MENTAL HEALTH AND LEARNING DISABILITY OPERATIONAL POLICY FOR THE IMPLEMENTATION OF SECTION 5 (2) OF THE MENTAL HEALTH ACT Document Reference No: Version No: 1 PTHB / MHP 070 Issue Date: September 2018 Review Date: September 2021 Author: Document Owner: Accountable Executive: Approved By: Head of Complex and Unscheduled Care, Mental Health Assistant Director Mental Health, Learning Disability and CAMHS Director of Primary and Community Care and Mental Health Senior Management Team Approval Date: 20 September 2018 Document Type: Policy Clinical Scope: Mental Health Service and Powys THB Hospitals The latest approved version of this document is online. If the review date has passed please contact the Author for advice. Powys Teaching Health Board is the operational name of Powys Teaching Local Health Board Bwrdd Iechyd Addysgu Powys yw enw gweithredol Bwrdd Iechyd Lleol Addysgu Powys
Version Control Version Summary of Changes/Amendments Issue Date 1 Initial Issue Sept 2018 Issue Date: September 2018 Page 2 of 10 Review Date: September 2021
Item Contents No. 1. Introduction 6 2. Objective 6 3. Definitions 6 4. Responsibilites 6 4.1 Assistant Director for Menatl Health and 6 Learning Disabilities 4.2 Doctor/AC role 6 4.3 AMHP role 7 4.4 Nursing Staff role 8 4.5 MHAA role 8 4.6 Hospital Managers role 8 5 Other Considerations 8 5.1 Time limits 8 5.2 Transfer 9 5.3 Treatment 9 5.4 Appeals 9 5.5 Notes 9 6 Service/Professional Commitees or Groups 9 7 Service/Department Specific Policies, Procedures 9 & other written control documents 8 Monitoring Compliance Audit and review 10 9 References/Bibliography 10 Page Issue Date: September 2018 Page 3 of 10 Review Date: September 2021
ENGAGEMENT & CONSULTATION Key Individuals/Groups Involved in Developing this Document Role / Designation Lead for Complex and Unscheduled Care, Mental Health Mental Health Act Administrator Circulated to the following for Consultation Date Role / Designation Assistant Director Mental Health and Learning Disabilities Operations Manager Mental Health Clinical Director Senior Nurses and Service Leads for Mental Health Ward Managers, Mental Health Mental Health Act Administrator Evidence Base Mental Health Act 1983 & 2007 Mental Health Code of Practice 2016 Mental Health Act Administrators; Manual 2009 (draft) Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA DoLS) All Wales Interim Policy & Procedures for the Protection of Vulnerable Adults (2014) Safe Management of Mental Health In-patients. Welsh Assembly Government circular: CNO(2008)01 / CMO(2008)01 NMC The Code for Nurses and Midwives - (NMC 2015) Consent to Treatment Policy (2011) Human Rights Act 1998. Providing Medical Care and Treatment to People who are Detained Guidance. British Medical Association (October 2007) Issue Date: September 2018 Page 4 of 10 Review Date: September 2021
IMPACT ASSESSMENTS Equality Impact Assessment Summary Age Disability Gender Race Religion/ Belief Sexual Orientation Welsh Language Human Rights No impact Adverse Differential x Positive Statement The use of this power confers rights upon the detained individual to ensure that their detention is legal. The procedure will need to be translated into Welsh x Risk Assessment Summary Have you identified any risks arising from the implementation of this policy / procedure / written control document? No risks identified Have you identified any Information Governance issues arising from the implementation of this policy / procedure / written control document? No risks identified Have you identified any training and / or resource implications as a result of implementing this? Refresher training to medical staff will be provided Issue Date: September 2018 Page 5 of 10 Review Date: September 2021
1. Introduction Section 5(2) of the Mental Health Act 1983 authorises the detention of a patient in hospital for a maximum of 72 hours so the patient can be assessed with the view to an application for detention under the Act being made. The patient must be unwilling to remain in hospital in order for the assessment for detention to be made and it must be necessary for the person to remain in hospital until the assessment can be undertaken. Where section 5(2) is used immediately following the nurses holding power under section 5(4) the 72-hour detention period will commence from the start of the section 5(4) order. The power under section 5(2) is not renewable. 2. Objective To ensure that all staff working on wards within Powys, particularly those on mental health units, are aware of their obligations and procedures to be followed when accepting patients who have been detained under the MHA. 3. Definitions AMHP Approved Mental Health Professional AC Approved Clinician CoP Mental Health Act Code of Practice for Wales 2016 MHA Mental Health Act 1983 (as amended by the 2007 Act) MHAA Mental Health Act Administrator PTHB Powys Teaching Health Board CAMHS Children and Adolescent Mental Health Services 4. Responsibilities 4.1 Assistant Director for Mental Health, Learning Disabilities and CAMHS Will ensure that all staff are made aware of this policy Will ensure compliance through a regular programme of audit Will provide training to ensure staff are aware of their responsibilities Will provide assurance to the Executive Director that the requirements of the MHA are being adhered to 4.2 Doctor/AC Role The registered medical practitioner or approved clinician in charge of the patient s treatment will furnish a report on Form HO12 stating how the criteria are met and why informal treatment is no longer appropriate. Copies of the prescribed Mental Health Act forms are available from the following link: http://www.wales.nhs.uk/sites3/page.cfm?orgid=816&pid=33958 Issue Date: September 2018 Page 6 of 10 Review Date: September 2021
