Mental Health Act Policy Practice Guidance Note Tribunal Reports V04 Date Issued Issue 1 May 16 Planned review May 2019 MHA-PGN-05 Part of NTW(C)55 Mental Health Act Policy Author/Designation Responsible Officer / Designation Sandra Ayre - Mental Health Legislation Manager Rajesh Nadkarni Executive Medical Director Contents Section Description Page No 1 Introduction 1 2 Responsibilities 1 3 Documentation / Reports 2 4 Change in patient circumstances 4 5 Change in Patient Status 4 6 Withholding Information in the Report 5 7 MAPPA Information in Social Circumstances Reports 5 8 Reports and statements relating to the Deprivation of Liberty Safeguards 6 9 Reports for conditionally discharged patients 6 10 Guidance for detaining Authorities and Tribunal Panels about medical evidence for the First Tier Tribunal Mental Health 11 Reports for Managers Panel Hearings 7 12 Impact on Equality and Diversity 8 13 Training and Support 8 14 Implementation 8 15 Review and Monitoring 8 7 Northumberland, Tyne and Wear NHS Foundation Trust
Appendices listed separate to practice guidance note Appendix Description Issue Issue Date Review Date Appendix 1 Authority Report (in-patient) Appendix 2 In-patient Nurse report Appendix 3 Responsible Clinician (in-patient) report Appendix 3a Responsible Clinician (In-patient) alternative report Appendix 4 Social circumstances (In-patient) report Appendix 5 Appendix 6 Appendix 7 Appendix 7a Appendix 8 Appendix 9 Appendix 10 Appendix 10a Appendix 11 Appendix 12 Social Circumstances (under 18 years old) report Authority Report (Community Treatment Order patient) Responsible Clinician (Community Treatment Order) report Responsible Clinician (Community Treatment Order) alternative report Social circumstances (Community Treatment Order) report Social Circumstances (Community Treatment Order under 18 years old) report Responsible Clinicians (Conditionally Discharged Patients) Report Responsible Clinician (Conditionally discharged Patients) alternative report Social Circumstances (Conditionally discharged patients over the age of 18) Report Social Circumstances (Conditionally discharged patients under the age of 18) report Appendix 13 Non-disclosure Request Template Appendix 14 Report Addendum Template Northumberland, Tyne and Wear NHS Foundation Trust
1 Introduction 1.1 The Tribunal is an independent judicial body. Its main purpose is to review the cases of detained, conditionally discharged and Community Treatment Order (CTO) patients under the Act and to direct the discharge of any patients where it thinks it appropriate. 1.2 It is for those who believe that a patient should continue to be detained or remain a CTO patient to prove their case, not for the patient to disprove it. They will therefore need to present the Tribunal with sufficient evidence to support continuing liability for detention or CTO. 1.2 Clinical and social reports form the backbone of this evidence. Care should be given to ensure that all information is as up to date as possible to avoid adjournment. In order to support the Tribunal in making its decision all information should be clear and concise. 2 Responsibilities 2.1 The Tribunal s rules and procedures place a statutory duty on the managers of the relevant responsible hospital to provide the Tribunal with a statement of relevant facts together with certain reports. 2.2 Professional staff are required to provide information and reports which are timely, factual, consistent, up to date, accurate, clearly written, typed, signed and dated. 2.3 It is important that reports are written for the specific purpose of the forthcoming Tribunal. 2.4 Where possible, reports should be written by the professionals with the best overall knowledge of the patient s situation. 2.5 If the Tribunal panel feels that it needs more information in respect of any report, it may request it, either in the form of a supplementary report or by questioning a witness at the hearing itself. 2.6 Training and development will ensure training is available for those staff needing to update their knowledge of Mental Health Tribunals. 2.7 Mental Health Legislation Steering Group (MHLSG) will ensure this practice guidance note is monitored, reviewed and updated as necessary. Northumberland, Tyne and Wear NHS Foundation Trust 1
3 Documentation / Reports 3.1 It is important that documents and information are provided in accordance with the Tribunal s rules and procedures in good time for any Tribunal hearing. Missing, out-of-date or inadequate reports can lead to adjournments or unnecessarily long hearings. Where responsible clinicians, social workers, nurses or other professionals are required to provide reports, they should do this promptly and within the statutory timescales, that is (except in section 2 cases) as soon as is practicable and in any event within 3 weeks after the responsible authority made the reference or received a copy of the application or reference. See 3.5 below for conditionally discharged patients. 