Emergency Detention under the MHA

Hello. Welcome to this mental health law session from Data Law. I'm Steph Barber, a retired solicitor from Law Hand Limited on I was formerly a member off the Law Society's mental health accreditation scheme. In this session, we're going to be looking at emergency detention under the Mental Health Act situations where there's a power to detain somebody against their will. The Mental Health Act 1983 or MH A. Deals with reception care and treatment off mentally disordered patients, the management of their property and other related matters and flooring. Amendments made by the MH A 2007. The current definition of mental disorder for the purposes off the MH A. Is any disorder or disability off the mind on the Department of Health? Have provided health care professionals with a code of practice to the MH A 1983 which are referred to as the code informal admissions Under Section 131 of the MH A. Any patient who requires treatment for mental disorder can be either admitted to or remain in any hospital or registered establishments on. Once the process has been explained on, the patient has been supplied with the relevant information than they will be asked to sign their consent to the admission. However, when a patient is age 16 or 17 on has the capacity in accordance with the Mental Capacity Act 2005 to consent to the admission. Then if they consent, their admission can take place, whether or not this anyone who has parental responsibility. Fourth, Um, and that's parental responsibility, as defined within the Children at 1989. If they don't consent, then their admission can take place with the consent of the person who has parental responsibility. Fourth, um, and patients who are admitted in this way I refer to as informal patients, which means that patients have certain legal right including, of course, the right to leave the ward and basically come and go as they please. Having said that, of course, both as a matter of courtesy and usually in line with the patients Cara Pan, they will be expected to discuss those plans with health care professionals who will, for example, assess current risks. Informal patients also have the right to discharge themselves at any time. However, if a patient wishes to do that, then again, the relevant health care professionals will ask the patient to stay until they've seen the doctor in charge off their care. Let's have a look at these Section five holding powers while the powers contained under Section five of the M. H. A. R referred to US holding powers and relate to somebody who's already in hospital. So the section can be used for an impatient if they're an informal or voluntary patient, for example, if they're intending to discharge themselves or leave the hospital patients who are in hospital by virtue off a deprivation of liberty authorization under the Mental Capacity Act 2000 and five and irrespective of whether there originally in hospital because of a physical or a mental disorder. So it won't be applied to someone who's already detained under another section of the MH A or subject to a community treatment order, or CDO, or someone who's being kept in hospital as a place of safety. Under Section 135 or 136 off the MH A on there must be a valid reason why the patient is an impatient. It wouldn't be acceptable, for example, to admit a patient informally with sole intention of then using holding powers and their two types of holding powers. One provided to doctors under Section five subsection two on 12 nurses under Section five subsection for In the limited circumstances, as described within Section five, the doctors powers under Section five subsection to convey, used when the patients and impatient, and it appears to a registered medical practitioner or an approved clinician in charge of the treatment of the patient or their nominated deputy that an application ought to be made under the MH A for the admission off the patient, the hospital and in those circumstances, the doctor can furnish the manager's a report in writing to that effect so this power can only be exercised by the registered medical practitioner or approved clinician, the person in charge of the patient's treatment. However, in the absence of either of those persons, they can nominate one but not more than one registered medical practitioner or approved condition off the hospital who is competent to carry out the role on their behalf. In their absence, the deputy could be a named individual or a nominated role, and the deputy has to use their own professional judgment on dis responsible for the actions they take. So, for example, a deputy can't be told to invoke the Section five to power as a matter of course, if any patient tries to discharge themselves on a particular ward on the code emphasizes that doctors and approved clinicians should use the holding power only after having personally examined the patients and the effects of the power being invoked. Dissipation can be detained in the hospital for a period of 72 hours from the time when the doctors or approve conditions application is made. In reality, that's the report that's handed to an officer who is authorized by the hospital managers to receive it or when it's put in the hospitals. Internal mail system on the submission of the application or report actually starts the detention clock so the patient can be treated as if they had been admitted to the hospital from the time when the application was received by the hospital. Managers on the idea behind the use of the word application is so that reasons can be given as to why a patient should be held. It would, of course, be a misuse of the section if a patient was held there when the registered medical part Titian or Approved commission, didn't actually believe that the patient ought to be detained for treatment or assessments. And so the power means that the patient can be held for up to 72 hours. Although arrangements for an assessment to consider an application under Section two or Section three of the MH A should really be put into place A soon as the Section five subsection two report is given to the managers on the section must end when the patient can no longer be detained. So that's if the 72 hours of past on this being no assessments. The Section five subsection two power is not renewable because, of course, the purpose off the holding power is to stop a patient from discharging themselves before this time to make arrangements for that assessment. With regard to potentially a Section two or Section three detention under the MH A Onda low, the holding power is 72 hours. The idea, really is to get things moving as quickly as possible thereafter, and assuming the patient is not detained for some other reason. For example, a criminal matter. Patients should be informed immediately that they're no longer detained under the holding power. Onda told that they are free to leave the hospital. So let's examine the nurses holding power and a Section five subsection four of the MH A and this applies if a patient is receiving treatment for mental disorder as an in patient in a hospital. On it appears to a nurse of the prescribed class that that patient is suffering from mental disorder to such a degree that it would be necessary for the patient's health or safety or for the protection of others. For the patient to be immediately restrained from leaving hospital. Andi