RECEIPT & SCRUTINY OF MENTAL HEALTH ACT PAPERS

SECTION: 8.0 - MENTAL HEALTH LEGISLATION POLICY AND PROCEDURE NO: 8.07 NATURE AND SCOPE: SUBJECT: POLICY & PROCEDURE - TRUSTWIDE RECEIPT & SCRUTINY OF MENTAL HEALTH ACT PAPERS This policy/procedure relates to the receipt and scrutiny of Mental Health Act papers and sets out a procedure and guidance for checking that the papers for patients who are to be detained in hospital or who are subject to Community Treatment Orders are legally correct. DATE OF LATEST RATIFICATION: AUGUST 2018 RATIFIED BY: EXECUTIVE LEADERSHIP TEAM IMPLEMENTATION DATE: MAY 2015 REVIEW DATE: JULY 2021 ASSOCIATED TRUST POLICIES & PROCEDURES: Mental Health Act 1983 -Section 5 Holding Power 8.06 Consent to Examination or Treatment 1.03 ISSUE 5 AUGUST 2018

1.0 Introduction 2.0 Policy Principles Receipt and Scrutiny of MHA Papers 8.07 NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST RECEIPT & SCRUTINY OF MENTAL HEALTH ACT PAPERS 2.1 General Guidance 2.2 General Procedure 2.3 Errors on Section Papers CONTENTS 2.4 Errors which cannot be rectified under S.15 2.5 Errors which can be rectified under S.15 (unless the documents have been issued by a Court) 2.6 Notes on Fresh Medical Recommendations 2.7 Invalid Applications 2.8 Actions to be taken if the Trust accepts that Detention is Invalid 2.9 Actions to be taken if the Trust does not accept that Detention is Invalid 2.10 Hospital Orders 2.11 Renewals of Detention in Hospital or Community Treatment Orders 3.0 Responsibilities 4.0 Training 5.0 Target Audience 6.0 Review Date 7.0 Consultation 8.0 Legislation Compliance 9.0 Monitoring Compliance 10.0 Equality Impact Assessment 11.0 Champion and Expert Writer 12.0 References Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 Appendix 7 Appendix 8 Checklist for Ward Nursing Staff MHA Administrators Checklist for Section 2 Papers MHA Administrators Checklist for Section 3 Papers MHA Administrators Checklist for Section 4 Papers MHA Administrators Checklist for CTO1 and CTO 3 and CTO5 papers List of Forms Referred to in this Policy Equality Impact Assessment (EIA) Screening Tool Record of Changes ISSUE 5 AUGUST 2018 2

1.0 INTRODUCTION Receipt and Scrutiny of MHA Papers 8.07 NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST MENTAL HEALTH ACT 1983 - RECEIPT AND SCRUTINY POLICY 1.1 Receipt and Scrutiny is the process of checking that the section papers for patients who are to be detained or subject to Community Treatment Orders under the Mental Health Act 1983 are legally correct. 1.2 For the purpose of the Mental Health Act 1983, Nottinghamshire Healthcare NHS Foundation Trust itself undertakes the role of hospital managers. It is the hospital manager s duty to ensure that patients are only detained as the Act allows. Most of the decisions of the hospital managers are taken by individuals or groups of individuals on behalf of the hospital managers (MHA Code 2015 (37.5)). 1.3 The Trust has a scheme of delegation which sets out who should be authorised to undertake functions on behalf of the hospital managers. 2.0 POLICY PRINCIPLES 2.1 General Guidance 2.1.1 The Hospital Managers have the authority to detain patients admitted under the Mental Health Act 1983. They have the key responsibility for ensuring that the requirements of the Act are followed. 1 The Hospital Managers can formally delegate their duties to receive and scrutinise papers to staff within the Trust. 2.1.2 Receipt of documents may be undertaken by the practitioner (most likely a nurse) in charge of the ward. If the person is below the grade of first level nurse or equivalent, he or she should seek the advice of a first level nurse, or equivalent, when receiving documents. 2.1.3 Scrutiny and rectification of documents is undertaken by the Mental Health Act administrators. Mental Health Act administrators will use the checklists in the Appendices to detect errors which may or may not be rectified at a later stage in the procedure. 2.1.4 Medical Scrutiny is undertaken by a Consultant Psychiatrist with appropriate clinical expertise. The identity of the medical scrutineer will be found on a rota which is made up for that purpose and circulated in advance. 2.1.5 If no original pink forms are available, photocopies of an original form can be used as can computer-generated forms. Colour and size of paper is not crucial. The wording of the forms must correspond to the current versions of the forms set out in the Mental Health (Hospital Guardianship and Treatment) (England) Regulations 2008. The name and designation of papers required to authorise detention a person in hospital or a Community Treatment Order, including renewals, are reproduced in the Appendix. The papers can also be found on the Trust intranet: 2.2 General Procedure http://connect/mental-health-act-section-forms?smbfolder=434 2.2.1 On admission, the member of staff receiving the admission documents should check the documents for obvious errors. Section 6(3) of the Mental Health Act 1983 1 Mental Health Act Code of Practice 2015 paragraph 37.3 ISSUE 5 AUGUST 2018 3

