Hospital Managers Appeal and Renewal Hearings

Standard Operating Procedure 10 (SOP 10) Hospital Managers Appeal and Renewal Hearings Why we have a procedure? It is the Hospital Managers (Managers) who have the power to detain patients who have been admitted under the Act. They have the key responsibility for ensuring the requirements of the Act are followed. In particular they must ensure that patients are detained only as the Act allows, that their treatment and care accord fully with its provisions, and that they are fully informed of, and are supporting in exercising, their statutory rights (Code of Practice 2015). What overarching policy the procedure links to? Mental Health Act Policy Which services of the trust does this apply to? Where is it in operation? Group Inpatients Community Locations Mental Health Services all Learning Disabilities Services all Children and Young People Services all Who does the procedure apply to? The powers to review detention are conferred by the Act upon Hospital Managers. The Trust has appointed a committee of its Board to undertake these duties. This committee comprises Non-Executive Directors of the Trust together with informed outside persons, known as Associate Hospital Managers. The Trust will satisfy itself that it has an adequate number of Associate Managers and that they are of appropriate character for the role. Associate Managers will receive an Honorary Contract and a rate of remuneration and expenses as decided by the Trust. When should the procedure be applied? Patients can be detained in a hospital against their will under a section of the Mental Health Act (MHA), e.g., Section 2, 3, 4 and 37, for assessment and/or treatment for mental disorder. They can also receive compulsory treatment outside hospital under section 17(A) (Supervised Community Treatment). The Act confers upon the Hospital Managers, the power to review detained patients (including Supervised Community Treatment) and to either discharge them from detention or uphold the section. Hospital Managers Appeal and Renewal Hearings Page 1 of 24 Version 2.0 October 2016

How to carry out this procedure When to Hold a Managers Review A Managers Review is the process by which the Managers decide whether a patient should either continue to be detained or should be discharged from their Section. (This should not be confused with a Mental Health Review Tribunal) A review may take place at any time at the Hospital Managers discretion, but Managers must hold a review: a) When the Responsible Clinician submits a report renewing the patient s detention. (Section 20) or extending Supervised Community Treatment (Section 20A) The Managers must consider holding a review: b) When the patient requests one (unless a hearing has recently taken place and the Manager s view is that the circumstances have not altered materially) c) When the Responsible Clinician makes a report to the Managers barring a discharge made by a Nearest Relative Criteria for Decision to Detain and Renew Section 2 a) The patient is or continues to be suffering from a mental disorder of a nature or degree which warrants his or her detention in a hospital for assessment (or assessment followed by medical treatment) for a limited period; and b) He or she ought to be so detained in the interest of his or her own health or safety or with a view to the protection of other persons Section 3 a) The patient is suffering from a mental disorder which is of a nature or degree which makes it appropriate for him/her to receive medical treatment in a hospital, and b) It is necessary for the health or safety of the patient or the protection of other persons that he/she should receive such treatment and it cannot be provided unless he/she is detained under this Section, and c) Appropriate medical treatment is available in the specified hospital section 17(a) Supervised Community Treatment a) The patient is suffering from a mental disorder which is of a nature or degree which makes it appropriate for him/her to receive medical treatment, and b) It is necessary for the health or safety of the patient or the protection of other persons that he/she should receive such treatment, and c) Subject to paragraph (d) treatment can be provided without the patient being detained in a hospital and d) It is necessary for the Responsible Clinician to be able to recall the person to hospital and e) Appropriate medical treatment is available Section 20 Renewal of Detention (secs 3 and 37) a) The patient is suffering from a mental disorder of a nature or degree which makes it appropriate for him/her to receive medical treatment in a hospital, and b) It is necessary for the health or safety of the patient or for the protection of other persons, that he/she should receive such treatment and that it cannot be provided unless he/she continues to receive treatment in a hospital c) Appropriate medical treatment is available in the specified hospital Hospital Managers Appeal and Renewal Hearings Page 2 of 24 Version 2.0 October 2016

