Written and recorded by Steph Barber, Law Hound
Hello. Welcome to this Data Lord training session in relation to mental health. This session looks the roll off the second opinion appointed doctor or sewed in terms. The Mental Health Act 1983. My name. Steph Barber. And I'm a consultant with Law Hound. I'm a retired solicitor. Andi I was previously a member off the Law Society Specialist panel in relation to Mental Health Law. In the session, we're going to be examining the role off the sold in relation to adult patients under the MH A on part ful off the Mental Health Act or the MH A, which deals with the treatment of patients detained under the MH A from mental disorder, also provides safeguards for patients, which includes the need to obtain a second medical opinion before treatment is administered. A soda or the second opinion appointed doctor is actually appointed by the Care Quality Commission or seek you see whose role is to provide. That additional opinion or safeguard for patients were required by the M A change, however, as the Department of Health's code of practice in relation to the Mental Health Act or the code make very plain, although sewed are appointed by the CQ see their role is to protect the patient's rights, primarily by deciding whether certain treatments are appropriate and assuring certificates accordingly. Therefore, sewed must act as independent professionals on must reach their own judgments about whether or not the post treatment is appropriate. So let's consider the safeguards for detained patients, while for these purposes, detained patients means those who are liable to be detained in hospital under any section off the act, including patients on community treatment orders or C to rose, who have Bean recalled to hospital. But subject to some exceptions regarding treatment on restricted patients, you have Bean conditionally discharged on, recalled the hospital and sanctioned 63 off the MH A makes it clear that a detained patients consent is not required for any treatment given to him for the mental disorder from which he's suffering, provided that the treatment is given by or under the direction off the approved commission in charge of the treatment. Unless it's a form of treatment to which sections 57 58 or 58 a apply. So unless it's an emergency or urgent as defined by Section 62 off the MH A sections 57 58 58 A. Contains special guidance or safeguards for certain types of treatment, subject to some exceptions. Well, a CDO patient is recalled to hospital. Firstly, we have Section 57. That's treatment which requires consent. Onda a second opinion. This currently means neurosurgery for mental disorder and surgical implantation of hormones to reduce the male sex drive. So it means that even if the patient consents to treatment, there must be a soldier who should agree with the clinical opinion to go ahead with the treatment. Sanction 58 relates to treatment, which requires consent or a second opinion, and it includes under Section 51 subsection wall, a treatment specified by the secretary of State but also includes under subsection one B medication provided to a detained patient where the medication has been given for three months or more since First administration. But with the exception off medication administered as part of the C T, which is dealt with under Section 58 A. So Section 58 A deals with E. C. T. On medication administered as part of the SETI, so it includes the actual electro convulsive therapy ons. The medication, irrespective of whether the patient is detained or not. E c T can be given in a nim urgency. That is, if it's immediately necessary to save life or prevent a serious deterioration off the patient's condition under Section 62 or if a patient consents to it on either the approved commission in charge of the treatment or sewed has certified that the patient is capable of understanding the nature, purpose and likely effects of the treatment on consents to it, or if a patient does not have the capacity to consent than the treatment can only be given. If it's sewed, certifies that it is appropriate and did you wouldn't conflict with a valid advanced decision. So let's consider the so droll in some more detail. So with those safeguarded treatments under Section 57 58 or 58 a sold will be considering either the patient's capacity to consent and or whether the treatment is appropriate on, of course, to detail what that treatment is. So let's have a look at capacity and consent. Once the patient has received the relevant information. The code advises that before the professional asks the CQ, see the start sold process to confirm a patient's consent that they should personally satisfied themselves that the patient is willing to give valid consent. Andi is capable off giving valid consent and when the sodas certifying in adults patient's consent. There's no actual statutory requirement for providing reasons why the treatment is appropriate. However, the CQ see do advise that sowed record their assessment. Andi what they refer to as an outline of the broad contents of discussion with the patient so including the patients after chewed and concerns so that that can be included in the patient's notes. The certificate relating to a patient's consent to medication for mental disorder will usually be completed by the approved collision in charge off the treatment, but on occasions are sewed may want to undertake that certification. Let's look so droll in relation to the appropriateness of treatment following amendments. Bybee Mental Health at 2007 when deciding whether it's appropriate for treatment to be given to a patient, sewed are required to consider both the clinical appropriateness off the treatment to the patients mental disorder Andi, its appropriateness taking into account all the other circumstances off the patient's case. So this means considering Section 145 subsection for treatment, the purpose of which is to alleviate or prevent a worse thing of the disorder or one or more of its symptoms or manifestations. Andi Section 64 subsection three. Appropriate in the patient's case, taking into account the nature and degree off the mental disorder from what she's suffering and all the other circumstances off his case. So it must also have regard to the five guiding principles off the code. They should be considered when making all decisions in relation to care, support or treatment provided under the act, and the principles are the least restrictive option on maximizing independence, empowerment, Andi involvement, respect and dignity, purpose and effectiveness. Andi efficiency. Andi equity So it must also have regard to the patients views on the code advises that in particular, so should seek to understand the patient's views on the proposed treatment on the reasons for thumb andi that includes involving any advocates, carers or making any reasonable adjustments as appropriate to give due weight to the patients views, including