible Clinician – is responsible foroverseeing the treatment of the patient’s mental disorder and must work closely with the consultant physician/surgeon to ensure that both physical and

mental health needs are addressed; this must be a mental health professional approved by the Secretary of State. They are responsible for deciding, before a detention expires, whether the current period of detention should be renewed.

Divisional Director of Nursing – Will maintain the record of all patients admitted subject to or whom become subject to detention under a section of the Act. Until further notice is responsible for the scrutiny of statutory paperwork on behalf of WAHT.and will also provide all the reminders to WAHT staff around review dates.

Deputy Chief Nursing Officer – is responsible until further notice for keeping the central repository

for all section documentation following the discharge of patients.

Information Team - Will complete the annual statutory KP90 return to Department of Health and provide an annual report to the Trust Board.

Key Documents Approval Group - responsible for approving this policy

Other staff members – all clinical staff need to understand what it means when a patient is detained under a section of the Mental Health Act. This includes providing detained patients with information on their legal rights during the detention.

Worcestershire Health and Care Trust Mental Health Act Administrators – From a date to be agreed will provide the secondary scrutiny and storage of all original statutory paperwork. Will return authorised copies of the section papers to the ward for filing in the notes after the confidentiality divider. Will provide all reminders to the wards regarding statutory reviews. Will administer any request for a hospital managers hearing and any mental health act tribunal. Will provide information required to complete the annual statutory KP90 return to the Department of Health.

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6. Application of the Mental Health Act

6.1 Guiding principles

6.1.1 In making any decisions under the Mental Health Act the guiding principles should be considered. These are laid out in Chapter 1 of the Mental Health Act Code of Practice and can be summarised as follows:-

 Purpose: Decisions under the Act must be taken with a view to minimising the

undesirable effects of mental disorder, by maximising the safety and wellbeing (mental and physical) of patients, promoting their recovery and protecting other people from harm.

 Least restrictive: People taking action without a patient’s consent must attempt to keep

to a minimum the restrictions they impose on the patient’s liberty, having regard to the purpose for which restrictions are imposed.

 Respect: People taking decisions under the Act must recognise and respect the diverse needs, values and circumstances of each patient, including their race, religion, culture, gender, age, sexual orientation and any disability. They must consider the patient’s views, wishes and feelings (whether expressed at the time or in advance) so far as they are reasonably ascertainable and follow those wishes wherever practicable and

consistent with the purpose of the decision. There must be no unlawful discrimination.

 Participation: Patient must be given the opportunity to be involved, as far as is practicable in the circumstances, in planning, developing and reviewing their own treatment and care to help ensure that it is delivered in a way that is as appropriate and effective for them as possible. The involvement of carers, family members and other people who have an interest in the patient’s welfare should be encouraged (unless these are particular reasons to the contrary) and their views taken seriously.

 Effectiveness, efficiency and equity: People taking decisions under the Act must seek to use the resources available to them and to patients in the most effective, efficient and equitable way, to meet the needs of patients and achieve the purpose for which the decision was taken.

6.1.2 Decisions made under the Mental Health Act must be supported and informed by the clinical assessment and care planning process and detention under the Mental Health Act is not a substitute for following these processes.

6.1.3 All staff should ensure that their decisions made and actions taken in respect of patients subject to the Mental Health Act follow procedures laid out in the legislation. All decisions made and actions taken should be in accordance with the Code of Practice and the Reference Guide unless there are robustly justified and documented reasons for deviation.

6.2 Defining the detaining authority

6.2.1 Section 17 leave – allows a patient detained by another provider service to be admitted to WAHT for care of their physical health; whilst the responsibility for the patient’s detention and treatment under the Act remains with the detaining organisation.

6.2.2 Section 19 transfer – a patient detained by another provider service is admitted to WAHT for care of their physical health and responsibility for the patient’s detention and treatment under the Act is transferred to WAHT. The RC retains responsibility for overseeing the care but WAHT has responsibility for funding any specialist nursing support for the patient.

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6.2.3 Section, 2, 3 or 5(2) – when an inpatient at WAHT is detained either in an emergency under section 5(2) or for longer term for assessment section 2 or treatment section 3; WAHT is responsible for the patient’s detention and treatment under the Act. For Section 2 & 3 an RC must have responsibility for overseeing the care but WAHT has responsibility for funding any specialist nursing support for the patient.

6.2.4 Other sections – where a patient transferred from prison or other hospital is subject to detention under any other section of the Act advice should be sought urgently from the matron.

6.2.5 Patients should be transferred to a mental health unit as soon as their physical health permits, so they can receive the mental health care and treatment for which they have been detained. A Section 19 transfer must be completed.

