Policy Document Control Page
Title Title: Report Writing and Attendance at (Mental Health) Tribunals and Hospital Managers’ Hearings Policy
Version: 5
Reference Number: CL33
Keywords: Mental Health Act, Reports, Tribunal, Hospital Manager, Hearings, Independent Mental Health Advocates, Tribunal Service, MHT, MHRT, Appeals, Renewals, Discharges, Practice Directions
Supersedes : Policy on Report Writing and Attendance at Mental Health Review Tribunals and Hospital Managers’ Hearings V4 Includes the Practice Direction amendments submitted by the Senior President of Tribunals with the agreement of the Lord Chancellor in the exercise of powers conferred by Section 23 of the Tribunals, Courts and Enforcement Act 2007. Nearest relative powers of discharge Includes guidance for Detaining Authorities and Tribunal Panels about medical evidence for First Tier Tribunal – mental health New Report Writing Templates included Originator
Originated By: Mental Health Law Manager
Designation: On behalf of the MH Law Scrutiny Group
Equality Analysis Assessment (EAA) Process
Equality Relevance Assessment Undertaken by: ERA undertaken on: ERA approved by EAA Work group on:
Where policy deemed relevant to equality -
EAA undertaken by: Mental Health Law Manager
EAA undertaken on: 28.01.2016
EAA approved by EAA work group on: 29.01.2016
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 1 of 65 Hospital Managers’ Hearings Policy V5 Approval and Ratification
Referred for approval by: Mental Health Law Manager
Date of Referral: 5th February 2016
Approved by: Operational Management Group
Approval Date: 5th February 2016
Date Ratified by Executive Directors: 5th February 2016
Executive Director Lead: Medical Director
Circulation
Issue Date: 8th February 2016
Circulated by: Performance and Information
Issued to: An e-copy of this policy is sent to all wards and departments
Policy to be uploaded to the Trust’s External Website? YES – Must be in word format so staff can use the report templates
Review Review Date: January 2017
Responsibility of: MHL Manager
Designation: MHL Manager
. This policy is to be disseminated to all relevant staff.
This policy must be posted on the Intranet.
Date Posted: 8th February 2016
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 2 of 65 Hospital Managers’ Hearings Policy V5 Guiding Principles
It is essential that all those undertaking the functions under the Mental Health Act 1983 (MHA) understand the five sets of overarching principles which should always be considered when making decisions in relation to care, support or treatment provided under the Act.
The five overarching principles are:
Least restrictive option and maximising independence Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. Wherever possible a patient’s independence should be encouraged and supported with a focus on promoting recovery wherever possible.
Empowerment and involvement Patients should be fully involved in decisions about care, support and treatment. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this.
Respect and dignity Patients, their families and carers should be treated with respect and dignity and listened to by professionals.
Purpose and effectiveness Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines.
Efficiency and equity Providers, commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. All relevant services should work together to facilitate timely, safe and supportive discharge from detention.
Staff must apply the principles to all decisions.
Any decision to depart from the directions of the policy and the Code of Practice must be justified and documented accordingly in the patient’s case notes. Staff should be aware that there is a statutory duty for these reasons to be cogent and appropriate in individual circumstances.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 3 of 65 Hospital Managers’ Hearings Policy V5 Contents
Number Item Page 1 Trust Statement 5 2 Aims of the Policy 5
3 Scope 5
4 Definitions 5 – 8
5 Accountabilities and Responsibilities Duty of Responsible Authority 8 Authorship of Report 9 Attendance 10
6 Preparation for the Hearings 11 7 Report Compilation 11 - 12
8 Timescales for Submissions of Reports 13
9 Withholding Information From Patients 13 10 Decision to Discharge 14
11 Special Notes 15
12 Withdrawal Requests 15 13 Monitoring of this Policy 15 14 Resources 16 Appendices 1 Practice Direction: First Tier Tribunal, Health Education 17-32 and Social Care Chamber, Statements and Reports in Mental Health Cases 2 Medical Report – Inpatient 33-35 3 Medical Report – Community 36-38 4 Social Circumstances Report – Inpatient 39-42 5 Social Circumstances Report – Community 43-46 6 Nursing Reports 47-49 7 Flowchart for Authorship of Social Circumstance 51 Reports & Attendance at Tribunal 8 Electronic Submission Guidance 52 9 Mental Health Law Team – Contact List 53 10 Rule 14 of the Tribunal Procedure (2008) relating to use 54 of Documents and Information 11 Guidance for MAPPA Referrals, Levels and Categories 55-60 12 Nearest Relative Powers of Discharge 61 13 Guidance for Detaining Authorities and Tribunal Panels 62-65 about medical evidence for First Tier Tribunal – mental health
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 4 of 65 Hospital Managers’ Hearings Policy V5 1. TRUST STATEMENT
1.1. As part of the Trust’s commitment to good practice and reducing risk associated with the management of the Trust, it is necessary to have a consistent approach in the production of professional reports and attendance at First Tier Tribunals (Mental Health) (commonly referred to as Mental Health Tribunal and Hospital Managers’ Reviews.
2. AIMS OF THE POLICY
2.1. The aim of this policy is to standardise, clarify and provide guidance to staff for preparing reports and for attendance at Mental Health Tribunals and Hospital Managers hearings.
2.2. This policy provides templates for those staff responsible for producing reports
3. SCOPE
3.1. This policy applies to all First Tier Tribunals (Mental Health) and Hospital Managers hearings for detained patients. The Trust recognises the specific responsibilities placed upon its employees by the Mental Health Act 1983 (MHA), the Tribunal Procedure (First Tier Tribunal) Health Education and Social Care Chamber Rules 2008 and the Tribunal Procedure (Amendment) Rules 2012 for proceedings before the Tribunal in mental health cases.