3.2 Where a report or statement is late, the Tribunal will send a direction to the writer of the late report personally. The Tribunal will generally give the report writer, a further seven days to comply. If the direction is not complied with then the case may be referred to the Judiciary to consider a summons. If the summons is not complied with the Tribunal can if they so choose refer the person to the Upper Tribunal for consideration of a penalty. 3.3 Information, documents and report format will comply with the Tribunals Judiciary s Practice Direction, Health and Social Care Chamber, Mental Health cases available on the internet; http://www.judiciary.gov.uk/wpcontent/uploads/jco/documents/practice+directions/tribunals/statements-in-mentalhealth-cases-hesc-28102013.pdf 3.3 Report formats have been designed to capture the necessary information required by the Tribunal; these are shown in appendices to this PGN and are listed below. Staff must follow these formats to provide consistency and ensure the necessary requirements of the Practice Directions in 3.2 above are met. However, the trust recognises the diverse needs of services and its service users and that there are times when the report format may not meet all requirements. For this reason individual report providers may add relevant sections to the report template but nothing should be removed. 3.4 The report templates are shown in; Appendix 1 - Authority report (in-patient) Appendix 2 - In-patient Nurse report Appendix 3 - Responsible Clinician (in-patient) report Appendix 3a Responsible Clinician (in-patient) Alternative report Appendix 4 - Social circumstances (In-patient) report Appendix 5 - Social Circumstances (under 18 years old) report Appendix 6 - Authority report (Community Treatment Order) Appendix 7 - Responsible Clinician (Community Treatment Order - patient) report Appendix 7a - Responsible Clinician (Community Treatment Order patient Alternative report Appendix 8 - Social circumstances (Community Treatment Order - patient) report Northumberland, Tyne and Wear NHS Foundation Trust 2
Appendix 9 - Social Circumstances (Community Treatment Order - patient under 18 years old) report Appendix 10 - Responsible Clinicians (Conditionally Discharged Patients) report Appendix 10a - Responsible Clinicians (Conditionally Discharged Patient Alternative report Appendix 11 - Social Circumstances (Conditionally discharged patients over the age of 18) report Appendix 12 - Social Circumstances (Conditionally discharged patients under the age of 18) report Appendix 13- Non-disclosure Request Template Appendix 14- Report Addendum Template 3.5 For conditionally discharged patients the responsible clinician and any social supervisor named by the Secretary of State must send or deliver their reports to the tribunal so that they are received by the tribunal as soon as practicable and in any event within 3 weeks after the notification of an application or reference from the tribunal. The report templates for conditionally discharged patients are the same as detailed in Appendices above. 3.6 It is essential for the authors to re-familiarise themselves with the content of any report before the hearing. 3.7 The responsible authority must ensure that up-to-date reports prepared specifically for the Tribunal are provided in accordance with the Tribunal s rules and procedures. In practice, this will normally include a report completed by the patient s responsible clinician. Where the patient is under the age of 18 and the responsible clinician is not a child and adolescent mental health service (CAMHS) specialist, hospital managers should ensure that a report is prepared by a CAMHS specialist. 3.8 Specific information is required for patients who are under 18 years old and report templates have been designed to meet this requirement. 3.9 Reports should be sent to the Mental Health Legislation Office that requested them for transmission by secure e-mail to the appropriate Tribunal office. 3.10 On receiving a request from the Mental Health Legislation Administrator to compile a report for a patient, the authors must give themselves enough time to prepare and consider carefully what is required. They should; work through the specified contents of the report, giving the relevant information that is required and any additional information to ensure that a comprehensive picture is given ensure they are familiar with the Trusts Corporate Identity Guidelines and that their report is prepared in accordance with its requirements utilise his/her knowledge of GMC or NMC guidelines on record keeping and work with these standards in mind Northumberland, Tyne and Wear NHS Foundation Trust 3