6.3 Consent to treatment

The Act enables patients to be treated against their will, but only for their mental disorder. The Act does not sanction treatment for physical disorders that are unconnected to the mental disorder, even where the patient is unable or unwilling to give consent. See Appendix 11

Flow chart of consent to treatment under the Mental Health Act.

6.4 Medical and administrative scrutiny and storage of section documents

6.4.1 The statutory (pink) forms must be used when a patient is subject to the Act. These are downloaded from intranet – Mental Health Act resources, small stocks will be on each ward.

6.4.2 The Trust’s Hospital Managers delegate their responsibilities to receive and check the accuracy of the statutory forms to ward managers and matrons. The statutory forms will be scrutinised for accuracy and completeness, to ensure they do not reveal any obvious infringement using the checklist Appendix 1.

6.4.3 From a date to be confirmed all original section papers must be sent to the

Worcestershire Health and Care Trust Mental Health Act Administrators for scrutiny and safe storage. Prior to this date send to Divisional Director of Nursing. Copies will be taken and returned to the ward to be filed in the medical record; after the confidentiality divider.

6.4.4 From a date to be confirmed WHCT MHA Admin will carry out the full scrutiny and rectification of the documentation in accordance with ‘WHCT Mental Health Act 1983 Receipt and Scrutiny of Statutory Guidance’ – CL-013. Prior to this date the Divisional Director of Nursing will undertake this role.

6.4.5 Medical recommendations must be scrutinised by an appropriate clinician with the expertise to check that the reasons for application are sufficient to support the detention of the individual.

6.5

Electronic record of an individual’s Mental Health Act activity

6.5.1 Whenever a patient who is subject to a section of the Act is admitted or an inpatient becomes subject to detention under the Act an entry should be made on DATIX.

6.5.2 It is the responsibility of Divisional Director of Nursing to ensure that the details of that individual’s mental health act admission and its associated activities are recorded on DATIX,

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This supports administering the various and complex components of the Act, including all types of hearing, treatment documentation and monitoring expiry dates.

6.6 Information about patients’ rights

6.6.1 Those responsible for care should ensure that patients are made aware of their rights and the effects of the Act. A record should be kept of how, when, where and by whom this information was given; this should include information on contacting an Independent Mental Health Advocate (IMHA). A monitoring form and standard leaflets to support this are

available.

6.6.2 In addition the Matron, Ward/Unit Manager or Deputy must notify the ‘Nearest Relative’ of a patient’s admission under the Act as soon as possible; unless the patient requests otherwise.

6.7 Procedures

Appendices 2 – 15 provide flow charts for managing various scenarios under the Act.

7. Implementation

7.1 Plan for implementation

 Mental Health Act Resources page is available on the Trust intranet which is easily accessible and contains all supporting documentation. Folders with all flowcharts and standard forms are available to each ward area.

7.2 Dissemination

 Trust policy and all relevant tools and reference material available on the Trust intranet

 Item on daily brief to inform all staff on updated policy and intranet page

7.3 Training and awareness

 Initial training for matrons and other senior nurses who cover on-call supported the launch of the policy.

 Individual professionals have a responsibility to ensure that they are aware of the contents of this policy and apply them. It is the responsibility of lead clinicians, matrons and ward managers to identify any training needs and to organise appropriate workplace

instruction.

8. Monitoring and compliance

Lead clinicians, matrons and ward managers are responsible for ensuring that their staff comply with this policy.

All detentions under the MHA will be reported as an incident via the DATIX system.

These detentions should be reported annually to Trust Board and to the Department of Health using KP90.

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Page/ Section of Key Document

Key control: Checks to be carried out to confirm compliance with the policy:

How often the check will be carried out:

Responsible for carrying out the check:

Results of check reported to:

(Responsible for also ensuring actions are developed to address any areas of non-compliance)

Frequency of

reporting:

WHAT? HOW? WHEN? WHO? WHERE? WHEN?

Compliance with legal documentation requirements

Spot check of section papers

Annually Lead nurse safeguarding adults

Divisional manager Annually

Monitor the use of Section 5(2)

Check each Section 5(2) detention reported on DATIX for items covered in section 18.39 of Code of Practice

Each detention

Divisional governance teams

Safeguarding committee

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9. Policy Review

This policy will be reviewed by the Key Documents Approval Group after two years or sooner if there are any changes in legislation or guidance related to this policy.

10. References

References: Code:

Mental Health Act 1983

Department of Health (2008) Mental Health Act 1983 Code of Practice (Revised 2015).

