“Assisting and supporting you on the road to service improvement and delivery”

Changes to the 1983 Mental Health Act

Gained Royal Assent on 19th July 2007

• Amends:

– Mental Health Act 1983

– Domestic Violence, Crime & Victims Act 2004

– Mental Capacity Act 2005

Changes to the Mental Health Act 1983

The main changes to the 1983 Act are:

1. Definition of mental disorder

2. Criteria for detention

3. Professional roles

4. Nearest relative

5. Supervised Community Treatment

6. Mental Health Review Tribunals

7. Age-appropriate services

8. Advocacy

9. Electro-convulsive therapy

10. Other changes to the MHA 1983

11. Changes to the Mental Capacity Act 2005

New Roles

• The Act introduces to new roles:

- the Approved Mental Health Professional

- Approved Clinicians (which includes Responsible Clinicians)

The Minister for Wales has agreed to the permissive introduction of the roles in Wales. However, the intention is that the introduction of the new roles is a flexibility rather than a mandatory requirements.

Approved Mental Health Professional

AMHP will replace the ASW:

• The main change here is that whilst in the main the roles and responsibilities currently carried out by Approved Social Works remains largely unchanged, other non social work professionals will be able to train and be approved as AMHPs. The professional groups include:

- social workers

- psychologists

- occupational therapists

- mental health nurses

A doctor cannot be an AMHP

Approved Clinicians

RMO replaced by Approved Clinicians (including Responsible clinicians):

• The RC is the lead clinician responsible for the care and treatment of patients once subject to compulsion

• Powers to renew section, discharge, grant leave, responsibilities under Community treatment Orders, power of recall to hospital for treatment

Responsible Clinicians can be:

• Doctors

• Nurses

• Social workers

• Psychologists

• Occupational therapists

FUTURE ACTIONS

• Local Authorities will have to prepare for the introduction of the AMHP

- panels

-nomination criteria for non – social work applicants

- governance arrangements between NHS and Local Authorities

- access to appropriate legal advice for all AMHPs

-access to training

-access and provision of practice supervisors

-funding to support non social work AMHP

-joined up workforce planning

-internal management, supervision

Commencement

Majority of provisions to be commenced in October 2008:

• Early commencement:– NHS Foundation Trusts 24/07/07– Amendments to MCA 01/10/07– Approval of courses for AMHPs

& amendment to CSA 2000 01/10/07– Cross border arrangements 01/10/07– Restriction orders and clarification

on CD and limitation directions 01/10/07– Clarification on LHBs 01/10/07– Civil partners as nearest relatives 01/12/07– Informal admission of 16/17 year olds 01/01/08– Deprivation of Liberty Spring Spring 09

Towards Implementation of changes to the MH Act 1983

Tasks facing LA Social Services Authorities:

• Use existing partnership structures to consider implementation with wider local mental health community

• Plan for the financial impact of the changes that will need to occur before and after the enactment

• Revise and update the governance arrangements (risk plans, audit programmes, staffing plans)

• Plan and implement the transition of ASW’s to AMHP’s

- training

- ensure sufficiency of AMHP’s to meet needs of MH service

• Develop approval and re-approval of AMHP’s acting on behalf of LSSA’s

• Ensure training is planned for the workforce across all related MH services/guidance

• Review and develop policies and procedures for the operation of the MHA e.g. nearest relative, guardianship

• Establish & maintain register of AMHP’s working on

behalf of LA’s

MCA Deprivation of Liberty Safeguards

Key provisions:

• Provides a procedure for the authorisation of the deprivation of liberty of persons resident in hospital or care home, who lack capacity (for decision to reside there), and who are not subject to mental health legislation safeguards

• Aim is to provide legal safeguards to prevent arbitrary decisions to deprive a person of liberty and gives rights of appeal

• A ‘Managing Authority’ (a hospital or care home) seeks authorisation from a ‘Supervisory Body’ (LHB or LA) in order to be able to deprive ‘P’ of their liberty;

• P must have a mental disorder and lack capacity to consent P can only be deprived of his/her liberty if:

– It is in his/her best interests– There is no less restrictive alternative

When should it be used and what does it look like?

Managing AuthorityHospital/Care Home

Decide if it is necessary to apply for authorisation from Supervisory Body to deprive someone of their liberty in their best interests

Supervisory BodyPCT/LA

Assess each individual case and provide or refuse authorisation for DOL as appropriate

Managing AuthoritySupervisory Body

Review cases to determine if DOL is still necessary and remove where no longer appropriate

Used when a resident or patient needs to go in to or remain in the registered care home or hospital in order to receive the care or treatment that is necessary to prevent harm to themselves.

