Mental Health Act restraint
The Mental Health Act (MHA) 2007 came into force in November 2008. The Act primarily amends and updates the MHA 1983. I It supports dignity in care by setting out the processes that must be followed and the safeguards for patients, to ensure that they are not inappropriately detained or treated. The main purpose of mental health legislation is to ensure that people with serious mental disorders can be treated without consent where it is necessary to prevent them from harming themselves or others. The 2007 Act was also used as a vehicle to introduce the Deprivation of Liberty Safeguards into the MCA 2005.
The main changes to the 1983 Act made by the 2007 amendments are:
Definition of mental disorder: a single definition applies throughout the Act, references to categories of disorder are abolished.
Criteria for detention: to be detained or ‘sectioned’ someone must be suffering from a mental disorder that requires assessment or treatment and this needs to be given in hospital in the interests of their own health or safety or to protect other people (Rethink 2011).
Professional roles: the Act replaced the role of the approved social worker with that of the approved mental health professional. The role is similar and requires specific training in the application of Mental Health legislation but practitioners are no longer required to have a social work qualification. They may be a psychologist, occupational therapist or psychiatric nurse
Nearest relative: a patient may now make an application to the county court to displace their nearest relative if they believe them to be ‘not a suitable person to act as such’.
Community Treatment Orders: were put in place to allow certain patients with a mental disorder to be discharged from hospital but supervised in the community to ensure, for example, they continue taking their medication or receive therapy. If they fail to comply with their treatment plan they can be recalled to hospital. This is particularly intended to help avoid situations in which some patients leave hospital and do not continue with their treatment, with the result that their health deteriorates and they require detention again – this is sometimes referred to as ‘the revolving door’.
Electro-convulsive therapy (ECT): ECT cannot generally be given without consent. If the patient lacks capacity ECT can be used if it is certified as ‘appropriate’, but it must not conflict with a valid and applicable advance decision or refusal of treatment by an LPA acting within their powers. In emergency situations, for example, in very severe cases of depression, ECT can be given without consent only where it is immediately necessary either to save the patient’s life or to prevent a serious deterioration of their condition (Mental Health Law Online).
Age-appropriate services: hospital managers are required to ensure that patients aged under 18 admitted to hospital for mental disorder are accommodated in an environment that is suitable for their age (subject to their needs).
Independent mental health advocates (IMHAs): although advocacy had been previously available the Act made independent mental health advocacy a requirement for ‘qualifying patients’. Mental health professionals must let people know they have a right to an IMHA. Qualifying patients are those with a mental disorder who are:
detained in hospital under the MHA
subject to a Guardianship Order under the MHA
subject to a Community Treatment Order in the community
discussing with their doctor the possibility of psychosurgery (any surgical operation on the brain tissue)
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