Department of Health (2008) Reference Guide to the Mental Health Act 1983

Patient Transfer Policy WHAT-CG-680

WHCT, Mental Health Act 1983 Receipt and Scrutiny of Statutory Guidance

CL-013

West Midlands Ambulance Service, Mental Health Act Conveyance Policy & Procedure

CLN-Policy-012 Place of Safety Operations – sections 135 / 6 Mental Health Act

Worcestershire Multi Agency Agreement

Care quality commission (2012) Use of the Mental Health Act 1983 in general hospitals without a psychiatric unit. The Care Quality

Commission Revised April 2010 (Online)

Missing in-patient guidelines WAHT-NUR-084

11. Background

11.1 Consultation

The initial policy was circulated to the following for comments:-

 Director of Nursing

 Heads of Nursing

 Head of Clinical Governance and Risk Management

 Chief Medical Officer

 Mental Health Records Manager

 Medical Records Manager

 Multi-Agency Working Group

The revised policy has been circulated to the following for comments:-

 Senior Nurse meeting

 Safeguarding Adults Committee

 Acute Hospitals Mental Health Service

 WHCT MHA administrator

 Divisional Medical Officers

 Divisional Directors of Nursing

11.2 Approval process

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11.3

Equality requirements

There are no equality requirements.

11.4 Financial risk assessment

If there is a need for a Hospital Managers Review Meeting there will be costs involved in using the Associate Hospital Managers. Once a Service Level Agreement has been negotiated to provide Responsible Clinician cover, expert administration of the section papers and processes there will be a cost associated with this.

11.5 Version Control

Date Amendment By:

Sept 2013

Major rewrite to address:-

Responsibilities and Duties section expanded Inclusion of managers hearings

Reference to IMHA

Establishment of central register for recording patients detained under MHA

Statutory duties to notify CQC of death or unauthorised absence

Change from ‘Mental Health Trust’ to – ‘another hospital with different managers’

Management of section papers

Use of new section 2 or 3 in the Acute Trust Clarification of section 5(2)

Sept 2013

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Appendix 1 Detention Document Checklist

Please download copy from intranet with patient identifier section and scanning codes

Documents checked for:

Checked & OK

(tick)

Rectifiable

Yes

No

Names and addressed:

Is the patient's name consistent on all papers? Yes

Is the patient's address consistent on all papers? Yes Medical Recommendations:

Have the two recommendations been made separately and if so, within 5 clear days?

No Has the patient been admitted within 14 days of the last medical

recommendation?

No Does one practitioner have special experience in the diagnosis of

mental illness?

No Are the recommendations dated on or before the application? No Have all sections been completed or deleted as necessary? Yes Are the recommendations signed and dated correctly? (Note month

and year)

No

Application:

Has the applicant stated the capacity in which (s)he is applying? Yes

Has the patient been seen in the last 14 days? No

Have all sections been completed or deleted as necessary? Yes On form 2 (section 2 application) check that the information regarding

informing nearest relative is completed

Is the application signed? No

Record of Admission:

Has the patient been informed of his/her rights? Yes Has the patient's nearest relative been informed of admission? Yes Has a copy of the AMHP assessment been received? Yes Has the appropriate Social Services department been informed of the

admission?

Yes If the application has been completed by the nearest relative, has the

AMHP report been requested?

Yes

I have received the section documentation in respect of the above named and checked it as indicated:

Signed ……….. Date …./…../……….

F r o m d ate to be confirmed - Send the section papers and this checklist to Mental Health Act Administrators, Worcestershire Health and Care Trust

Until further notice - Send the section papers and this checklist to Divisional Director of Nursing

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Appendix 2 Key actions for Managing all Detained Patients

Patient admitted who is already detained under a section of MHA or is detained under a

section of the MHA after being admitted

Ward manager or 401/0903 bleep holder checks section papers using detention document

checklist – appendix 1

Ward manager or 401/0903 bleep holder signs to accept the section papers on behalf of the

hospital managers

NIC sends the section forms to the Divisional Director of Nursing/MHA Admin

Ensure patient is aware of their rights and has also received this in writing - NIC completes

Form WAHT132

and send to Divisional Director of Nursing/MHA Admin

NIC completes a Mental Health Act Detention incident report on Datix

The Divisional Director of Operations will ensure that a RC is appointed and this is clearly

documented. Until a service level agreement is in place this has to be negotiated with the

individual psychiatrists at WHCT

On a daily basis the divisional manager will ensure the detention and care is reviewed

NIC will ensure that any instructions from the Divisional Director of Nursing/MHA Admin are

acted on ASAP and always within the timescales given

Matron will ensure that the rights are re-presented as required for the specific section

On discharge from the Acute Trust or from detention all appropriate documentation must be

completed and sent to the Divisional Director of Nursing/MHA Admin

Once file complete Deputy Chief Nursing Officer/MHA Admin keep the file for safe storage

