Mental Health Legislation for Children and Young People in Scotland some practical points

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1 Mental Health Legislation for Children and Young People in Scotland some practical points Dr Helen Dawson Medical Officer Mental Welfare Commission for Scotland

2 Commission s role under the 2003 Mental Health Act Remit covers all people with mental disorder in Scotland and includes: Monitoring its operation Promoting best practice, including the principles Specific duties to visit, investigate, give advice, publish etc Other duties around safeguards including DMP visits

3 Challenges for Child and Adolescent Psychiatrists Relative lack of experience with key legislation MHA AWIA, Wealth of legislation in existence for under 18s Developmental impact on issues in under 18s Systemic nature of Child and Adolescent Psychiatry

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5 Topics to be covered today MHA CTOs Specified persons Cross border Medical treatment under MHA Mental Health (Scotland) Act 2015

6 Compulsory Treatment Orders (CTO) Hospital or Community based A hospital is specified for both Model of regional adolescent inpatient provision & national child inpatient provision MUST know hospital CTO attached to Inpatient process discharge planning Community CAMHS Consultants

7 HCTO Question A young person has been discharged from the regional inpatient unit and returns home two hundred miles away on suspension of detention of his HCTO. There is no transfer of HCTO to the local psychiatric hospital. His mental health deteriorates and he requires readmission to a hospital. The regional unit is full. What options are there for his community CAMHS consultant?

8 CCTO question A young person has been discharged from the regional inpatient unit and returns home on a CCTO. CCTO transfer to the local hospital. His mental health deteriorates and he requires readmission to a hospital. What options are there for his community CAMHS consultant? What options would there be if the patient breached the conditions of his CCTO?

9 Specified Persons Regulations

10 Specified Persons Regulations Regulation framework which enables restrictions to be placed on detained patients in hospital 3 areas- Correspondence Use of telephones Safety and Security in Hospitals

11 Specified Persons Regulations Not routine Not a substitute for ward policies or hospital policies Some automatic- TSH, medium secure units Principles of MHA especially least restriction and patient participation

12 Specified Persons Regulations RMO must record reasoned opinion that without restrictions... risk to individual or others RMO assessed at least once, significant amt info and support for necessity Notification of patient, NP by writing, MWC by Res forms

13 Specified Persons Regulations Review of SP status once per six months; outcome communicated to pt, NP & MWC. Review of telephone prohibitions ever three months MWC can prohibit implementation of regulations

14 Use of telephones S284 MHA Determination that telephone calls made to/by pt may cause distress to pt or other or pose significant risk to health safety and welfare of pt or others Prohibit use of phone or restrict duration, frequency, range of people called. Mobile phones included ( +texts) but cannot be confiscated ( safety and security needed also)

15 Correspondence S281-S283 Mail can be withheld if post sent by pt may cause distress to addressee or any other or pose a danger to anyone Reception of post by pt my not be in interests of health or safety of pt or may cause danger to an other. Nurses able to open/ inspect mail & withhold mail. MWC must be notified <7days if mail withheld & why.

16 Safety and Security Determination pt has sought to acquire or is likely to seek to acquire any item which is prejudicial to health/safety of any person or security/good order of hospital Authorised interventions must be clearly identified. Not catch all. Searching/ possession of articles/ Taking samples/visitor restrictions

17 Case example A patient tends to monopolise the patient phone... Other patients have complained... Do we have to make him a Specified Person to restrict his calls?

18 Cross Border Issues Resources: MWC: Cross Border fact sheet CAMHS protocol Andy Lawson,Directorate for Population Health Improvement/Mental Health, 3ER St Andrews House, Regents Road, Edinburgh, EH1 3DG

19 CAMHS protocol and process for transfer of patient on HCTO to England/Wales RMO gets agreement of receiving hospital and discusses with patient, MHO and relevant parties Gives notice in writing to all of intention to apply for a warrant got removal. Parties have 7 days to make representation to RMO, patient has 7 days to give notice to SM of wishes MHO within that 7 days must interview the pt, inform of rights, advocacy, inform RMO if MHO agrees/disagrees

20 CAMHS protocol and process for transfer of patient on HCTO to England/Wales RMO applies to SM for warrant with appropriate info and proposed arrangements TX1a SM give notice of their decision to all parties and info on patient s right of appeal SM issue warrant for removal with any instructions re conveyance, copy to all parties. Effective date on or after which patient can be removed. Warrant valid 14 days.