any objections that to the proposed treatment on any preferences for an alternative to consider the appropriateness off alternative forms of treatment, not just the one proposed to balance the potential therapeutic efficacy off the proposed treatment against the side effects. Andi. Any other potential disadvantages to the patients to take into account any previous experience of comparable treatment for a similar episode of Disorder on to give due weight to the opinions, knowledge, experience and skills off those consulted. There also needs to be clarity on the treatment and conditions attached to it. So when a sewed gives certificate relating to treatments, assuming that they believe they have sufficient information on which to make a judgment, it's important that they consider and clarify what treatments, if any, are approved. So, for example, the maximum number of administrations of E. C. T. Which is approved, or what treatments, if any, can be given to a CTO patient who was recalled to hospital on. Of course, what conditions, if any, are imposed on that approval, a ZA code advises. Unless they specify otherwise, the certificate will authorize the treatment even if the patient has capacity to refuse it, unless it's a Section 58 a type treatment, So, for example, in a part for a certificate in relation to community treatment order patient. A sewed may specify that certain treatment can be given to the patient only if certain conditions are satisfied. So, for example, the sewed could specify a particular medication, and dosage is given whilst the patient is in the community, provided that the patient retains capacity to consent on whether treatments can be given to patients on recalls, the hospital and, if so, what? The treatment is on under what circumstances they can be given. So, for example, the sold can specify on recall. A particular medication is given, where appropriate, without the patient's consent. So let's examine the sewed process. The commission in charge of the relevant treatment in question has a personal responsibility to ensure that a request is made to the CQ see for so to visit when a sewed certificate is required. The sewed will then visit the detained patient in hospital on interview them in private wherever possible. And this would usually be alone unless the patient and sewed requests or its belief sewed would be at significant risk off physical harm for the patient on the so degrees. With that opinion, Andi, it's down to the hospital managers to ensure that the sold can meet with any of the people that they want to, including any clinicians in charge of the treatment. So do have a right of access to records on without the patient's consent, if necessary. Andi In fact, the code specifically advises that where proposed treatments includes medication, the sewed attention should be drawn specifically to any recent reviews of the patient's treatment, including the rationale for using medication on what other forms of treatment have bean tried or tested. The code also advised that conditions should consider seeking a review by a specialist mental health pharmacist before seeking a sewed certificate, particularly if the patient's medication regime is complex or unusual on the so should also be made aware of anyone authorized on TMC A. To make decisions on the patient's behalf about medical treatment on any relevant advanced decisions or advanced statements of you. Wishes or feelings should be particularly brought to their attention if they're not already recorded in the patient's notes. Andi thesis old should consult others in relation to the decision making. The soda must firstly consult to statutory consul teas before a certificate approving treatment could be issued. The consultation may be face to face on the so should record this, so it become part of the patient's records. Stategy Consul T should have details on door up to date knowledge off the patient on the patient's treatment on to assist this old when making decisions as to the patients capacity to consent to or to refuse treatment, as well as the appropriateness off the proposed treatment. Council teas should also consider whether they're sufficiently concerned professionally with the patient's care to fulfill that function. And if not, they should be advising of someone else. Better place to fulfill it for part for a certificates. Only one of the statutory council teas can be a medical doctor, but not the clinician in charge of the proposed treatment or the responsible clinician, so that would usually be the patient's GP. The sowed is also under a duty to consult with a wider range of people concerned with the patient's care. So potentially, of course, that's the patient's nearest relative families Carers GP on. Of course, anyone representing the patient in terms off the sodas decision so must provide written reasons in support of their decisions to approve specific treatments for patients. As the code explains. It doesn't have to be an exhaustive explanation, but should provide their reasons for what they consider to be the substantive point on which they made their clinical judgment on. The reasons can be recorded on the certificate itself when it's given or be provided. The two v clinician in charge of treatments separately assumes is possible afterwards. The sewed certificate can be acted on without having received their reasons on. The code advises, though, that conditions should wait unless the treatment needs to begin immediately. It's the personal responsibility off the clinician in charge of the treatment to communicate the results off the sodas visit to the patients. They may wish to do this before or after the reasons have been received from the sold. In most cases, it's expected that thesis odes reasons will be shared with the patients. Assume is possible after a seat. But the condition must decide whether disclosing the reasons the patient would be likely to cause serious harm to the patients, physical or mental health or to that of any other person. The so should in fact cover this aspect when providing the reasons so that the soldier view can be taken into account by the clinician when deciding whether or not to share the reasons with the patients. Any documents provided by sewed are part off and should be kept in the patient's notes. The commission in charge off the treatment should record their actions in providing patients with or with holding the reasons supplied by sewed. Sowed is personally responsible for their decision on there's no right of appeal to the CQ. See the issuing off a sewed certificate is not an instruction to administer treatments on. It doesn't always mean that the treatment will be appropriate on DSO. Anyone who administers the treatment must satisfy themselves that it's appropriate before that treatment is given. And that brings us to the end of this session on Thank you for Joining Me, Steph Barber.
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