NB Until date to be confirmed forms should be sent to Divisional Director of Nursing and not WCHT MHA Administrator

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Appendix 3 Section 5(2) Holding Power

 Inpatient (not in A&E or outpatient department) wanting to leave hospital premises  Staff feel that the patient would be a risk to self or others if allowed to leave  Staff have attempted to discuss/reason with the patient

 Patient is still refusing to stay on premises

 Staff have reason to believe the patient may have a mental health condition

NIC makes every effort to contact Consultant or nominated deputy and request they attend the ward as a matter of urgency

After examination does the Consultant/nominated deputy consider that detention under the MHA may be necessary and that a MHA assessment should take place?

Yes No Consultant/nominated deputy completes

Form H1Ward manager or 401/0903 completespart 2

DATIX incident is completed by NIC

Patient is free to leave unless the provisions of the Mental Capacity Act, Deprivation of Liberties Safeguards could be used to restrict the patient in their best interests

Patient detained under Section 5(2)

Ward manager or 401/0903 bleep holder checks all forms and completes Form H3 part 1a signs and send to Divisional Director of Nursing MHA Admin within 1 working day along with the original Form H1.

Named nurse completes Form WAHT132

Detaining doctor to document in the patient’s health record the reasons for the detention and actions taken

MHA assessment arranged by the NIC through the DDN/MHA Admin. Consultant/nominated deputy to complete the medical recommendation. If the nominated deputy they must ensure the Consultant is aware. The patient can be detained with minimum force necessary for a maximum of 72 hours or until a MHA assessment has taken place (whichever is the sooner) and is not subject to Part IV consent rules therefore any treatment must be in accordance with common law consent or the Mental Capacity Act

If prior to the MHA assessment being completed the Consultant/nominated deputy decides that further assessment and detention is not required they should complete Form S23and send through to DDN If on assessment the AMHP does not believe that further detention is required the Consultant/nominated deputy should complete Form S23and send to DDN/MHA Admin

The NIC must ensure that the decision to remove the Section has been documented in the patient’s health record including the time this occurred

NB Until further notice forms should be sent to Divisional Director of Nursing and not WCHT MHA Administrator

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Appendix 4 - Section 2 Admission for Assessment

NB Until a date to be confirmed forms should be sent to Divisional Director of Nursing and not WCHT MHA Administrator

Doctors complete 1 x Form A3or 2 x Form A4

AMHP completesForm A2. The AMHP informs the NR of application and their rights (including the right to IMHA). AMHP should check all forms for consistency and correctness.

NIC completes Form H3 and sends to DDN/MHA Admin within 1 working day along with original detention papers. NIC asks if LPA or any ADRTs are present. NIC completes DATIX incident.

Named nurse completes FormWAHT132 and makes referral to IMHA where appropriate, if rights not understood to revisit this the following day. In completing Form WAHT132 and providing information in accordance with section 132 of the MHA the NIC should ensure that all reasonable steps are taken to ensure

the patient understands: their right to an IMHA, their right to apply to the MHT within 14 days of admission under Section 2 and their right to appeal against their detention to the Hospital Managers at any time. The

patient should be provided with the relevant leaflets.

DDN/MHA Adminchecks all the forms and records the date of detention on the central database. DDN/MHA Admin send medical recommendation to a nominated doctor for scrutiny

The patient’s named nurse should ensure the patient is informed of their rights on a regular basis and Form WAHT132signed on each time

Patient can be detained for 28 days and is subject to consent rules as per appendix 11 At each MDT the necessity for the patient to remain

under section should be reviewed and documented in Review Summary

By day 21 a decision should be made regarding the need for section 3. Section 3 required?

The DDN/MHA Admin will inform the ward manager/ NIC that they need to complete an

incident report on the Datix system for any situations where Form D1 or appropriate section paperwork is not received classified as ‘Breach of

MHA’.

Divisional Director contacts RC to request action. Each Wednesday DDN/MHA Admin send a list of sections which are due to expire in the next week for which they have not received Form WAHT23 or appropriate section paperwork to the DDN/MHA

Admin

At day 21 DDN/MHA Admin write to RC and Ward Manager requesting Form WAHT23 if patient is to be discharged or for a section 3 assessment to be

arranged.

RC (which could be delegated to NIC) arranges for AMHP &

second medical recommendation.

Forms A6, A7/A8 & H3 completed and sent

to DDN/MHA Admin

RC informs patient that they are an informal patient and what this means and documents

conversation in the healthcare record. RC completes Form

WAHT23 and sends to

DDN/MHA Admin ASAP RC completes first

medical recommendation

All situations where Form D1 or appropriate section paperwork not received before date of section 2 expiry will be investigated and reported to the appropriate Executive and Board Committees.

