Download - Mental Health and the Law (April 2012)
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Mental Health and the Law
April 2012 / Darius Whelan
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Ill ?
Insane ?
Oslopolitidistrikt CC BY ND
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Mental Health Act 2001
• E.g. establishes Mental Health Tribunals
• Rights-based focus• Influenced by European Convention
on Human Rights 1950 • “Best interests” of service user
(patient)• Autonomy / privacy / dignity / bodily
integrity / information rights
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Issues with 2001 Act
• “Voluntary” patients• Paternalistic interpretation by courts• Sections on treatment are weak• Does not solve issues of wards of
court and other issues of mental capacity
• UN Convention on Rights of Persons with Disabilities 2006
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Mental Health Tribunals
• Chairperson must have 7 yrs practice immediately before appointment
• Psychiatrist may be retired psychiatrist employed by HSE or Approved Centre provided retired within 7 years. s.48(2)
• Other person must not be in previous categories or be a doctor or nurse
Chairperson:Barrister / Solicitor
Consultant Psychiatrist
AnotherPerson
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Functions of MHTs• Main function: automatic review of
detention of patients detained involuntarily
• Other functions:– Role in decisions concerning psycho-surgery– Role in transfers to Central Mental Hospital
• No role in following– Treatment / medication decisions– Criminal matters – separate Review Board
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Limited Powers
• Tribunal has limited powers – only two main choices: confirm or revoke order
• Arguable that Tribunals need to have more extensive powers, e.g. to order conditional discharge; defer discharge until place available
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Representation
• Patient normally uses services of legal representative assigned by Commission
• Important protection for patient’s rights
• Training• Legal Aid Scheme + Terms and
Conditions• Fees
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Statistics• 1,771 MHT hearings in 2011• 145 (8%) revoked at hearing – “Revoked” means MHT ordered patient’s
release
• 3,163 involuntary admissions / renewals/ regradings
• 1,397 (44%) revocations before hearing by Responsible Consultant Psychiatrist
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Frequency of Reviews
• While automatic reviews are desirable, they do not necessarily fully comply with Article 5
• “The detainee’s access to the judge should not depend on the good will of the detaining authority.”– Rakevich v Russia (2003)
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• Tribunal must confirm or revoke admission or renewal order
• Section 18 – Excusing Procedural Failings:• To affirm order, MHT must be satisfied that
– patient is “suffering from a mental disorder” and– certain procedures have been complied with, or, “if
there has been a failure to comply with [these procedures], that the failure does not affect the substance of the order and does not cause an injustice.” s.18(1)(a)(ii)
• If revokes order, must direct that patient be discharged
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Two schools of thought
• One school: S.18 can only be used to excuse minor failures of an insubstantial nature
• Other school: MHTs can excuse virtually any procedural defect, unless it is in reckless disregard of the statutory scheme
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MHTs – Proposals for Reform
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Amnesty - examples
• Should be audits of MHT hearings• Person subject to detention > 3 months
should have right to apply to MHT for review
• If individual re-graded from involuntary to voluntary before hearing, MHT hearing should be held
• Act should state that only minor failures of compliance … will be excused
• Patient should have right to nominate person to attend MHT with them
• Legal Rep should be appointed within 24 hours
• Legal reps should have access to client records
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