Section 20(A) Renewal of Supervised Community Treatment a) The patient is suffering from a mental disorder which is of a nature or degree which makes it appropriate for him/her to receive medical treatment, and b) It is necessary for the health or safety of the patient or the protection of other persons that he/she should receive such treatment, and c) Subject to paragraph (d) treatment can be provided without the patient being detained in a hospital and d) It is necessary for the Responsible Clinician to be able to recall the person to hospital and e) Appropriate medical treatment is available Panel Decisions In deciding whether a patient should be discharged under the above criteria, the Hospital Managers must consider whether the grounds for admission, continued detention, or continued supervised community treatment under the Act are satisfied. To ensure that this is done in a consistent way, the Hospital Managers should consider the following, in the order stated: For section 2 Is the patient suffering from mental disorder? If so is it of a nature or degree which warrants assessment as an inpatient? Is detention in hospital still necessary in the interests of the patient s health or safety, or for the protection of other people? For sections 3 and 37 Is the patient suffering from mental disorder? If so, is the disorder of a nature or degree, which makes treatment in hospital appropriate? Is detention in hospital still necessary in the interests of the patient s health or safety, or for the protection of other people Is the appropriate treatment available? For section 17(A) Is the patient suffering from mental disorder? If so, is the disorder of a nature or degree, which makes Supervised Community Treatment appropriate? Is the Supervised Community Treatment order still necessary in the interests of the patient s health or safety, or for the protection of other people? Is it necessary for the Responsible Clinician to continue to have the power of recall to hospital? Is the recommended treatment available? If the panel is satisfied from the evidence presented to them that the answer to any of these questions is no, then the patient should be discharged, providing there is evidence that adequate community care is in place. If it is not in place and its absence makes it likely that the patient s health or safety will be compromised, the panel has the powers to adjourn the hearing for a reasonable specified period to allow these arrangements to be put in place. Hospital Managers Appeal and Renewal Hearings Page 3 of 24 Version 2.0 October 2016

Managers should be aware that unreasonable delay in discharge in these circumstances could violate Article 5 of the Human Rights Act 1998 Right to Liberty. In exercising the powers of discharge, the Hospital Managers must act in a way that is fair, reasonable and lawful, giving due consideration to the various reports and recommendations made, but not necessarily being bound by such reports and recommendations. Managers power to discharge a detained patient can only be exercised when all three members of the panel are in favour of discharge otherwise the decision will be unlawful. In cases where Managers uphold a patient s continued detention they must ensure that the patient and the patient s nearest relative are fully informed of the reasons for this decision in line with guidance given in the Code of Practice and Article 5(2) of the Human Rights Act 1998. Managers should always ensure that full and comprehensive reasons are clearly recorded on the Managers Review of Detention Meeting Control Form (Appendix 2). In the event that a legal challenge to a decision to continue detention arises, the information will facilitate a response. Responsible Clinician Barring Discharge In cases, where the Responsible Clinician makes a report to the Hospital Managers barring a discharge application made by a nearest relative (N.B. this also applies to Supervised Community Treatment), the Managers should not only consider the questions above, but also the following: Would the patient, if discharged from detention or Supervised Community Treatment, be likely to act in a manner dangerous to other persons or himself/herself? Legal Challenge to Decision to Detain If the Manager s decision to continue detention is legally challenged, the following action should be taken: In collaboration with the Managers, the Mental Health Act Office should write to the patient s solicitor giving a clear account of the reasons for the continued detention Copies of relevant supporting documentation should accompany the letter In the event that the patient s solicitor continues to challenge the decision, further advice must be obtained from the Trust s solicitors Prior to the Hearing The Hospital Managers should ensure: That they have reports from the patient s Responsible Clinician and other relevant disciplines That, if the patient consents, his/her nearest relative is informed of the review and asked to attend That, if the patient withholds consent for his/her nearest relative to attend, the appropriate professional concerned should obtain the views of his/her nearest relative and include these in his/her report The Mental Health Act Office should: Identify panel members, paying due attention to the gender, ethnicity and other needs of the patient Hospital Managers Appeal and Renewal Hearings Page 4 of 24 Version 2.0 October 2016