allows the receiving officer to act upon the documents without further proof of the signature, qualifications or of any matter of fact or opinion stated in them 2.2.2 If the documents appear to the member of staff receiving them to be completed accurately, the member of staff will complete Form H3 (Record of detention in hospital) or CT04 (record of detention after recall) whichever is appropriate in the circumstances. 2.2.3 With the exception of Section 5(4), a patient s detention commences only when the papers have been accepted by or on behalf of the Hospital Managers and the Form H3 has been completed. 2.2.4 In the event that the papers appear not to be valid, the Mental Health Act Administrator must be contacted immediately. If this occurs out of office hours, assistance should be sought from the relevant AMHP team. 2.2.5 The papers should be photocopied and placed in the patient s healthcare records, and the original papers must be sent to the Mental Health Act Department by the next working day. 2.2.6 The appropriate checklist will be completed by the Mental Health Act administrator. Any errors which can be amended must only be amended by the person completing the Section Paper, within 14 days. All amendments must be initialled and dated. 2.3 Errors on Section Papers 2.3.1 Section 15 of the Mental Health Act 1983 provides for rectifiable errors to be amended by the person completing the form, within the period of 14 days, beginning with the date the patient is admitted to hospital. Section 15 does not apply to documents which are issued by the Court. 2.3.2 There is no provision in the Act for rectification of CTO documentation. Significant errors or inadequacies in community treatment orders themselves may render patient s community treatment order invalid, and errors in recall notices or revocations may invalidate hospital managers authority to detain (MHA Code 13.16). 2.4 Errors which cannot be rectified under s 15 2.4.1 If any forms contain the errors below there is no legal authority for a patient s detention. Authority can only be obtained through a new application. The forms are not signed by person (or persons in the case of joint medical recommendations) who is empowered under the Act to do so. The two medical recommendations are more than 5 clear days apart (this refers to the dates on which the doctors examined the patient) The application by an AMHP is not completed within 14 days of seeing the patient. The application is completed after the medical recommendations. The admission of the patient to hospital is later than 14 days after the completion of the later of the two medical recommendations. The Medical recommendations which support an application for detention under section 3 do not state the name of the hospital where appropriate treatment is available. The patient has been admitted or conveyed to a hospital which is not named on the application form or in the case of a CTO, the hospital named on the CTO3 notice of recall. ISSUE 5 AUGUST 2018 4