Y

N

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Appendix 5 Section 3 Admission for Treatment

.

Appropriateness of section 3 agreed by all assessors

Doctors agree where this treatment can be given and complete 1 x Form A7 or 2 x Form A8, documenting all the various alternatives on the paperwork.

AHMP consults with NR. If this is not appropriate or possible reasons must be documented. If the NR objects to the use of section 3 the section cannot be applied. If NR maintains objection AHMP should consider

displacement under s 29 if grounds are met. (Appendix 17) AMHP consults their legal department. AMHP completes Form A6ensuring correct address of hospital including name of Trust. AMHP informs NR of

their rights (including right to refer to IMHA). AMHP should check all forms for consistency and correctness. Ward manager or 401/0903 bleep holder checks all forms and completes Form H3 part 1a signs and send to

DDN/MHA Admin within 1 working day along with the original Forms A7 or A8 .

Named nurse completes Form WAHT132and makes referral to IMHA where appropriate, if rights not understood to revisit this the following day. In completing Form WAHT132 and providing information in accordance with section 132 of the MHA the Named nurse should ensure that all reasonable steps are taken

to ensure the patient understands: their right to an IMHA, their right to apply to the MHT and their right to appeal against their detention to the Hospital Managers at any time. The patient should be provided with the

relevant leaflets.

DDN/MHA Adminchecks all formsand records the date of detention on the central database. After 3 days the NIC should refer the patient to an IMHA (if they have not already been referred) unless the patient objects (to be recorded on Form WAHT132). The patient’s named nurse should ensure the patient is

informed of their rights on a regular basis and Form WAHT132signed on each time Patient can be detained for 6 months and is subject to consent rules as per appendix 11.

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Trust Policy

Appendix 6 Section 19 Transfer (internal and external)

Where a patient subject to MHA requires transfer (whether internal or external) the Patient transfer policy WHAT-CG-680 should be followed; in addition:

From one Trust ward/unit to another Trust ward/unit

From a Trust ward/unit to a hospital managed by a different Trust Ward manager/NIC updates

DATIX information. . Where the RC will change Form RC1must also be completed. Forms to be sent to DDN/MHA Admin

Ward manager/NIC to speak to proposed destination to ensure they can take a sectioned patient. This should be checked with DDN who will check the CQC

registration.

NIC completes Form H4

NIC informs patient of their rights and documents on Form WAHT132

NIC informs DDN/MHA Admin

Original section papers and Form H4 must accompany the patient

Receiving hospital sign and date Form H4

Staff member accompanying patient keeps a copy of the completed Form H4 and leaves the section papers

The copy of Form H4sent to DDN/MHA Admin

Where a patient is transferred to the Trust from another Trust/Independent Hospital the ward manager or in their absence 401/0903 bleep holder accepting the transfer must ensure that the original section papers are received (including Form H3) and checked as well as the relevant transfer documents (as above) before accepting responsibility or signing Form H4 - the transfer documentation. For transfer into the Trust of section 2 or section 3 patients, the admitting nurse should follow the procedure described in appendix 4 and 5

respectively. All paperwork should be sent to MHA Adminwithin 1 working day.

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Trust Policy

Appendix 7 Section 17 Leave of Absence

Patient attends WAHT for emergency care or outpatient investigation or treatment; whilst detained under a Section of the Act by another provider

A copy (a fax is acceptable) of the Section 17 leave form should have accompanied the patient, in an emergency situation it may be necessary to receive the patient before the documentation is completed. There is no prescribed format for granting Section 17 leave but the documentation may include conditions that have

to be complied with.

Check to see what restrictions if any apply to the leave – must they be escorted at all times and if so is this by accompanying staff member or family member

Responsibility for the patient remains with the detaining hospital

If admission to WAHT is recommended the Trust doctor must have a discussion with the RC to establish if Section 17 leave will continue or if a transfer of care under section 19 should take place

If the patient is admitted under Section 17 leave NIC completes DATIX incident. Notify the DDN/MHA Admin so that compliance with their existing Section is maintained

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Trust Policy

Appendix 8 Section 18 Absence without leave

Is the patient absent from the hospital without having section 17 leave granted? Missing in patient guidelines followed

Inform the RC, DDN/MHA Admin, NR and social services (if appropriate) as soon as possible. NIC completes incident report on DATIX, including police incident number

Patient found. Police to be informed. If the patient is in a public place they can be picked up or if in a private residence a warrant can be applied for to gain entry.