Agree a date and time for the hearing with the Responsible Clinician and panel Organise legal representation on behalf of the patient, if so requested Explain the procedure to the patient and his/her legal representative Ascertain whether the patient wishes a relative or friend to attend Inform the patient, legal representative and nearest relative (if appropriate) of the date, time and venue of the hearing Inform relevant professional staff of the date, time and venue of the hearing Ensure that medical, nursing, social circumstances reports and those from professional staff (if required) are circulated to the Hospital Managers 5 days in advance for Section 3, 17(a) and 37 and no less than 30 minutes prior to the hearing for Section 2 Ensure that a copy of the reports are handed to the patient, his legal representative and his/her relative, as appropriate (other than in exceptional circumstances where Non-disclosure to Patient is requested) Immediately prior to the hearing, the patient and his/her legal representative will be given the opportunity to speak to the panel alone The professional staff involved in the case should: Should produce independent written, signed and dated reports for the Mental Health Act office Notify the Mental Health Act office in exceptional circumstances of any sections of the report which should not be disclosed to the patient, on the following grounds: - The information is likely to cause serious harm to the physical or mental health of the patient or any person, or - The information relates to or has been provided by another person who could be identified by that information and that other person does not consent Attend the hearing in person to present their report, or where that is not possible ensure that an appropriate representative who knows the patient presents and is able to speak to the report The named nurse should encourage the patient to seek a friend, relative or advocate to attend with them and help them to represent themselves The report should provide the following information: The Responsible Clinician s report should state the grounds for further detention. It should contain comments on the patient s current mental state, response to treatment and prognosis. It should also attempt to forecast the effect on the patient of the discontinuance of treatment under section The primary nurse s report should give details of the patient s care plan, and behaviour on the ward and other relevant information, including their response and compliance with treatment. It should also include level of observation, any history of seclusion and any self-harm behaviour The social circumstance report prepared by the patient s care coordinator should give information about the patient s family background and relationships within and outside the family. It should also give an opinion on the patient s capacity to live outside the hospital, with or without support and information regarding community support available. It should detail the patient s financial position and any strengths which would allow the panel to form a balanced view on discharge. Where possible a post-discharge Care Plan should be attached. If this is not possible, then the report should describe details of aftercare. It is accepted that staff other than a social worker may sometimes prepare Social Circumstance Reports Hospital Managers Appeal and Renewal Hearings Page 5 of 24 Version 2.0 October 2016

In addition, reports may be obtained from other professionals e.g. psychology as appropriate. The patient is also entitled to obtain an Independent Medical or Social Work report NB The above are minimum standards, ideally all reports should follow the requirements directed by the First Tier Tribunal. This guidance can be found at: http://www.mhrt.org.uk/documents/forms/reportsguidancebooklet.pdf The Hearing The review will be conducted by a Review Panel of three Hospital Managers selected to provide a balance of experience, gender and ethnicity with regard to the patient concerned All efforts should be made to achieve a relaxed and informal atmosphere in which the patient can feel at ease At the start of the hearing the Chairperson should ensure that everyone introduces themselves and explain clearly to the patient what is the purpose of the hearing and how it will proceed All parties should normally be present throughout the hearing. However, the Chairperson will ask the patient if they wish to speak to the Panel alone with or without the patient s advocate At times Doctors, Social Workers may have to leave before the conclusion of the hearing. This should only be with the permission of the Chairperson and with the agreement of the patient s solicitor. The Named Nurse must always remain throughout the hearing to escort the patient During the hearing, the Chair s role is to encourage comprehensive questioning and thorough consideration of issues, and to ensure that each panel member has fully participated in discussion and the decision-making process Professional Attendance and Postponement of Hearings Only a doctor with the power to discharge the patient should attend hearings. It is desirable for the Responsible Clinician to be present but, if absence is unavoidable, a senior medical member of the team must attend in place of the Responsible Clinician. If both Doctors are unavailable, the hearing must be adjourned. Where appropriate professional staff are not present and/or up-to date reports are missing, the Managers must consider whether or not they have sufficient available information in order to make an informed decision. In such circumstances, it may be necessary, in consultation with the patient and/or their legal representative and/or advocate, to postpone the hearing due to insufficient information being available. Mental Health Act Office Attendance A member of staff from the mental health act office will attend the hearings to assist in taking supporting notes, and be available should advice on operational procedures be required. Complex legal advice should be obtained from the Trust s solicitors. Order of Proceedings At the start of the hearing, the Chairperson should state clearly the order of proceedings, which should normally be as follows: Introduce all those in attendance State clearly the purpose of the hearing and the order of proceedings (to help focus the discussion and set the agenda) Invite the patient and/or their legal representative or advocate to state the case for the patient s discharge Hospital Managers Appeal and Renewal Hearings Page 6 of 24 Version 2.0 October 2016