2.5 Errors which can be rectified under s 15 (unless the documents have been issued by a Court) 2 2.5.1 The following may be rectified within 14 days of the patient being admitted on a section: The leaving blank of a space on the form other than the signature. Failure to delete one or more alternatives. A patient s forename, surname or address not being fully completed or being inaccurately stated or not being identical on all forms. Spelling mistakes. Genuine errors in entering dates. Where each medical recommendation is valid, but taken together they do not comply with the Act (e.g. two doctors from the same hospital); one of the recommendations can be replaced with a new one. The detention will be valid if together the existing recommendation and the new recommendation comply with the Act. In this case the normal time-period governing medical recommendations (i.e. 5 clear days) ceases to apply. A single medical recommendation for Section 3 which contains insufficient clinical description of grounds for detention may be disregarded and replaced with a fresh recommendation within the 14 day specified period. However, it is not possible to amend a joint medical recommendation as both will be found to be insufficient. 2.5.2 The person who signed the form must rectify any errors and initial and date the correction, within the specified timescale. This does not apply when a new medical recommendation is completed. 2.6 Notes on Fresh Medical Recommendations 2.6.1 If a fresh medical recommendation is required, the Applicant (the AMHP) should be notified. It is the responsibility of the applicant and not the doctor to obtain the fresh recommendation within 14 days of the formal admission to hospital. 2.6.2 A fresh (replacement) medical recommendation does not have to be made by the same doctor who completed the one considered insufficient. In cases where, for example, neither of the recommendations was from a section12 approved doctor or the two doctors were from the same hospital/unit, a different doctor would be required. 2.6.3 Where one of the two recommendations is insufficient (e.g. because the clinical description is inadequate or neither doctor is S.12 approved) a third medical recommendation may be obtained. 2.6.4 If an application is supported by two inadequate/invalid medical recommendations it is not possible to replace both. Neither is it possible to obtain a third medical recommendation to supplement a defective joint medical recommendation. 3 Any new application must be accompanied by medical recommendations which comply with the Act, but this does not exclude the possibility of one of the two existing medical recommendations being used if the time limits and other provisions of the Act still apply. 2.6.5 Rectification of errors may be made at the unit/ward level by staff when receiving papers, or later by the MHA Administrator. If there are correctable errors, the person responsible for the error, (the doctors or the AMHP concerned) should be asked to 2 See 2.10 Hospital Orders 3 S.15 of MHA 1983 Subsection (2) ISSUE 5 AUGUST 2018 5

2.7 Invalid Applications Receipt and Scrutiny of MHA Papers 8.07 return to rectify the papers within 14 days of the formal admission. If this appears impractical, papers may be sent by first class post and returned by post. In this case, copies must be kept as a record until the rectified papers are returned. 2.7.1 Situations in which an invalid detention may be found could include where:- The practitioner receives the section paperwork on the ward at the time of the admission. The MHA Administrator scrutinises the section paperwork. The Hospital Managers conduct an appeal/renewal hearing. A solicitor acting on behalf of the patient raises the issue. 2.7.2 Where the problem with the papers is found by the practitioner in charge of the ward at the time of receipt, the following steps should be taken: - If the question has been raised by anyone other than the MHA Administrator for the area concerned, it should be immediately raised with the MHA administrator. The MHA Administrator should gather and review all the facts/evidence and if there seems to be a real doubt about the lawfulness of detention, discuss it with the MHA line manager as a matter of urgency. The MHA line manager will make a decision about whether the detention is unlawful. Before any detention is declared invalid, the MHA line manager may consider that advice may need to be sought from the Trust s solicitors to establish the legal position. In no circumstances should any action be taken to declare a detention invalid until the above procedure has been followed. The law allows a reasonable period of time for the Trust to establish whether or not detention is invalid. It is Trust policy to rectify minor errors, where necessary. Minor errors such as misspellings, even if left uncorrected may not invalidate the application. In the event of a dispute where the Trust believes that an application is valid, the position is that the detention remains in place until set aside by a Court. 2.8 Actions to be taken if the Trust accepts that detention is invalid 2.8.1 If the detention is declared invalid the following will apply:- The patient s responsible clinician will be notified. In the case of detention on the ward (including recall from a CTO), the issue will be discussed with the practitioner in charge of the ward to ensure an appropriate practitioner informs the patient that they are not detained under a section of the Act and the reason for this. The practitioner should also advise the patient of their right to seek legal advice and of the advisability of them accepting medical/nursing advice about remaining in hospital. A letter will be sent to the patient to confirm this information in writing and to advise the patient to take legal advice. ISSUE 5 AUGUST 2018 6