be able to prepare and present effective reports on a patient when an appeal is made to either the Tribunal or the Hospital Managers Panel. 3.11 Key points for reports Reports should be factual, consistent, up to date and accurate, written in a way that the meaning is clear, concise and contemporary (avoid copying large sections of patient information from previous notes and records and pasting into reports) Do not include abbreviations, jargon or meaningless phrases Check spelling, punctuation and grammar before submitting Reports should be typed, signed and dated Allow enough time to complete and return the report within the required timescales Keep a copy of the report in the patients records and a note of how, when and to whom you submitted it. 4 Change in patient circumstances 4.2 In some circumstances, the Tribunal will not sit immediately after receiving the report. In these cases, the report writers should consider whether anything in the patient s circumstances have changed and should produce a concise update to the report using the addendum template (Appendix 14). 4.3 Hospital managers should ensure that the Tribunal is notified immediately of any events or changes that might have a bearing on Tribunal proceedings for example, where a patient is discharged or one of the parties is unavailable. 4.4 In the case of a restricted patient, if the opinion of the responsible clinician or other professional changes from what was recorded in the original Tribunal report(s), it is vital that this is communicated in writing, prior to the hearing, to the Tribunal office and the Mental Health Unit of the Ministry of Justice to allow them the opportunity to prepare a supplementary statement. 5 Changes in Patient Status 5.1 Where there is a change in the patient s status, such as a patient becomes a CTO patient or moves from detention under section 2 to section 3, the application will need to be considered under the new circumstances, and the report will need to provide a justification for continued detention or liability to recall under the new circumstances. 5.2 The Tribunal may ask the author of the report to talk through it, so it is important the authors re-familiarise themselves with the content of any report before the hearing. If the author of the report is unable to attend, it is important that anyone attending in their place should familiarise themselves with the content of the report and also have a good knowledge of the patient s case. Northumberland, Tyne and Wear NHS Foundation Trust 4
5.3 An addendum to a previously submitted report should only be used where an existing report has become out-of-date, or if the status or the circumstances of the patient has changed since your previous report was written but before the tribunal hearing has taken place (e.g. if a patient is discharged, or is recalled), the author of the report should then send to the tribunal an addendum addressing the up-to-date situation and, where necessary, the new applicable statutory criteria. A template for this is in Appendix 14. 5.4 An addendum should also be submitted if directed by the Tribunal. 6 Withholding Information in the Report 6.1 Ultimately, it is for the Tribunal to decide what should be disclosed to the patient. If the author of a report prepared for the Tribunal is aware of information they do not think the patient should see, they should follow the Tribunal s procedure set out below for the submission of such information. Any document not for disclosure to the patient should be annotated clearly A written explanation as to reasons for requesting non-disclosure to be attached The Tribunal can override the wishes of the author of the report The Tribunal will only agree to non-disclosure: o where there are compelling reasons to do so, and o they are convinced that disclosure would be likely to cause that person or some other person serious harm (physical and mental health) The Tribunal may give a direction that reports are to be made available to the patient s representative Guidance contained in the Code of Practice (chapter 38.28 and 38.29) in relation to managers panels is similar to above 6.2 The non-disclosure request template in Appendix 13 should be used to inform the MHT of any non-disclosure request. 7 MAPPA Information in Social Circumstances Reports 7.2 Where the person is subject to MAPPA the above, in Section 6, continues to apply. If the author considers that the information should not to be disclosed to the patient then they must highlight the reasons why and provide details of the harm / risks to the patient or other person. Northumberland, Tyne and Wear NHS Foundation Trust 5
7.3 The Tribunals Judiciary Practice Direction First-Tier Tribunal Health and Social Care Chamber Statements and reports in Mental Health Cases states that information regarding MAPPA should include - whether the patient is known to any MAPPA meeting or agency and, if so, in which area, for what reason, and at what level - together with the name of the Chair of any MAPPA meeting concerned with the patient, and the name of the representative of the lead agency; 7.4 The Practice Direction also states that in the event that a MAPPA meeting or agency wishes to put forward evidence of its views in relation to the level and management of risk, a summary of those views (or an Executive Summary may be attached to the report); and where relevant, a copy of the Police National Computer record of previous convictions should be attached. 