Ask the Responsible Clinician and other professionals to give their views on whether the patient s continued detention is justified and the factors on which those views are based Give the patient the opportunity to comment on the views expressed through his/her legal representative or advocate After each presentation, seek clarification or any further information Provide the patient and/or his or her legal representative, advocate or nearest relative, the opportunity to ask questions The Panel should bear in mind that: The hearing likely to be stressful for the patient. The Panel should therefore balance the formality necessary to carry out their tasks with informality in the interest of supporting the patient; They should assist the patient in making his or her case for discharge as effectively as possible; There is no set time for the length of a hearing. However, the Panel should consider the effect of a lengthy review on the patient s wellbeing; If the patient become distressed, a short break may be directed by the Chairperson; If the patient chooses to absent himself/herself from the hearing, the Panel should decide whether to continue with the appeal; The procedures for the hearing should be informal. Although all parties should be actively and positively questioned, formal cross examination should be avoided. The questions should be asked of all parties in a manner, which is both thorough, fair and courteous. Care should be taken not to undermine the patient s relationship with His/her family and with professional staff; Subject to the patient s right to object to the presence of relatives, all parties should normally be present throughout the hearing except; - During any time when the patient wishes to speak to the Panel alone - When the patient does not wish to be present Reaching a Decision The Panel should: Be clear about the criteria for discharge Find the agreed facts Consider the facts which are not agreed and decide whose version is to be preferred Identify the opinions that are agreed by all parties. Consider the opinions which are not agreed and decide which opinions are to be preferred On the basis of the agreed or preferred statements of facts and opinions, determine whether the criteria for continued detention are satisfied If the criteria are not satisfied, order discharge subject to provisions laid out in 4.3 The reasons for the decision must be clearly documented on the appropriate form Consider any Advance Statements/Directives In arriving at a decision, the Panel should in particular: Be cautious of and test hearsay evidence that is second or third hand Carefully examine opinions about risk both to the patient and others Consider the patient s state of mind and insight into his/her illness Hospital Managers Appeal and Renewal Hearings Page 7 of 24 Version 2.0 October 2016

Assess the credibility of the patient and weigh his/her views against professional opinion Decision The decision of the Panel should be to continue to detain the patient, to adjourn the hearing, or to discharge the patient. Where the Panel is of the opinion that discharge arrangements are not sufficiently advanced and, on the basis of the criteria set out above, are concerned for the welfare of the patient, they may decide either to continue to detain the patient and to hold a further review after a specified period. Managers should take into account the potential to violate Article 5 of the Human Rights Act 1998 if the length of delay in discharge could be construed as being unreasonable. The decision, and the rationale for it, should be recorded by the Chair of the panel on the decision form and kept with the section papers. Copies of these will be circulated to the professionals involved. Communicating and Recording the Hospital Managers Decision In communicating their decision, the Panel should ensure that: Their decision and the reasons for it are communicated immediately to the patient, to any relative who has been involved and to the relevant professionals; Wherever possible, at least one member of the Panel explains to the patient in person the reason for the decision. But if the patient is unavailable or unwilling to meet with a panel member, the reason for the decision should be communicated by their advocate or a member of the professional staff Copies of the reports prepared for the review, together with the Panel s decision are placed in the patient s records Recording the Decision The Panel s decision should be recorded on the Managers Review of Detention Meeting Control form (Appendix 2). This will show: Which Hospital Managers took part The professionals involved in the patient s care, and who attended the hearing That the documentation relating to the appropriate section of the Act is correct The decision of the Panel with the reasons for the decision comprehensively and clearly stated In case a decision is challenged, the form should provide a clear rationale for the decision made Where the patient is capable of understanding the nature and consequences of giving or withholding consent, his/her wishes should be ascertained before confidential information is disclosed to any third party not actively concerned with his/her treatment or care. Renewal of Authority to Detain Sections 20 and 20(A) A Managers Renewal hearing must always take place when a Section 3, or 37 is renewed by the Responsible Clinician. This is a statutory requirement. If the patient s Responsible Clinician decides towards the end of the patient s current period of detention that further detention is justified under Section 20 of the Mental Health Act, he/should complete Form H5 and forward this to the Mental Health Act office to enable the patient s detention to be reviewed as close as possible to the expiry date of detention. On receipt of the Form, the Mental Health Act office will request reports from the relevant professionals. Hospital Managers Appeal and Renewal Hearings Page 8 of 24 Version 2.0 October 2016