If the responsible clinician s view is that the patient does not meet the criteria for detention or recall from a CTO, the patient may be given advice from both medical and nursing staff to stay in hospital, but is free to remain or leave as they wish. The doctor in charge will complete a s23 discharge form. If the patient is an inpatient, consideration may be given to the use of section 5(4) or section 5(2) where the criteria are met. Note: The use of s 5(2) or 5(4) is prohibited by the Act where the patient is on a CTO but not recalled. 2.9 Actions to be taken if the Trust does not accept that detention is invalid 2.9.1 The action to be taken in these circumstances will vary according to where the challenge to the section is coming from. If it is from Trust staff no action needs to be taken other than to ensure a full note of the issue and the reason for upholding the sections are placed in the medical records. 2.9.2 If the challenge is directly from the patient or their representative the Trust will seek legal advice and respond as advised. 2.10 Hospital Orders Section 15, which allows for the correction of errors in statutory documents, does not apply to Hospital Orders or other documents issued by the Court. Unlike civil sections, Hospital Orders are not accepted by the Hospital Managers and paperwork cannot be corrected. Any serious errors should be raised by the MHA Manager with the Clerk to the Court, but should not be thought to invalidate the section unless there is direction to this effect from the Court. 2.11 Renewals of detention in hospital or Community Treatment Orders 2.11.1 There is no provision in Section 15 for the rectification of defective renewal documentation. 2.11.2 The renewal documentation must be completed by the Responsible Clinician, before the section 3/37 or CTO expires, and not more than two months before expiry date. Non-compliance with these requirements will result in the renewal being invalidated. 3.0 RESPONSIBILITIES 3.1 Executive Directors, Clinical Directors and Managers of appropriate seniority will be responsible for ensuring that local procedures are agreed for each Care Group they manage and that these are updated periodically. 4.0 TRAINING 4.1 Mental Health Act Training will include papers workshops. 5.0 TARGET AUDIENCE 5.1 All staff to whom responsibility for receiving and scrutinising Mental Health Act Section Papers has been delegated by the Trust s Hospital Managers. 6.0 REVIEW DATE 6.1 Review of this policy will commence 3 years after implementation or in light of legislative or organisational change. 7.0 CONSULTATION ISSUE 5 AUGUST 2018 7

7.1 Executive Leadership Council 8.0 LEGISLATION COMPLIANCE 8.1 This policy must be read in conjunction with Section 15 of the MHA 1983 and the MHA Code of Practice 2015. 9.0 MONITORING COMPLIANCE 9.1 All Mental Health Act Section papers are scrutinised by the MHA Caseworkers for amendable errors and a checklist is completed. (See attached appendices) They are then medically scrutinised. 9.2 A quarterly report is submitted to the MHA Associate Managers Committee Meeting. Where appropriate, a report will be made to the Legislation Operational Group. 10.0 EQUALITY IMPACT ASSESSMENT 10.1 This policy has been assessed using the Equality Impact Assessment Screening Tool. The assessment concluded that the policy would have no adverse impact on, or result in the positive discrimination of, any of the diverse groups which include the disability, ethnicity, gender, gender identity, age, sexual orientation, religion/belief, social inclusion and community cohesion with the exception for Human Rights. 10.2 The Mental Health Act allows for the detention of a person against their consent, with appropriate appeals process. By ensuring the policy is correctly enacted this seeks to redress the balance for Human Rights implications. 11.0 CHAMPION AND EXPERT WRITER 11.1 The Champion of this policy is Dr Julie Hankin, Medical Director. The Expert Writer is Mike Sergeant, MHA/MCA/DOLS Lead. 12.0 REFERENCES Section 15 of the Mental Health Act 1983 Mental Health Act Code of Practice 2015 Chapter 35 ISSUE 5 AUGUST 2018 8