Dependent on a risk assessment the patient can be brought back to hospital by:  AMHP

 Any member of staff from the ward/unit  Any police officer

 Any other person authorised by the Hospital Managers

It is the responsibility of the detaining authority to arrange for the patient to be conveyed back to the place where they are liable to be detained. Transport will normally be arranged by the detaining ward see Appendix 12.

All relevant individuals informed of patient’s return. DATIX record updated.

Sections 2, 4, 5(2), 135 and 136 Patient cannot be returned under section 18 if their time period of liability to detention has expired

Section 3

Patient can be returned under section 18 until the later of:

 6 months after the start of the absence  The expiry of their current period of

detention

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Trust Policy

Appendix 9 Section 136 Police removal powers

Reference must also be made to:-



Place of Safety Operations – sections 135 / 6 Mental Health Act Worcestershire Multi Agency Agreement



West Midlands Ambulance Service, Mental Health Act Conveyance Policy & Procedure Police officer finds individual in a public place who they believe has a mental disorder and is a danger to

themselves or others.

Most appropriate place of safety has been identified as Emergency Department as there is physical injury or illness that requires immediate assessment/intervention

At triage the time of arrival is completed on the Section 136 monitoring form

In tandem to treating the physical injury/illness check that the police officer has contacted AMHP to start the mental health assessment process

An incident report will be raised on Datix

The patient should be informed of their rights and provided with a copy of these. This must be recorded on the monitoring form

The police constable will stay with the patient until the patient is deemed: By doctor to be medically fit to be

transferred to the 136 Suite

By doctor not to have a mental disorder

Conveyance arranged to 136 in accordance with appendix 12

The individual can no longer be detained and must be informed they are free to leave. To requires admission for assessment or treatment – proceed as per Appendix 4 or 5

The police will remain involved if on-going conveyance is required and their assistance is assessed as necessary

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Trust Policy

Appendix 10 Revoking of a Section

RC reviews a patient detained under Section 2, 3, 4 or 5(2) and determines that statutory

criteria are no longer met

RC completes

Form WAHT23

and sends this to DDN/MHA Admin

NIC ensures that the patient is aware they are no longer subject to detention

If the patient agrees NIC informs the NR

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Trust Policy

Appendix 11 Flow chart of consent to treatment under the Mental Health Act

Y

Is the patient detained under the Mental Health Act?

Do they have capacity to consent to treatment?

Use the Mental Capacity Act The patient can refuse treatment

Is the treatment for the mental disorder?

Do they have capacity to consent to treatment?

The patient can refuse treatment

Use the Mental Capacity Act Is the patient detained on a

Section 2, 3, 36, 37, 38, 47 or 48 of the Mental Health Act with or without

restrictions?

Is the treatment ECT?

It must be determined that the detained patient has capacity to

make a decision to agree to treatment or not. If it is deemed that they have capacity; but they refuse treatment

ECT cannot be administered

Treatment can be given with or without consent. However after 3 months,

medication can only be given if the patient consents

or a second opinion doctor agrees

Yes

No

Yes No

No

No No Yes

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Trust Policy

Appendix 12 Conveyance

Reference must also be made to:-



West Midlands Ambulance Service, Mental Health Act Conveyance Policy & Procedure Patient needs conveying:

 Between hospitals

 When absent without leave (AWOL) to be brought back to ward

 Being taken to or transferred between places of safety

Factors for consideration of transport:

 Risk (full risk assessment should be undertaken). Ensure details on Authority to Convey Form

available.

 Privacy and dignity of the patient – the most humane and least threatening method of transport should be used

 The wishes of the patient and any family/ friends

 Aggression

 Alcohol/ drugs

 Urgency of the transport

 CS sprayed

West Midland Ambulance Service will assist with the conveyance of patients with mental disorder where it is confirmed that this is required/the most appropriate alternative.

Ambulance to be arranged if:

 Patient sedated

 Police are assisting (as police vehicles not suitable)

 Need due to physical condition

In order to protect members of the public, multi-agency staff and the patient, West Mercia Police will respond to requests for assistance with the conveyance of a mentally disordered patient in violent circumstances or where the patient is likely to become violent. In these situations the responsibility of West Midlands Police is to assist in conveyance to a place of safety. There is no responsibility to convey patients between hospitals. ( In this situation sedation/ private secure transport may be required.)

Contact should be made via the Force Control Room. Police to assist if:

 Patient violent or dangerous

 Risk assessment suggests potential for violence or aggression.

A patient should only be taken by car if everyone is completely satisfied that this is the most appropriate method and there is an escort other than the driver. It may be appropriate for the patient to be transferred in a

taxi if sufficient staff are available.

