Introduction to the Mental Health Act 1983

Introduction to the Mental
Health Act 1983 as amended by
the Mental Health Act 2007
Introductions and Housekeeping
What is mental illness?
‘Mental illness’ is a general term that refers to a
group of illnesses affecting the mind, in the same
way that physical illness refers to illnesses which
affect the body.
 Episodes of a mental illness can come and go
through people's lives. Some people experience
their illness only once and then fully recover. For
others, it may recur throughout their lives.
Mental Health Statistics
Around 300 people out of 1,000 will experience
mental health problems every year in Britain
230 of these will visit a GP
102 of these will be diagnosed as having a mental
health problem
24 of these will be referred to a specialist
psychiatric service
6 will become inpatients in psychiatric hospitals
Source: based on figures from Goldberg, D. & Huxley, P, 1992,
Common mental disorders a bio-social model, Routledge.)
What is the purpose of mental health
‘To regulate the circumstances in which the
liberty of persons who are mentally
disordered may be restricted and, where
there is conflict, balance their interests
against those of public policy’
McGowan LJ in R v Secretary of State for the Home
Department ex p K [1990] 3 All ER 562
Mental Health Act Definitions
Under the new Act, there is a single definition of
mental disorder:
‘any disorder or disability of the mind’
• Learning disability, unless ‘associated with’ abnormally
aggressive or seriously irresponsible behaviour
• Dependence on alcohol and drugs
People who may be involved in
the admission process
General Practitioner
Approved Clinician (AC)
Approved Mental Health Professional (AMHP)
Nearest Relative
Ambulance Crew
Administration Staff
What are the most common elements
of the Mental Health Act?
Section 2 – admission for assessment (up to 28 days)
 Section 3 – admission for treatment (up to 6 months, may
be renewed)
 Section 4 - Admission for assessment in cases of
 Section 5(2) - Doctors and Approved Clinicians Holding
Power (up to 72 Hours)
 Section 5(4) - Nurses Holding Power (up to 6 Hours)
 Part 3 – provision for mentally disordered offenders
 Section 117 Aftercare
Section 2: Admission for Assessment
Duration - Up to 28 days
 Application - AMHP or Nearest Relative. (report from AMHP
 Medical Recommendation x 2-One by ‘S12’ doctor. The other
by doctor who has previous knowledge of patient, if practicable.
 Criteria – The patient is:
a) suffering from a mental disorder of a nature or degree which
warrants the detention of the patient in a hospital for assessment
(or assessment followed by medical treatment) and
b) ought to be detained in the interests of his/her own health or
safety or with a view to the protection of other persons.
 Appeal - Apply to Mental Health Review Tribunal within 14
days. Must take place within 7 days. Decision within 3 days.
Section 3: Admission for Treatment
Duration - Up to 6 months: Renewable for 6 months, thereafter 12
 Application - AMHP or Nearest Relative.
 Medical Recommendation x 2 - One by ‘S12’ doctor. The other by
doctor who knows the patient, if practicable.
 Criteria a) Mental illness of a nature or degree which makes it appropriate for
him/her to receive medical treatment.
b) It is necessary for the health or safety of the patient or for the protection
of other persons.
 Appeal - Can apply to Mental Health Review Tribunal once in each
Section 117 Aftercare
Section 117 aftercare applies to people who
have been detained under Section 3.
The Local NHS Trust and Social Services
must provide after-care services for anyone
who is eligible until practitioners are
satisfied that the person concerned no
longer needs them.
The Mental Health Act Commission
Reviews the operation of the Act and the way in
which powers of detention are exercised.
Carries out official visits to Hospitals
Provides Second Opinion Appointed Doctors
(SOAD) for Consent to Treatment.
Receives complaints in regard to any matter
relating to the detention and treatment of patients
under the Act.
Monitors deaths of detained patients.
From April 2009 these duties will be carried out in
Wales by Health Inspectorate Wales (HIW).
The ‘New’ Mental Health Act
The Mental Health Act 2007 amends
existing current legislation, including:
• Mental Health Act 1983
• Mental Capacity Act 2005
• Domestic Violence, Crime & Victims Act 2004
What are the key changes to the
Mental Health Act?
Responsible Medical Officer (RMO) to
Responsible Clinician (RC)
• Functions generally the same and has ‘overall
responsibility for the patient’s case’
• Must be approved (an ‘approved clinician’)
• Can now be a registered medical practitioner, a
chartered psychologist, a first level nurse (MH
or LD), an occupational therapist or a social
What are the key changes to the
Mental Health Act?
ASW to Approved Mental Health
Practitioner (AMHP)
• Functions generally the same, with additional
functions under Supervised Community
Treatment (SCT)
• Approved by Local Social Services Authorities
• AMHP regulations allow for a social worker, a
chartered psychologist, a first level nurse (MH
or LD) or an occupational therapist.
What are the key changes to the
Mental Health Act?
Independent Mental Health Advocacy (IMHA)
• For patients who are liable to be detained under the Act
• An Independent Mental Health Advocate (IMHA) will
meet with the patient on their request, or that of the
nearest relative, the RC or an AMHP
• An IMHA can help the patient obtain and understand
information about their treatment or rights, and help
exercise those rights
What are the key changes to the
Mental Health Act?
Supervised Community Treatment (SCT)
• Provides for some patients to live in the community
while still being subject to powers under the Act to
ensure they continue with the treatment they need
• The aim of SCT is to break the cycle in which some
patients leave the hospital and do not continue with
their treatment.
• Can only be offered (through a Community Treatment
Order – CTO) to patients subject to a Section 3.
• Initially lasts for 6 months: can be extended for 6
months then one year at a time.
What are the key changes to the
Mental Health Act?
The Mental Health Act 1983 Code of Practice for
• A Code of Practice specifically for Wales for the first
time, reflecting Welsh policy and strategy
• Provides the principles and guidance on how the Act
should be applied in practice.
• Nine guiding principles, under three broad headings of
equity, empowerment and effectiveness & efficiency:
should be considered during any decision making
process under the Act
Other legislation amended by the
Mental Health Act 2007
Mental Capacity Act 2005 has been amended to:
• Provide additional safeguards for people who lack
capacity to consent, and
• Whose care or treatment necessarily involves a
deprivation of liberty, but
• Who either are not, or cannot be, detained under the
Mental Health Act 1983.
These safeguards are referred to as deprivation of
liberty safeguards (DoLS) and are expected to
commence in April 2009
Deprivation of Liberty Safeguards
Come into play when:
Someone who has a mental disorder, and
Who lacks capacity to make decisions for themselves,
Is (or is to be) deprived of their liberty
In a hospital or care home
Except where that person:
• Is detained under the provisions of the Mental Health
Act 1983, or
• Is under 18 years of age
For further information
Participants Packs and printouts of slides
 Web resources:
• for the 2007 Act and explanatory
• for Welsh measures
For more information on implementation of the
new Act in Conwy & Denbighshire, contact
 Liz Grieve, MHA Act Implementation Manager,
on 01745 443167 or [email protected]
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