Similarly if the period of supervised community treatment is to be extended the Responsible Clinician completes form CT07 and follows the procedure as above. In the case of renewals, a full hearing will be held whether the renewal is contested or not. At the Renewal Hearing, the Review Panel should review the patient s circumstances, giving due consideration to the information gathered, satisfying themselves that the criteria for renewal of detention or supervised community treatment has been followed. If the Review Panel then agree that the patient should not be discharged, the review can be concluded and the outcome recorded on the Decision Form. A copy of this decision should be filed in the patient s records. The Trust recommends that renewal reviews should normally have taken place as near as possible to the renewal date of the detention or supervised community treatment. Recommendations/ Evaluations Any evaluations or recommendations made at hearings will be entered onto the evaluation form and discussed at Hospital Managers meeting, which take place quarterly. Any urgent recommendation requiring a response will be forwarded to the Service Director of the relevant Directorate, with an indication of when a reply is expected. Hospital Managers Appeal and Renewal Hearings Page 9 of 24 Version 2.0 October 2016

Appendix 1 To Whom and When Can a Patient Appeal? Following are guidelines for the correct avenues to proceed with when a detained patient wishes to appeal against their section Section Section 2 Section 3 Section 37 Section 17(A) Supervised Community Treatment Hospital Managers Yes, at any time Yes. Can be heard more than once in each period of detention at the Manager s discretion Yes. Can be heard more than once in each period of detention at the Manager s discretion Yes. Can be heard more than once in each period of renewal at the Manager s discretion Patients on the following short sections do not have the right to appeal to the Managers Appeal: Section 5(4) Section 5(2) Section 135/136 Section 4 can appeal, but would be heard under either a Section 2 or Section 3 Hospital Managers Appeal and Renewal Hearings Page 10 of 24 Version 2.0 October 2016

Appendix 2 Managers Review of Detention Meeting Control Form Venue Date Time. PANEL DETAILS Chair of panel Name PATIENT DETAILS 2 nd Member RC 3 rd Member Current Section Date From:.. To: Observing: Reason for Meeting:- (please tick) Patient Request: S20 Renewal: Form H5 received. Date. S25 Discharge by Nearest Relative: Form M2 received. Date S17A Supervised Community Treatment Form CTO7 received. Date Hearings Held or booked for current episode MHRT/Hospital Managers Date Outcome Care Plan/Risk Assessment in place Yes/No Other: Copy to Patient: Yes/No Reports Provided by: RC/Doctor: Primary Nurse: Other: Interpreter: Social Worker: Psychologist: Yes/No Hospital Managers Appeal and Renewal Hearings Page 11 of 24 Version 2.0 October 2016

Present at Hearing:- RC/Doctor: Social Worker: Nurse: Nearest Relative: Patient: Solicitor: Other: CHECKLIST FOR CONDUCT OF HEARING / 1. Ensure MHA Clerk has ascertained from patient, and any relative present, their views on their involvement in the Hearing. COMMENT 2. Check all mobile phones are switched off. 3. Chairman and Panel Members introduce themselves to the Patient. 4. Everyone in room asked to introduce themselves including Mental Health Act team. 5. Explain the purpose of the meeting. 6. Ask patient, or their representative, what they are seeking a) agree Review procedure b) Offer patient opportunity to meet managers on their own 7. Report discussed with RC/Doctor 8. Invite Patient or advocate to express views 9. Discuss Social Circumstance Report with Social Worker 10. Report discussed with Clinical Psychologist 11. Nursing Report discussed with Nurse 12. Other professions views heard 13. Check relatives views 14. Patient or representative to be given an opportunity to sum up their case 15. Is there evidence of a Risk Assessment/CPA meeting. Hospital Managers Appeal and Renewal Hearings Page 12 of 24 Version 2.0 October 2016