8 Reports and statements relating to the Deprivation of Liberty Safeguards 8.1 Where a patient lacks the mental capacity to agree or object to their care, treatment and/or admission to hospital a statement should be included in the Responsible Clinician and the Social Circumstances Reports regarding the consideration of the use of the Deprivation of Liberty Safeguards as an alternative to the use of detention under the MHA. 8.2 The statement should include details as to why the MHA is the appropriate detention authority over the DoLS in this particular case. This can include; Eligibility criteria for MHA and DoLS Whether treatment is predominantly for mental disorder or physical disorder Any objection and likelihood of continued/non-continued compliance Mental capacity and/or any fluctuating capacity Treatment required for health or safety of others Wishes/views and feelings of the patient Impact of detention on patient and others Any valid and applicable Advance Decision and/or LPA 9 Reports for conditionally discharged patients 9.1 If the patient is a conditionally discharged patient, there is a requirement that the reports are sent to the Tribunal directly. The Secretary of State must send or deliver a statement to the Tribunal so that it is received by the Tribunal as soon as practicable, and in any event within the required timescales 9.2 The required reports are: A report by the Responsible Clinician (completed on Appendix 10 or 10A) with any further information in order to provide a comprehensive picture included Northumberland, Tyne and Wear NHS Foundation Trust 6
A social circumstances report - (completed on Appendix 11 or 11A (as applicable)) with any further information in order to provide a comprehensive picture included 10 Guidance for detaining Authorities and Tribunal Panels about medical evidence for the First Tier Tribunal Mental Health 10.1 The Tribunal Judiciary and the Royal College of Psychiatrists have jointly produced guidance to ensure all Medical Practitioners who give evidence to Tribunals are qualified to do so. The guidance refers to the need for higher trainees to attain the required experience (in relation to report writing) under supervision. The document also includes guidance on Medical Report writing, experience required to give oral evidence at a Tribunal hearing and observations at Tribunal hearings See Annex / or include link. 11 Reports for Managers Panel Hearings 11.1 The content for panel hearings is not prescribed by legislation and it is usual practice to mirror the content of reports required for Tribunals (see Code of Practice 38.32 re content of the Responsible Clinician report) 11.2 Reports are required from RC and from other key individuals involved in the patient s care e.g. named nurse, care co-ordinator, social worker, OT, Psychology. 11.3 It is essential to include; History of violence or self harm Recent risk assessment Up to date information regarding the presence or absence of adequate community care arrangements which may be critical in deciding whether continued detention or CTO is necessary. 11.4 Other Documentation may be required (as applicable) by Managers Panels; Renewal Report (Copy of Form H5 or H6 as the case may be) Extension Report CTO (Copy of Form CTO7 or CTO8 as the case may be) Order made by the RC barring an order by NR for the patients discharge (Copy of Form M2) 11.5 MHA Code of Practice contains guidance (Chapter 38) Northumberland, Tyne and Wear NHS Foundation Trust 7
12 Impact on Equality and Diversity 12.1 In conjunction with the Trust s Equality and Diversity Officer this practice guidance note has undergone an Equality and Diversity Impact Assessment which has taken into account all human rights in relation to disability, ethnicity, age and gender. The Trust undertakes to improve the working experience of staff and to ensure everyone is treated in a fair and consistent manner. 13. Training and Support 13.1 Training - Training of staff to comply with this practice guidance note will be integrated into the MHA/MCA/DoLS training programme. A stand alone session may be delivered in response to local need. 13.2 Support for the operation of this practice guidance note will be sought via line management, and the Mental Health Legislation Steering Group. 14 Implementation 14.1 This practice guidance note will be implemented at ratification and reviewed in 3 years or sooner if there are changes to national or local guidance. 15 Review and Monitoring 15.1 This practice guidance note will be monitored by the Mental Health Legislation Steering Group. Any issues with the operation of this document will be brought to the attention of the Quality and Performance Effective Sub Group who will agree any required actions. 15.2 Specific issues detailed below will be reported to MHLC for monitoring: Any directions or summons issued by the Mental Health Tribunal, relating to reports, will be reported by exception to the relevant Quality and Performance Effective Sub Group and the Mental Health Legislation Steering Group. Northumberland, Tyne and Wear NHS Foundation Trust 8