A healthcare professional or AMHP should accompany a patient during conveyance. The authority to convey an individual can be conferred using Authority to Convey Form

Only such force as is necessary, justifiable and proportionate should be used giving due regard to the dignity of the individual.

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Trust Policy

Appendix 13 - Discharge – Mental Health Tribunal

Times when the patient and NR have the right to apply for a Tribunal:

 Within 14 days of section 2 commencing (patient only)

 Once in each period of section 3 detention (patient only)

 Following displacement of NR (12 months) (NR)

 Following barring of discharge by NR (28 days) (NR)

Times when Hospital Managers automatically refer a patient to the Tribunal:

 After six months of detention if the patient has not applied (including time on section 2)

 Every 3 years if the patient has not applied (from the date of the last tribunal) (every year if <18)

Patient should be regularly informed of their rights and confirmation of this discussion confirmed on Form WAHT132.This discussion should include information regarding the patient’s right to apply to the Mental Health Tribunal. Patient should be referred to an IMHA

unless they object. Patient requests a Tribunal

NIC completes MHT applicationand sends to DDN/MHA Admin ASAP indicating name of chosen solicitor where patient has chosen a representative from the lists available from DDN/MHA Admin.

DDN/MHA Admin send request to the Tribunal Office. For automatic referrals DDN/MHA Admin write to the Tribunal on behalf of the Hospital Managers.

Tribunal will request via DDN/MHA Admin: 1. Authority’s statement

2. RC’s report

3. Social circumstances report (from Care Co-ordinator) 4. In-patient nursing report (as appropriate)

5. Copies of detention papers, renewals, treatment forms and leave papers.

DDN/MHA Admin will request reports from the relevant professionals providing a deadline for completion (3 weeks from the date of application generally or 1 day before the Tribunal for section 2 patients). All instances where reports are not available at least 1 working

day prior to the Tribunal will be recorded as incidents on the Datix system, investigated and reported to the relevant Executive and Board Committees.

Relevant professionals should inform the DDN/MHA Admin of any dates that they or the patient (or nominated representative) would be unable to attend so that they can liaise with the Tribunal Office to arrange a mutually convenient date and time.

Date offered by the Tribunal Office (within 7 days of application for section 2 patients)

All parties (including patient, representative, advocate and NR as well as health professionals) informed of date, time and venue. DDN/MHA Admin liaise with named nurse/ ward manager to establish if the patient has the capacity to appoint or instruct their own solicitor/ representative. The patient should be provided with a list of solicitors specialising in mental health law. (The Trust does not

allow the display of posters advertising individual solicitors, nor does it make recommendations).

Where the patient lacks capacity to appoint/ instruct a representative it is the responsibility of the Tribunal to appoint a representative for the patient.

Pre-discharge planning meeting held to consider plans should Tribunal discharge the patient. Assessments and Care Plans updated.

Review summarycompleted

Medical member of Tribunal will examine patient before the Tribunal (this may be on the actual day of the Tribunal) Tribunal panel sits at the hospital to review the case. The attendance of the RC, the Care Co-coordinator and the named nurse is

expected. All instances on non-attendance will be reported to the relevant Executive & Board Committees.

After private discussion, the decision of the Tribunal will be announced verbally at the end of the hearing to all present. The written decision must be sent to all parties concerned within 7 days of receipt.

If the patient asks to withdraw their application at any time the DDN/MHA Admin should be informed immediately so that they can begin the process to formally withdraw the application.

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Trust Policy

Appendix 14 Discharge – Hospital manager’s review meetings and appeal hearings

Times when the patient (or LPA) have the right to apply for an HM Appeal Hearing:

 At any time during detention in hospital under the MHA (patient and NR) Times when Hospital Managers automatically hold a renewal meeting:

 On renewal of detention under section 3 or 37 (receipt of Form H5)

Patients should be regularly informed of their rights and confirmation of this discussion confirmed on Form WAHT132. This discussion should include information regarding the patient’s right to apply to the Hospital Managers. Patient should be referred

to an IMHA unless they object.

Relevant professionals should inform DDN/MHA Admin of any dates that they or the patient (or nominated

representative/advocate) would be unable to attend so that they can liaise with the Hospital managers to arrange a mutually convenient date and time.

DDN?MHA Admin arrange for a minimum of 3 Hospital managers to convene

All parties (including patient, representative, advocate and NR as well as RC and other health professionals) informed of date, time and venue. If reports have not been received a reminder will be sent with the date of the meeting.

A private consultation room is required for the representative and/or advocate.

Pre-discharge planning meeting held to consider plans should the HM panel discharge the patient. Assessments and care Plans updated. Review Summary completed.