The doctor / AC or nominated deputy should only complete Form HO12 after personally examining the patient. The Form HO12 should not be completed and left on the ward with instruction for others to submit it to the Hospital Managers if the patient tries to leave. The detention period under section 5(2) starts when the report is given to the Hospital Managers, i.e. when it is put in the internal mail system or having it hand delivered to a person authorised by the Hospital Managers to receive it. Arrangements should immediately be made by the doctor /AC invoking the holding power for a full assessment to be carried out by a second doctor and an AMHP for possible admission under section 2 or section 3 of the Act. If, whilst awaiting the arrival of the second doctor and the approved mental health professional, the patient s condition improves, the doctor / approved clinician in charge of the patient s treatment or the doctor invoking the power (usually the nominated deputy) can conclude that an assessment is no longer necessary. Detention under section 5(2) will end if an application under section 2 or section 3 is made. Detention under section 5(2) will also end and the patient immediately reverts to informal status if: The result of the assessment indicates that further detention is not necessary. The patient is removed into police custody prior to the assessment being carried out. The patient should be informed once he or she is no longer held under section 5(2) and, if not further detained under the Act, the patient should be informed that they are free to leave hospital if they wish to do so. 4.3 AMHP Role Upon receipt of notification of the section 5(2), the approved mental health professional will liaise with the clinical team and arrange to visit the patient at the earliest opportunity. There should be no unnecessary delay in commencing the assessment, particularly at weekends, and the 60-hour good practice guideline promulgated by the Mental Health Act Commission should be adhered to wherever possible. Issue Date: September 2018 Page 7 of 10 Review Date: September 2021
4.4 Nursing Staff Role The senior nurse in charge of the ward will ensure the report (Form HO12) is delivered to the Hospital Managers representative on completion. The senior nurse in charge of the ward will ensure that the completed receipt and scrutiny checklist is filed in the patient s health record with a copy of the Form HO12. 4.5 The MHAA Role The MHAA will carry out initial scrutiny of the Form HO12 and ensure that a full medical scrutiny is completed at the earliest possible time. The MHAA will ensure that all relevant documents are stored safely in the statutory folder within the Mental Health Act department and copies of all documents are sent to the ward to be filed in the patient health record. The MHAA and/or the nurse in charge of the ward will notify the patient s approved mental health professional (or Team Leader) on receipt of the Form HO12. 4.6 Hospital Managers Role The Hospital Managers will ensure that there are sufficient staff authorised to receive reports within the Directorate in order to ensure that the patient is received onto section 5(2) without unnecessary delay. The Hospital Managers will ensure that all patients detained under section 5(2) are provided with a copy of leaflet 4 which explains their legal rights in a medium that they understand. The Hospital Managers will obtain interpretation and translation services for the patient if required. The Hospital Managers should monitor the use of section 5(2) at quarterly intervals which should be presented to the Powers of Discharge Committee and Mental Health Services Assurance committee. 5 Other considerations 5.1 Time Limits The power to detain under section 5(2) lasts for a maximum of 72 hours (which will include any time that the patient is held under section 5(4), the nurse s holding power)and commences when the report (Form HO12) is delivered to the Hospital Managers or someone authorised to receive it on their behalf. The end date and time should be accurately recorded in the patient s notes, together with the reasons and outcome. Issue Date: September 2018 Page 8 of 10 Review Date: September 2021
5.2 Transfer Section 19 does not provide for the lawful transfer of a patient detained under section 5(2) to other hospitals. Where circumstances indicate that an immediate transfer to more appropriate facilities is necessary, the patient should be transferred informally or assessed without delay to determine whether detention under section 2 or section 3 is appropriate. Any transfer of patients under common law should be fully documented in the patient s health record. If, following transfer, the patient tries to leave the receiving hospital, a new holding power can be applied to provide authority to detain the patient in that hospital. 5.3 Treatment Part 4 of the Mental Health Act 1983 (medical treatment) does not apply to a patient detained under section 5(2). The patient can only be given treatment if he/she consents; in the absence of the patient s consent, treatment can only be given once under common law. 5.4 Appeals A patient detained under section 5(2) cannot make an application to the Mental Health Review Tribunal for Wales or appeal to the Hospital Managers. 5.5 Notes Section 5(2) can be used in a General Hospital; in such instances contact must be made immediately with the nearest Psychiatric unit. Section 5(2) cannot be used in Accident & Emergency Departments because the patient is not an inpatient at that time. Nominated deputies Guidance on the nomination of deputies is given in sections 8.9, 8.10 and 8.11 of the CoP which should be strictly adhered to. It is bad practice to allow a section 5(2) to lapse. Under no circumstances should instructions to use the powers under section 5(2) be left in advance of any situation. 6. Service /professional committees or groups Power of discharge committee Mental Health Services Assurance Committee 7. Service/Department Specific Policies, Procedures & other written control documents Mental health Act Code of Practice 2016. Issue Date: September 2018 Page 9 of 10 Review Date: September 2021
8. Monitoring Compliance Audit and review Audit of the application of Section 5(2) will form part of the rolling programme of MHA audits. This document will be reviewed every three years or earlier should audit results or changes to legislation / practice within the PTHB indicate otherwise. 9. References / Bibliography Mental Health Act 1983 Code of Practice for Wales. Revised 2016. Issue Date: September 2018 Page 10 of 10 Review Date: September 2021