Mental Health ActDefinitions of Mental Disorder, changes, ammendments and full document downloads

The Mental Health Act 2007 (the 2007 Act) received Royal Assent on 19 July 2007. It amends the Mental Health Act 1983 (the 1983 Act), the Mental Capacity Act 2005 (MCA) and the Domestic Violence, Crime and Victims Act 2004.

Amendments to the Mental Health Act 1983

The 1983 Act is largely concerned with the circumstances in which a person with a mental disorder can be detained for treatment for that disorder without his or her consent. It also sets out the processes that must be followed and the safeguards for patients, to ensure that they are not inappropriately detained or treated without their consent. The main purpose of the legislation is to ensure that people with serious mental disorders which threaten their health or safety or the safety of the public can be treated irrespective of their consent where it is necessary to prevent them from harming themselves or others.

The following are the main changes to the 1983 Act made by the 2007 Act:

• definition of mental disorder: it changes the way the 1983 Act defines mental disorder, so that a single definition applies throughout the Act, and abolishes references to categories of disorder.
• criteria for detention: it introduces a new appropriate medical treatment test which applies to all the longer-term powers of detention. As a result, it is not be possible for patients to be compulsorily detained, or their detention continued, unless appropriate medical treatment and all other circumstances of the case is available to that patient. These criteria abolished the treatability test.
• professional roles: it is broadening the group of practitioners who can take on the functions currently performed by the approved social worker (ASW) and responsible medical officer (RMO).
• nearest relative: it gives to patients the right to make an application to the county court to displace their nearest relative and enables county courts to displace a nearest relative who it thinks is not suitable to act as such.
• nearest relative: the provisions for determining the nearest relative are amended to include civil partners amongst the list of relatives.
• Supervised Community Treatment (SCT): it introduces SCT for patients following a period of detention in hospital. SCT will allow certain patients with a mental disorder to be discharged from detention subject to the possibility of recall to hospital if necessary. This is particularly intended to help avoid situations in which some patients leave hospital and do not continue with their treatment, with the result that their health deteriorates and they require detention again – this is sometimes referred to as the revolving door.
• electro-convulsive therapy: it introduces new safeguards for patients
• Tribunal: it reduces the periods after which hospital managers must refer certain patients’ cases to the Tribunal if they do not apply themselves. It introduces an order-making power to make further reductions in due course.
• independent mental health advocacy: it places a duty on the appropriate national authority to make arrangements for help to be provided by independent mental health advocates.
• age-appropriate services: it will requires hospital managers to ensure that patients aged under 18 admitted to hospital for mental disorder are accommodated in an environment that is suitable for their age (subject to their needs). This is on course to be implemented in April 2010.

You can read and download the full Mental Health Act 2007 here: http://www.opsi.gov.uk/acts/acts2007/pdf/ukpga_20070012_en.pdf

Summary of the Mental Health Act 1983

1. The main purpose of the Mental Health Act 1983 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.

2. 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.

3. In certain circumstances, people who have been detained in hospital for treatment can be discharged onto a Community Treatment Order (CTO) by their responsible clinician, the senior professional in charge of their case. This means they are free to leave hospital and continue their treatment in the community, subject to the possibility of being recalled to hospital if necessary.  This is also known as Supervised Community Treatment (SCT).

4. Part 2 also sets out the procedures for making an application for someone to be received into guardianship under the Act.

5. Part 3 of the Act concerns the criminal justice system. It provides powers for Crown or Magistrates’ Courts to remand an accused person to hospital either for treatment or a report on their mental disorder. It also provides powers for a Court to make a hospital order, on the basis of two medical recommendations, for the detention in hospital of a person convicted of an offence who requires treatment and care. The Court may also make a guardianship order. A restriction order may be imposed at the same time as a hospital order to place restrictions on the movement and discharge of a patient for the protection of the public; all movement is then subject to the agreement of the Secretary of State for Justice. This part of the Act also contains powers to transfer prisoners to hospital for treatment of a mental disorder.

Most patients who are detained in hospital under the Act can be given treatment for their mental disorder without their consent.  Some types of treatment have to be approved first by an independent doctor – a Second Opinion Appointed Doctor (SOAD). Unless it is an emergency, patients who have the capacity to consent cannot be given Electro-Convulsive Therapy (ECT) unless they agree. SOADs must also approve certain types of treatment given to SCT patients. With very limited exceptions, SCT patients cannot be treated against their wishes unless they have been recalled to hospital.

6. Most patients who are detained, or on SCT or guardianship, have the right to apply to a Tribunal for their discharge. The Tribunal is an independent, judicial body. Part 5 of the Act sets out when patients, and sometimes their nearest relatives can apply. Most detained patients and all SCT patients can also ask the managers of the relevant hospital to discharge them. Patients’ responsible clinicians must also keep the appropriateness of continued compulsory measures under review.

7. In England, the Care Quality Commission is responsible for monitoring the way the Act is used and protecting the interests of patients. It sends Mental Health Act Commissioners to visit hospitals and talk to patients about their care and treatment. It also appoints SOADs.

You can read and download the full Mental Health Act 1983 here: http://www.cqc.org.uk/_db/_documents/Mental_Health_Act_1983_201002170112.pdf