21 CAMHS protocol and process for transfer of patient on HCTO to England/Wales Period can be waived if patient agrees or if urgently necessary but must not be less than 3 days Transfer is to nearest equivalent order, expiry date is calculated from day of transfer Patient can appeal to MHTS against transfer when SM have notified them of their decision TX4 Transfer is suspended until appeal heard

22 Medical Treatment under MHA Definition of medical treatment Includes related physical disorder Safeguarded medical treatment Children under 16 year s S244 T2, T3 T4 forms

23 Calculating the two month period of medication for T2 and T3 Emergency detention certificate granted 3rd April; Lorazepam given IM as urgent medical treatment under Section 243 on 4th April; STDC granted on 5th April. Further doses of if required medication given; Regular antipsychotic commenced, mood stabiliser commenced 6th April; Interim CTO granted 4th May; Progressed to full CTO 18th May. T2 or T3 form needs to be in place to authorise any medication for mental disorder from 4th June. This is two months from the first administration of medication authorised by the 2003 Act.

24 T2 forms Where the patient can and does consent in writing & the RMO certifies that in pts best interests that ttment given. RMO certifies that capable of consenting, pt consent in writing & medical ttment outline. T2 must be sent to MWC within 7 days. RMO must be child specialist for under 18s for T2 Not im medication for rapid tranquillisation For NG feeding T2 must be in place from start of ttment, for medication after 2 months

25 T3 If patient is incapable of consenting or does not consent then the RMO is required to arrange for a DMP to examine the patient and consider whether ttment should be authorised RMO or DMP must be child specialist for under 18s RMO contacts MWC with request. MWC organises usually <7 days. DMP issues T3

26 T4 Urgent and necessary medical treatment commensurate with risk Retrospective To MWC within 7 days Does not provide authority to treat

27 Resources MWC part 16 guidance MWC DMP handbook CoP vol 1 ch 8 MWC Consent to treatment, Right to treat guidance

28 Mental Health Act (Scotland) 2015 Limited review Most Autumn Excessive Security Nov 2015 Includes - Suspension of detention, Cross Border regulations Named Person >16yrs Advanced Statements Register at MWC

29 Contact the MWC (advice, information, raise concerns) By phone By Via website By post at Thistle House 91 Haymarket Terrace Edinburgh EH12 5HE

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31 Immediate redetention

32 Question: A patient was assessed for STDC in the community. He absconded and was taken to IPCU by police escort and the RMO and MHO followed behind in their car. Somewhere along the way the detention papers were lost. It is week later the RMO and MHO are together at the hospital. They ask can they redo the STDC form and backdate it so the patient is not disadvantaged by the loss of the original form?

33 Viewpoints

34 Can you detain someone who wont talk to you?

35 What are the principles of the MHA?

36 Overview Mental Health (Care & Treatment)(Scotland) Act 2003 MHA & Mental Health (Scotland) Act 2015 Adults with Incapacity Act ( 2000) AWIA Adult Support and Protection Act 2007 ASP Criminal Procedures Scotland Act CPSA 1995 Age of Legal Capacity ( Scotland) Act 1991 Children (Scotland) Act 1995 Children and Young People ( Scotland) Act 2014 Children s Hearing ( Scotland) Act 2011 Additional support for learning act

37 Form Fatigue

38 Patients transferred to Scotland from England Agreement with receiving hospital in Scotland SM consider request for consent to transfer patient into Scotland TX1b SM notify their intentions to hospitals and any instructions re conveyance Managers of notifying hospitals notify LA so MHO appointed

39 Patients transferred to Scotland from England Transfer date arranged-english order should come with patient and be lodged with MR Transfer onto nearest equivalent order Expiry dates remain as if not transferred MHO carries out functions re NP, advocacy and opinion to RMO for need for detention RMO carries out assessment within 7 days re need for detention having consulted MHO

40 Patients transferred to Scotland from England RMO completes TX5 and notifies all relevant parties inc SM, MHTS and MWC RMO prepares S76 treatment plan MWC visits within 6 mths Legally require DMP opinion 2 mths after cross border transfer for medication No legal validity if DMP undertaken earlier