APPENDIX 1 RECEIPT OF MHA SECTION PAPERS: A QUICK GUIDE FOR WARD STAFF The AMHP application and medical recommendations: Section 2 1 x Form A2 (AMHP Application) 1 x Form A3 or 2 x Form A4 (Medical Recommendations) 1 x Form H3 (Record of Detention) Check that all papers are signed and dated. Check that the AMHP application is dated on or after the medical recommendations. It must not be before. Check that the AMHP application names the admitting hospital (the name of the ward is not essential). Section 3-1 x Form A6 (AMHP Application) 1 x Form A7 or 2 x Form A8 (Medical Recommendations) 1 x Form H3 (Record of Detention) Check that all papers are signed and dated. Check that the AMHP application is dated on or after the medical recommendations. It must not be before. Check that the AMHP application names the admitting hospital. The name of the ward is not essential unless the medical recommendations state that treatment is only available on that ward. Check that section 3 medical recommendations name the hospital where appropriate treatment is available. The AMHP application must be made out to that hospital. Record of Detention (Form H3): If the patient is admitted to the ward on Section, part (a) of Form H3 is completed. The time written on Form H3 should match the admission time on RIO. If the patient who is placed on a Section is already an inpatient, part (b) of Form H3 is completed. Transfers to the ward from outside the Trust (Form H4): If a detained patient is transferred to the ward from outside the Trust, a Form H4 is required from the transferring ward. Clarify that this has been completed prior to the transfer being accepted. Part 2 (Record of Admission) of the H4 should be completed when the patient arrives on the ward. An H4 is not required for transfer between Trust hospitals e.g. Millbrook to Highbury. Sending for scrutiny: Take photocopies of section papers for the patients file. Scan the section papers through to the MHA Office as soon as possible. Send the original section papers to the MHA Office. The MHA caseworker will scrutinise the papers and may need to return for correction. ISSUE 5 AUGUST 2018 9

RECEIPT OF CTO RECALL PAPERS: A QUICK GUIDE FOR WARD STAFF Notice of Recall (CTO3) Check that the CTO3 is signed and dated. Check that the CTO3 names the admitting hospital (the name of the ward is not essential a patient may be recalled to an outpatient s clinic). This may be the hospital where either the patient is currently an informal inpatient, or the hospital where the patient has been brought. Ensure that the CTO1 the current Community Treatment Order - and associated documentation such as variation of conditions (CTO2) and any subsequent renewals (CTO7) are in the patient s file. Record of patient s detention in hospital after recall (CTO4) The nurse will complete on arrival at the hospital. If the patient is already on a ward at the time that the CTO3 is served, complete the CTO4 at the time of service. Ensure that the form is dated and timed. The 72 hour period of recall begins from that time. Revocation of Community Treatment Order (CTO5) Check that all three parts of the CTO5 are signed and dated by the AMHP and the RC. Revocation never precedes recall. Check that there is a valid CTO3 and CTO4 following recall. Ensure that the underlying section 3 (or 37) papers are placed with the CTO5. Sending for scrutiny: Take photocopies of the papers for the patients file. Scan the papers through to the MHA Office as soon as possible. Send the original papers to the MHA Office. The MHA caseworker will scrutinise the papers and may need to return for correction. ISSUE 5 AUGUST 2018 10

MHA OFFICE ADMINISTRATORS CHECKLIST SECTION 2 Receipt and Scrutiny of MHA Papers 8.07 APPENDIX 2 1. APPLICATION SECTION 2 Yes No Has an application been received either on: Form A1 (Sec 2 Nearest Relative) Form A2 (Sec 2 AMHP) Has Nottinghamshire Healthcare NHS Foundation Trust been stated in the address of the hospital? (Necessary if ward is B1, B2 at Bassetlaw or Mother & Baby at QMC) Are all the names and addresses on the document correctly spelt? If any alterations or crossings out appear on the form they must be initialled by the person signing the form (if not, return to originator for amendment) Is the application made out to the hospital to which the patient was admitted? Is the name and spelling of the hospital correct? Have all alternatives/options been deleted? Is the application signed? Is the application dated? Has the applicant seen patient within the period of 14 days ending with the signing of the application? Is application date the same as or after the medical recommendation (it must not be before?) Has nearest relative been informed or every effort made to contact them? AMHP report includes details how the nearest relative was identified and informed The patient must be admitted within 14 days from the date of the last medical recommendation (if not, application is invalid) If any alterations or crossings out appear on the forms they must be initialled by the person signing the form (if no, return to originator for amendment) Are all: (i) blank spaces on forms which should have been filled in been completed (ii) alternatives/options deleted 2. MEDICAL RECOMMENDATIONS SECTION 2 Have two medical recommendations been received either on one form A3 or 2 form A4s? Are all the names and addresses on all documents correctly spelt? If any alterations or crossings out appear on the forms they must be initialled by the person signing the form (if not, return to originator for amendment) Yes No ISSUE 5 AUGUST 2018 11