16. Decision to be conveyed to patient REASON FOR PATIENT REQUESTING A HEARING DECISION OF THE PANEL OF HOSPITAL MANAGERS a) The patient SHALL be discharged from liability to be detained with effect from b) The patient SHALL T be discharged c) The hearing SHALL be adjourned. d) The hearing WILL be reviewed in. GROUNDS FOR PANEL S DECISION The Panel is obliged to discharge the patient if the answer to any of the following questions is. SECTION 2 a) Is the patient suffering from a mental disorder of a nature or degree which warrants his/her detention in hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and b) Is the detention justified in the interest of his/her own health or safety or with a view to the protection of other persons? Hospital Managers Appeal and Renewal Hearings Page 13 of 24 Version 2.0 October 2016

SECTION 3 OR 37 a) Is the patient suffering from a mental disorder of a nature or degree which warrants his/her detention in hospital for medical treatment; and b) Is appropriate medical treatment available for the patient? And c) Is it necessary for the health or safety of the patient or the protection of other persons that he/she should receive such treatment and that it cannot be provided unless he/she continues to be detained? SECTION 17(A) - SCT a) Is the patient still suffering from mental disorder? b) If so, is the disorder of a nature or degree, which makes it appropriate for the patient to receive medical treatment? c) If so, is it necessary in the interests of the patient s health or safety or the protection of other people that the patient should receive such treatment? d) Is it still necessary for the responsible clinician to be able to exercise the power to recall the patient to hospital, if that is needed? e) Is appropriate medical treatment available for the patient? SECTION 25 In addition to the above questions under Section 3, 37 and 17A: a) If discharged, would the patient be likely to act in a manner dangerous to other persons or to him/herself Hospital Managers Appeal and Renewal Hearings Page 14 of 24 Version 2.0 October 2016

REASON FOR THE PANEL S DECISION SIGNED: (Chair) (2 nd Member) (3 rd Member) DATED:. Hospital Managers Appeal and Renewal Hearings Page 15 of 24 Version 2.0 October 2016

Hospital Managers Hearing Evaluation Form PATIENT: SECTION:. HOSPITAL: WARD: TYPE OF HEARING:.. DATE: PANEL:... Evaluation of Hearing:- Recommendations/Actions:- Hospital Managers Appeal and Renewal Hearings Page 16 of 24 Version 2.0 October 2016

Black Country Partnership NHS Foundation Trust Managers Review of Detention Meeting Control Form Venue Date Time PANEL DETAILS Chair of panel Name PATIENT DETAILS 2 nd Member RC 3 rd Member Current Section Date From:.. To: Observing: Reason for Meeting:- (please tick) Patient Request: S20 Renewal: Form H5 received. Date. S25 Discharge by Nearest Relative: Form M2 received. Date S17A Supervised Community Treatment Form CTO7 received. Date Hearings Held or booked for current episode MHRT/Hospital Managers Date Outcome Care Plan/Risk Assessment in place Yes/No Other: Copy to Patient: Yes/No Reports Provided by: RC/Doctor: Primary Nurse: Other: Interpreter: Social Worker: Psychologist: Yes/No Hospital Managers Appeal and Renewal Hearings Page 17 of 24 Version 2.0 October 2016