If the relevant reports have not been received 10 days before the hearing reminder sent to the professionals, copying in the Clinical Director/ General Manager as appropriate.

After private discussion, the decision of the panel will be announced verbally at the end of the review meeting/ appeal hearing to all present. DDN/MHA Admin records the decision.

Chair of Hospital Manager’s Panel completes relevant decision form.

Patient/NR requests a hearing

NIC informs DDN/MHA Admin of request within 1 working day.

If patient lacks capacity or objects to their renewal an appeal hearing will be held.

DDN/MHA Admin will request reports from the relevant professionals providing a deadline for completion:

1.RC’s report

2.Social circumstances report (from Care Co-ordinator) 3. In-patient nursing report

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Trust Policy

Appendix 15 Change of responsible clinician

On admission under detention an Approved Clinician is assigned as a patient’s Responsible Clinician. This will be the AC with the most appropriate expertise to meet the patient’s main assessment and treatment needs.

Divisional Manager should be made aware of who a patient’s RC is and this should be entered onto the electronic patient record system as soon as possible after admission or after any change in RC (within 24 hours) so that it can be easily

determined at any point who a patient’s RC is.

The appropriateness of the RC should be kept under review through the planning process. The functions that can only be undertaken by the RC are:

 Granting section 17 leave

 Renewal of detention

 Discharge from detention (other than by HMs, MHT or NR)

Other functions (such as prescribing and administering of medication/ treatment or application of section 5(2) can be undertaken by an appropriately qualified practitioner who has been nominated by the RC to perform these functions.

Where the care of a patient is to be transferred between Responsible Clinicians detailsshould be completed in the medical record and a copy sent to the DDN/MHA Admin

Where the allocated RC is unavailable the Trust authorises a nominated AC (or the on-call consultant OOH) to temporarily become the RC for a particular patient where necessary and appropriate in order to perform functions only RC can

complete this

Where a nominated AC (or the on-call consultant OOH) performs RC functions the following standard form of words should be written into the Healthcare Record at the earliest opportunity:

“I am undertaking duties on behalf of …………(normal RC). In order to ensure the best interests of………. (patient) are met, the Trust has authorised that I temporarily undertake the role of his/her Responsible Clinician. In this capacity I

have taken the following action………Signed………..name……….. NB Until a date to be confirmed forms should be sent to Divisional Director of Nursing and not WCHT MHA Administrator

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Trust Policy

Appendix 16 Death of a Detained Patient

Patient who is detained dies

Care of the deceased patient procedures followed RC informs the coroner

NIC submits an incident report on DATIX

Patient Safety Team completes CQC Notification of Death Formand faxes to CQC Hard copy of CQC Notification of Death Formsent to DDN and MHA Admin

CQC will request various documents which will be sent to them by the Records Manager as soon as possible and at the very least within any time frame set by the CQC

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Trust Policy

Appendix 17 Section 29 Displacement of Nearest Relative

The NR is established using a set hierarchy. The NR is the first individual on the following list:  Relative that the individual ordinarily resides with (over 18)

 Husband, wife, civil partner (or living with as such for at least 6 months)  Son / daughter (over 18)

 Father / mother (if born out of wedlock – father can only qualify as NR if parental responsibility has been officially assigned to him)

 Brother / sister (over 18)  Grandparent

 Grandchild (over 18)  Uncle / aunt

 Nephew / niece (over 18)

 Non-relative that the patient has been living with for at least 5 years In establishing complex situations:

 Whole blood relatives rank higher than half blood relatives

 The eldest of several relatives covered by the same bullet pint ranks highest  Step relatives DO NOT count as relatives

 Individuals living outside the UK do not count (where the patient is ordinarily resident in the UK) The NIC may bring to the attention of the AHMP any case where they believe the patient’s NR is not appropriate.

An AMHP must decide for themselves at any time that a patient’s nearest relative is nor appropriate. Possible reasons include:

 Abuse / domestic violence  NR not known to the patient

 NR is unreasonably objecting to Section 3 against patient’s best interests  NR is incompetent due to mental illness

 Patient does not want NR to perform that role  NR does not want to perform that role

If appropriate talk to NR and see if NR will authorise someone else to perform role. Form NR1 to be completed –

this can be revoked at any time

If the patient does not have NR the AMHP should advise then of their right to have one appointed and instigate proceedings. Ensure referral to IMHA made unless patient objects

If the patient states that they don’t want their NR to perform the role but the AMHP believes the NR is appropriate advise the patient of their right to initiate displacement proceedings or the NR could authorise someone else by completing Form NR1

AMHP to consider all the circumstances of the case and use their discretion as to whether to instigate proceedings

Advice to be sought by AMPH from Local Authority Legal Department