Are the examinations not more than 5 clear days apart? Are the recommendations dated on or before the date of the application? Is at least one recommendation by a doctor previously acquainted with the patient? If no previous acquaintance, is a reason given on the application? Is one doctor approved under Section 12 of the MHA 1983? Do both doctors work as part of the same team or is one directly managed by the other? Are the recommendations signed? Are the recommendations dated? 3. FORM H3 (RECORD OF DETENTION IN HOSPITAL) Is it correctly completed? ISSUE 5 AUGUST 2018 12

MHA ADMINISTRATORS CHECKLIST SECTION 3 Receipt and Scrutiny of MHA Papers 8.07 APPENDIX 3 1. APPLICATION Yes No Has application been received either: Form A5 (Sec 3 Nearest relative) Form A6 (Sec 3 AMHP) Has Nottinghamshire Healthcare NHS Foundation Trust been stated in the address of the hospital? (Necessary if ward is B1, B2 at Bassetlaw or Mother & Baby at QMC) Are all the names and addresses on the document correctly spelt? If any alterations or crossings out appear on the form they must be initialled by the person signing the form (if not, return to originator for amendment) Is the application made out to the (or one of the) hospital(s) named in the medical recommendations? Is the application made out to the hospital to which the patient was admitted? Is the name and spelling of the hospital correct? Have all alternatives/options been deleted? Is the application signed? Is the application dated? Has the applicant seen patient within the period of 14 days ending with the signing of the application? Is application date the same as or after the medical recommendation (it must not be before?) Has nearest relative been consulted or every effort made to contact them? Has nearest relative NOT objected to application being made if has application cannot proceed (Sec11(4)) AMHP report included ensuring details how the nearest relative was identified and consulted The patient must be admitted within 14 days of the signing of the last medical recommendation (if not, application is invalid) If any alterations or crossings out appear on the forms they must be initialled by the person signing the form (if no, return to originator for amendment) Are all: (i) blank spaces on forms which should have been filled in been completed (ii) alternatives/options deleted ISSUE 5 AUGUST 2018 13

2. MEDICAL RECOMMENDATIONS Have 2 medical recommendations been received either on one form A7 or two on form A8 (Sec 3) Are all the names and addresses on all documents correctly spelt? If any alterations or crossings out appear on the forms they must be initialled by the person signing the form (if not, return to originator for amendment) Yes No Are the examinations not more than 5 clear days apart? Are the recommendations dated on or before the date of the application? Is at least one recommendation by a doctor of previously acquainted with the patient? If no previous acquaintance, is a reason given on the Application? Is one doctor approved under Section 12 of the MHA 1983? Do both doctors work as part of the same team or is one directly managed by the other? Recommendation(s) state that appropriate medical treatment will be available if the patient is admitted to one or more specific hospitals (or units within a hospital) (CoP 4..77). Trust name only not acceptable Are the recommendations signed? Are the recommendations dated? 3. FORM H3 (RECORD OF DETENTION IN HOSPITAL) Is it correctly completed? ISSUE 5 AUGUST 2018 14