D) Best interest assessor recommends

period

Age assessment

A) Hospital or care home managers identify those at risk of deprivation of liberty & request authorisation from

supervisory body

B) Assessment commissioned by supervisory

body. IMCA appointed for unbefriended

C) Request for authorisation

declined

Mental health assessment

Mental capacity

assessment

No Refusals assessment

Best interest assessment

Eligibility assessment

Any assessment

says no

All assessments support

authorisation

In an emergency hospital or care

home can issue an urgent

authorisation for 7 days while obtaining

authorisation

F) Authorisation is granted and persons representative

appointed

E) Best interest assessor

recommends person to be appointed as

representative

G) Authorisation implemented by managing

authority

Managing authority requests review

because circumstances change

Authorisation expires and Managing authority

requests further authorisation

H) Review

Person or their representative

appeals to Court of Protection

which has powers to terminate

authorisation or vary conditions

Person or their representative requests

review

AssessorsCarry out assessments

Managing AuthorityHospital or Care Home

Responsible for care and requesting an assessment of deprivation of liberty

Relevant PersonPerson being deprived of liberty

RepresentativeProviding independent support

Family/Friends/CarersConsulted, involved and provided

with all information

Supervisory BodyPCT or LA

Responsible for assessing the need for and authorising deprivation of liberty

IMCA Court of Protection

Responsibilities in Deprivation of Liberty

Person in need of care to prevent harm to themselves

Is it necessary to deprive them of their liberty?

Apply to SB for standard authorisation

Is application appropriate?

Conduct assessments

Do all assessments support DoL?

Grant authorisation

Monitor and Review DoL

Appoint a representative

Grant urgent authorisation

Reject application

Reject application

Yes

No

Now?

No

Yes

Yes

DoL Process

Purpose: To prevent unlawful deprivation of liberty

MCA Deprivation of Liberty Safeguards

Key Provisions:

• PCT or LA responsible for assessing the need for an authorising Deprivation of Liberty

MCA Deprivation of Liberty Safeguards

Tasks facing LA Social Services Authorities:

• Develop arrangements & processes to perform the function of supervisory body within the requirements of DOLs – responsibilities to assess individual cases and provide or refuse authorisation for DOL as appropriate

• Review cases to determine if DOL is necessary or remove if no longer appropriate

• Provision for a person who needs to go into or remain in the registered care home or hospital in order to receive the care or treatment that is necessary to prevent harm to themselves

• Ensure local authority care homes are familiar with DOLs & local arrangements for applying the standard and urgent authorisations

MCA Deprivation of Liberty Safeguards

Tasks facing LA Social Services Authorities:

• LA’s, PCT’s, Hospitals, Care Homes and other key stakeholder organisations need to work in partnership to deliver DOL safeguards and reduce the numbers referred unnecessarily for assessment

• Availability of trained Best interest assessors, AMHPs, social workers – taking into account the rules relating to conflict of interest

• Capacity issues – Regulatory Impact Assessment estimated 21,000 people requiring assessment within the first year – 80% burden on LA and 20% on NHS

• Training

– all those with formal role within DOLS ,best interest and mental health assessors

- “brief” those with an admin/managerial role in care homes, hospitals and PCT’s and LA’s

- awareness of all others affected more indirectly i.e. staff who provide day to day care and treatment but not involved in the statutory process

-

Towards Implementation

Support Mechanisms:

• Local Implementation groups established across Wales – funding bids to WAG to support project plans, now approved to support implementation

• WAG implementation support and programme – ongoing.

• WAG commissioned training materials to be available in Spring 08:

Core module on MHA 2007 (approx ½ day) and shorter specialist modules (approx 2-3 hours):

• AMHPs• ACs and RCs• Section 12 doctors• Hospital Managers• Registered care homes• “Other settings”• Voluntary organisations

• Will be piloted

• Slides, handouts, case studies, facilitator’s packs, workbooks

Towards Implementation

Support Mechanisms:

• NLIAH implementation project:

- self assessment tool produced

- training report developed and distributed

- support to local joint implementation groups

- employers guidance document Spring 08

- training support

Chris Merchant DS Ltd

NLIAH Mental Health Act Implementation Project

E mail: chrismerchant.damascus-music@virgin.net

Tel: 07879401178