Present at Hearing:- RC/Doctor: Social Worker: Nurse: Nearest Relative: Patient: Solicitor: Other: CHECKLIST FOR CONDUCT OF HEARING / 1. Ensure MHA Clerk has ascertained from patient, and any relative present, their views on their involvement in the Hearing. COMMENT 17. Check all mobile phones are switched off. 18. Chairman and Panel Members introduce themselves to the Patient. 19. Everyone in room asked to introduce themselves including Mental Health Act team. 20. Explain the purpose of the meeting. 21. Ask patient, or their representative, what they are seeking c) agree Review procedure d) Offer patient opportunity to meet managers on their own 22. Report discussed with RC/Doctor 23. Invite Patient or advocate to express views 24. Discuss Social Circumstance Report with Social Worker 25. Report discussed with Clinical Psychologist 26. Nursing Report discussed with Nurse 27. Other professions views heard 28. Check relatives views 29. Patient or representative to be given an opportunity to sum up their case 30. Is there evidence of a Risk Assessment/CPA meeting. 31. Decision to be conveyed to patient Hospital Managers Appeal and Renewal Hearings Page 18 of 24 Version 2.0 October 2016

REASON FOR PATIENT REQUESTING A HEARING DECISION OF THE PANEL OF HOSPITAL MANAGERS e) The patient SHALL be discharged from liability to be detained with effect from f) The patient SHALL T be discharged g) The hearing SHALL be adjourned. h) The hearing WILL be reviewed in. GROUNDS FOR PANEL S DECISION The Panel is obliged to discharge the patient if the answer to any of the following questions is. SECTION 2 a) Is the patient suffering from a mental disorder of a nature or degree which warrants his/her detention in hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and b) Is the detention justified in the interest of his/her own health or safety or with a view to the protection of other persons? SECTION 3 OR 37 a) Is the patient suffering from a mental disorder of a nature or degree which warrants his/her detention in hospital for medical treatment; and b) Is appropriate medical treatment available for the patient? And c) Is it necessary for the health or safety of the patient or the protection of other persons that he/she should receive such treatment and that it cannot be provided unless he/she continues to be detained? Hospital Managers Appeal and Renewal Hearings Page 19 of 24 Version 2.0 October 2016

SECTION 17(A) - SCT a) Is the patient still suffering from mental disorder? b) If so, is the disorder of a nature or degree, which makes it appropriate for the patient to receive medical treatment? c) If so, is it necessary in the interests of the patient s health or safety or the protection of other people that the patient should receive such treatment? d) Is it still necessary for the responsible clinician to be able to exercise the power to recall the patient to hospital, if that is needed? e) Is appropriate medical treatment available for the patient? SECTION 25 In addition to the above questions under Section 3, 37 and 17A: a) If discharged, would the patient be likely to act in a manner dangerous to other persons or to him/herself Hospital Managers Appeal and Renewal Hearings Page 20 of 24 Version 2.0 October 2016

REASON FOR THE PANEL S DECISION SIGNED: (Chair) (2 nd Member) (3 rd Member) DATED:. Hospital Managers Appeal and Renewal Hearings Page 21 of 24 Version 2.0 October 2016

Hospital Managers Hearing Evaluation Form PATIENT: SECTION:. HOSPITAL: WARD: TYPE OF HEARING:.. DATE: PANEL:....... Evaluation of Hearing:-.................... Recommendations/Actions:-.................. Hospital Managers Appeal and Renewal Hearings Page 22 of 24 Version 2.0 October 2016

Where do I go for further advice or information? Mental Health Act Office - 0121 612 8035 Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust s Mandatory & Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Equality Impact Assessment Please refer to overarching policy Data Protection Act and Freedom of Information Act Please refer to overarching policy Hospital Managers Appeal and Renewal Hearings Page 23 of 24 Version 2.0 October 2016

Standard Operating Procedure Details Unique Identifier for this SOP is State if SOP is New or Revised BCPFT-MHA-SOP-02-10 Revised Policy Category Executive Director whose portfolio this SOP comes under Policy Lead/Author Job titles only Committee/Group Responsible for Approval of this SOP Month/year consultation process completed Mental Health Act Medical Director Month/year SOP was approved October 2016 Next review due October 2019 Disclosure Status Mental Health Act Coordinator Mental Health Act Legislation Forum B can be disclosed to patients and the public Review and Amendment History Version Date Description of Change 2.0 Oct 2016 Full review and new SOP format 1.0 Jul 2013 New SOP for BCPFT Hospital Managers Appeal and Renewal Hearings Page 24 of 24 Version 2.0 October 2016