APPENDIX 4 Medical Recommendations MHA ADMINISTRATORS CHECKLIST SECTION 4 Yes No 1 Is there one medical recommendation on Form A11? 2 Is the medical recommendation signed by a doctor previously acquainted with the patient? 3 If NO, has the paragraph set aside on Form A10 been completed? 4 Is the date of admission on Form H3 within 24 hours of the recommending doctor s examination? Application Yes No 1 Is there an application on Form A9 or A10 2 If the application is on Form A9, has it been signed and dated by the nearest relative? OR 3 If the application is on Form A10, has it been signed and dated by an AMHP? 4 Did the applicant see the patient within 24 hours, ending with the time of the application? 5 Has the admission taken place within 24 hours, starting with the time of the medical examination or with the time of the application, whichever is earlier? All Documents 1 Are name and address spelt correctly on all documents 2 Are alternatives/options deleted 3 If alterations or crossings out appear on the forms, are they initialled by person signing form 4 Have all the forms been made out to the appropriate hospital? Yes No If the answers to questions marked with an asterisk the documents must be declared INVALID and there is no authority to detain. New forms must be provided. Amendments to other errors must be done within 14 days of patient s admission. NB: Section 15 does not allow rectification of an emergency application after it has expired unless it has been converted under the provisions of section 4(4) to a Section 2. Receive and Complete Forms Form H3. Record of detention in hospital:- Yes No ISSUE 5 AUGUST 2018 15

MHA ADMINISTRATORS CHECKLIST COMMUNITY TREATMENT ORDER (FORM CT01) APPENDIX 5 Part 1 Yes No Full name and address of responsible clinician inserted? Patient s name and address in full and spelt correctly? Opinion section completed? Have conditions been imposed (other than the 2 necessary conditions)? Has separate sheet been used and attached? Is Part 1 signed and dated? Part 2 Full name and address of Approved Mental Health Professional inserted? AMHP working on behalf of named Local Social Services Authority (LSSA)? AMHP approved by named LSSA (if different from above)? Is Part 2 signed and dated? Part 3 Has RC inserted time and date when CTO will be effective? Is Part 3 signed and dated? ISSUE 5 AUGUST 2018 16

LIST OF FORMS REFERRED TO IN THIS POLICY (For a complete list and blank copies of all MHA papers see Trust intranet) A1 Section 2: Nearest Relative Application A2 Section 2: Approved Mental Health Professional Application A3 Section 2: Joint Medical Recommendation A4 Section 2: Single Medical Recommendation A5 Section 3: Nearest Relative Application A6 Section 3: Approved Mental Health Professional Application A7 Section 3: Joint Medical Recommendation A8 Section 3: Single Medical Recommendation A9 Section 4: Nearest Relative Application A10 Section 4: Approved Mental Health Professional Application H1 Section 5(2): Doctor s Holding Power H2 Section 5(4): Nurse s Holding Power H3 Record of Detention in Hospital H4 Transfer to a hospital under different Hospital Managers H5 Renewal of detention CTO1 Community Treatment Order CTO2 Variation of CTO conditions CTO3 Notice of Recall to Hospital CTO4 Record of Patient s Detention after Recall CTO5 Revocation of Community Treatment Order CTO7 CTO Renewal APPENDIX 6 ISSUE 5 AUGUST 2018 17

EQUALITY IMPACT ASSESSMENT (EIA) SCREENING TOOL (Towards an Equality and Recovery Focused Organisation) APPENDIX 7 A. Name of policy/procedure/strategy/plan/function etc. being assessed: RECEIPT & SCRUTINY OF MENTAL HEALTH ACT PAPERS B. Brief description of policy/procedure/strategy/ plan/function etc. and reason for EIA: This policy/procedure relates to the receipt and scrutiny of Mental Health Act papers and sets out a procedure and guidance for checking that the papers for patients who are to be detained in hospital or who are subject to Community Treatment Orders are legally correct. C. Names and designations of EIA group members: Michael Sergeant MHA/MCA Lead Local Services Division Jaswinder Basi CPA & MHA Manager. Michelle Booth MHA Hospital Mangers Administrator D. List of key groups/organisations consulted: Executive Leadership Council E. Data, Intelligence and Evidence used to conduct the screening exercise: Mental Health Act Code of Practice ISSUE 5 AUGUST 2018