that it's not practicable to secure the immediate attendance off a practitioner or condition for the purposes are furnishing report under Section five, Subsection two and basically the nurse has to record that fact in writing, so the power can only be exercised by a nurse off the prescribed class. Andi in England. That's nurses. According to the mental Health nurses, England order 2000 and eight on its those nurses who are registered in either support warm or two off the register, maintained under Article eight off the nursing and midwifery order of 2000 and one whose registration also includes an entry indicating that the nurses fields of practice is either mental health learning or learning disabilities. Nursing anthee code does provide some recommendations two nurses before using the power, recommending that they assess the likely arrival time off the doctor or approved condition as against the likely intention off the patient to leave. Because, of course, it may be possible to persuade the patient to wait until the doctor or approved clinician arrives to discuss the matter further. And secondly, the nurse should also consider the consequences off the patient, leaving the hospital before the doctor or approved commission arrives. In other words, the harm that might occur to either that patient or the others. Andi. The code also makes it very plain that the reasons for invoking the power should be entered in the patient's notes. Details. Many patients who remain subject to the power at the time of a shift change should be given to the stuff who are coming onto duty. And so the nurses record, which should be delivered to hospital managers as soon as is possible, allows the patient to be detained in the hospital for up to six hours from the time when that fact was recorded. Or, of course, until a clinician or practitioner can provide a report actually arrives in terms of Section five. Generally, a detention doesn't allow patients to be treated without consent on the Section five. Power can't be renewed. However, of course, it doesn't stop it being used again in future, with same patients on in terms off Section five holding powers. Generally, the code makes it very clear that decision makers should always consider whether there are, in fact, less restrictive alternatives to detention under the MH A before they even think about the Section five holding powers and utilizing them. And, of course, detention under Section five doesn't allow patients to be treated without consent, and Section five holding power cannot be renewed. However, of course, it doesn't stop it being used again in the future. You wouldn't normally expect it to be used immediately or time and time again in respect of the same admission, because, of course, that would very much amount to a misuse. Let's explore Section four of the MH A admission for assessment in cases off emergency now by wave backgrounds. Section two of the MH A allows an application for patient be detained for Sussman's or assessment, followed by treatment for up to a period of 28 days. On that application must be made on the written recommendations in the prescribed format of two registered medical practitioners, and Section four is a way of dealing with a situation where there are not two registered medical practitioners available, and Section four subsection one allows for what's referred to as an emergency application. So on application for admission for assessment off a patient when the patient meets the criteria for detention for assessment under Section two of the MH A on the patient, detention is required as a matter off urgent necessity and there is one medical recommendation available. But obtaining a second medical recommendation would cause undesirable delay. And under Section four, subsection to the application can be made by an approved mental health professional who should tell the patients nearest relative unless the patient requests otherwise. Or of course, unless the patient doesn't have a nearest relative or alternatively, the application can be made by the nearest relative off the patient's Onda. Under Section four, subsection five, the applicant must have seen the patient in the previous 24 hours on that's rather than the 14 days required for Section two on the Section four application must include a statement that it is off. Urgent necessity for the patient to be admitted on detained under Section two. On that the compliance with the provisions under Section two would involve on desirable delay and that is undesirable because of the patient's mental state, all the patient's behavior and so the emergency application requires just one off the medical recommendations usually required by Section two. But that should be, if practicable by a practitioner who's had previous acquaintance with the patients, and otherwise they should be complying with the requirements of Section 12. So faras is applicable to a second recommendation and they need to verify the application statements of being urgent. Necessity on doff undesirable delay on the code makes it playing that on application under Section four of the MH A, should never be used as one off administrative convenience, but only used in genuine emergency. Where the patients need for urgent assessment outweighs the desirability of actually waiting for a second doctor, so emergencies occur where the patient's mental state or behavior presents problems which those involved can't reasonably be expected to manage whilst waiting for that. Second doctor on the code says that to be satisfied that an emergency has arisen, the person making the application on the doctor making supporting recommendation should have evidence, often immediate and significant risk off mental or physical harm to the patient or to others, or danger of serious harm to property or need for the use of restrictive interventions on a patient. And the patient could be detained for up to 72 hours from the time when the patient was admitted unless a second medical recommendation, as required by Section two, is given on providing. Of course, that second medical recommendation complies with all of the requirements that are necessary to meet the criteria off the section. The second medical opinion should be sort as soon as possible. It's not about taking the luxury of the full 72 hours on providing, of course. The second medical recommendation complies with the requirements it converts the section for to a Section two in accordance with Section four subsection full patients detained under Section four and not subject to being treated against their consent on the code very much recommend that Section four detentions are monitored to ensure that they're not misused in terms of emergency detention. It's also important to remember professions of sections 135 on 136 off the MH A and following the amendments by the policing and crime at 2017 or the P C. A. Thes sections allow intervention in the case of someone who appears to be suffering from a mental disorder on who's either a the subject off. Ah, warrant under Section 135 or be in a public place under Section 136 to be taken or kept in a place of safety for 24 hours, or a maximum of 36 where the extension is authorized by a registered medical practitioner. That now brings this current mental health session to an end. Thank you very much for joining me. Steph Barber on this Data Law mental health session