F. Equality Strand Does the proposed policy/procedure/ strategy/ plan/ function etc. have a positive or negative (adverse) impact on people from these key equality groups? Please describe Race This policy aims to have a positive impact on any member of the wider community. Consequently the Trust as a public authority must, in the exercise of its functions, have due regard to the need to a) eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010 in regard to the nine protected characteristics in the Equality Act 2010 (age, disability gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex, sexual orientation). Are there any changes which could be made to the proposals which would minimise any adverse impact identified? What changes can be made to the proposals to ensure that a positive impact is achieved? Please describe Have any mitigating circumstances been identified? Please describe Areas for Review/Actions Taken (with timescales and name of responsible officer) N/A N/A Expert Writer to review in 3 years Gender- Including Transgender and Pregnancy & Maternity Disability Including Mental Health, Intellectual and Learning Disabilities Religion/Belief The policy must be read in the context of the statement of guiding principles found in Chapter 1 of the Mental Health Act Code of Practice As Race As Race N/A Expert Writer to review in 3 years As Race. However, as mental health is classified as a disability under the Disability Discrimination Act this policy promotes consistency of mental health issues. ISSUE 5 AUGUST 2018 19 N/A N/A Expert Writer to review in 3 years As Race N/A Expert Writer to review As Race in 3 years Sexual Orientation- As Race As Race N/A Expert Writer to review

Including Marriage & in 3 years Civil Partnership Age As Race As Race N/A Expert Writer to review in 3 years Social Inclusion 1 As Race As Race N/A Expert Writer to review in 3 years Community Cohesion 2 As Race As Race N/A Expert Writer to review in 3 years Human Rights 3 - Including Safeguarding As Race As Race N/A Expert Writer to review in 3 years 1 for Social Inclusion please consider any issues which contribute to or act as barriers, resulting in people being excluded from society e.g. homelessness, unemployment, poor educational outcomes, health inequalities, poverty etc. 2 Community Cohesion essentially means ensuring that people from different groups and communities interact with each other and do not exclusively live parallel lives. Actions which you may consider, where appropriate, could include ensuring that people with disabilities and non-disabled people interact, or that people from different areas of the City or County have the chance to meet, discuss issues and are given the opportunity to learn from and understand each other. 3 The Human Rights Act 1998 prevents discrimination in the enjoyment of a set of fundamental human rights including: The Right to a Fair Trial; Freedom of Thought, Conscience and Religion; Freedom of Expression; Freedom of Assembly and Association; the Right to Education; the Right Not to be Subjected to Torture, Degrading or Inhumane Treatment; and the Right to Enjoy Private, Family and Home Life Without Unjustified Interference from Public Authorities. G. Conclusions and Further Action (including whether a full EIA is deemed necessary and agreed date for completion) H. Screening Tool Consultation End Date I. Name and Contact Details of Person Responsible for EIA (tel. e-mail, postal) J. Name of Group Approving EIA (i.e. Directorate E&D Group; Divisional Workforce, Equality & Diversity Group; Trustwide E&D Subcommittee; or Divisional Policy & Procedures Group) This policy has been assessed using the Equality Impact Assessment Screening Tool. The assessment concluded that the policy, properly followed, would have no adverse impact on any of the nine protected characteristics in the Equality Act 2010 (age, disability gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex, sexual orientation). Equality and Diversity Sub-Committee of Board of Directors Michael Sergeant e-mail: michael.sergeant@nottshc.nhs.uk Postal: Mental Health Act Department, Duncan Macmillan House, Porchester Road, Mapperley, Nottingham NG3 6AA ISSUE 5 AUGUST 2018 20

APPENDIX 8 Policy/Procedure for: Receipt & Scrutiny of MHA Papers Issue: 05 Status: Author Name and Title: APPROVED Mike Sergeant, MHA/MCA/DOLS Lead Issue Date: AUGUST 2018 Review Date: JULY 2021 Approved by: Distribution/Access: EXECUTIVE LEADERSHIP TEAM NORMAL RECORD OF CHANGES DATE AUTHOR POLICY/ PROCEDURE DETAILS OF CHANGE Aug 10 J Harris 8.07 Changes to Section 2 and Appendices 1 to 3 Dec 2013 February 2015 May 2018 M Sergeant M Sergeant M Sergeant 8.07 (Issue 3) 8.07 (Issue 3) 8.07 (Issue 5) Changes and additions throughout MHA 2015 Code References Changes and additions throughout ISSUE 5 AUGUST 2018 21