3.2. This policy should be read and considered in conjunction with the Care Programme Approach Policy (CL3) and the Section 117 Aftercare Policy (CL49).
4. DEFINITIONS
4.1 Responsible Clinician (RC)
4.1.1 The RC will be the approved clinician identified under the Mental Health Act with overall responsibility for the patient’s care.
4.1 Named Nurse (NN) 4.2.1 The primary role of the NN is to co-ordinate the delivery of individualised and comprehensive nursing care from the point of admission to the point of discharge in collaboration with the multi-disciplinary team.
4.3 Care Co-ordinator 4.3.1 A care co-ordinator is the named individual who is designated as the main point of contact and support for a person who has a need for on-going care.
4.4 Social Supervisor 4.4.1 The forensic social supervisor bridges the gap between hospital and community. The social supervisor has several duties including applications to hospital for admission when necessary; arrange aftercare and social assessments amongst others.
4.5 Hospital Managers (HM)
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 5 of 65 Hospital Managers’ Hearings Policy V5 4.5.1 The term ‘Hospital Managers’ as used in the Act, refers to the NHS Trust (or other body such as a private hospital or care home) which detains a person. The legislation gives the Hospital Managers a number of duties and powers, the most prominent of which is the authority to discharge detained patients via Hospital Managers’ hearings. This power and others can be delegated to a committee consisting of people appointed to act as managers but who are not employees of the NHS Trust.
4.5.2 A Hospital Managers’ hearing is very similar in procedure to a Mental Health Tribunal. However in contrast to the Tribunal there is no requirement for the panel to contain legally or medically qualified members. The Hospital Managers’ should contain at least three members who have appropriate experience and training.
4.5.3 Hospital Managers: May undertake a review of whether or not a patient should be discharged at any time at their decision. Must undertake a review if the patient’s RC submits a report to them under section 20 of the Act renewing detention or under section 20A extending the CTO. It is desirable that this review takes place before the section expiry. Should consider holding a review when they receive a request from the patient. Should consider holding a review when the RC makes a report to them under section 25 barring an order by the nearest relative to discharge a patient.
4.5.4 In the last two situations discussed in paragraph 4.5.3 Hospital Managers’ panels are entitled to take into account whether the Tribunal has recently considered the patient’s case or is due to do so in the future.
4.5.5 If a hearing is arranged under section 25 barring an order by the nearest relative the reports need to reflect the dangerousness criteria. Further information can be found at Appendix 12 on the nearest relative powers of discharge and the term dangerousness in this context. Without a thorough explanation of the dangerousness criteria the patient is likely to be discharged.
4.6 Limitations of Hospital Managers 4.6.1 The members of the panel are not in a position to make their own clinical judgments (as they do not have a medical member) and consequently, in the event of a difference of opinion, they should consider adjourning the matter in order to seek further medical or other professional advice.
4.6.2 Hospital Managers are not able to discharge patients under sections 35, 36 or 38. Further, they cannot discharge restricted patients without the agreement of the Secretary of State.
4.7 Discharge Criteria 4.7.1 The legal criteria applied by the Hospital Managers are not stated in the Act but will essentially mirror that of the Mental Health Tribunal.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 6 of 65 Hospital Managers’ Hearings Policy V5 4.7.2 The courts have ruled that in a decision to discharge a person from section, the members of a Hospital Manager’s hearing panel must all agree.
4.8 The First Tier Tribunal (Mental Health) 4.8.1 The Mental Health Tribunal is the statutory, independent body responsible for hearing appeals against detention and references1 for people detained under the Act. It operates like a mobile court and sits at the hospital where the patient is detained. The patient may appeal once in each period of detention to the tribunal.2 Attorneys and deputies appointed by the Court of Protection are also able to appeal if they have the authority under the LPA or the Court if the patient lacks the capacity to do so themselves.
4.8.2 The Tribunal decides whether, at the time of the hearing, the patient concerned should remain subject to the relevant aspect of the Act.
4.8.3 The Tribunal panel is composed of a judge, medical and specialist lay member with the judge chairing the proceedings.
4.8.4 The Tribunal’s recommendations are not binding on Hospital Managers or RC’s (although they must be considered). If its recommendations are not put into practice, the Tribunal may (if it wishes) further consider a patients case, without the patient or anyone else having to make a new application.
4.8.5 The Tribunal also has the power to adjourn a hearing. This maybe for further information in the form of reports or for a witness to attend a reconvened hearing. Directions maybe made as to when and how the information should be provided, and for the issuing of a witness summons in accordance with the relevant rules.
4.8.6 For patients detained under section 2 the hearing must take place within 7 days of receipt of the application by the Tribunal office.
4.8.7 For non-restricted patients the hearing will normally take place within 5 to 8 weeks.
4.8.8 For restricted patients the hearing will normally take place within 14-16 weeks.
4.8.9 Usually once a date has been fixed it will not be changed by the Tribunal Office, however you can apply to the Tribunal (via your local Mental Health Law Office) to request a change of date using form CMR1, The Mental Health Law Office coordinate the hearing and need to ensure that they 1 A hospital will automatically send the case of a patient to the Tribunal after the first 6 months of detention (including anytime spent under S2). A consideration of the case where a patient’s detention is extended under section 29 will be reviewed and a request made to the Secretary of State if appropriate (only if patient detained on section 2) and certainly would be after a period of 6 months. A patient will also be automatically referred if three years (or one year if patient is under 18) have passed without the patient’s case being heard by the Tribunal through any of the above methods. This includes patients on S3, 37, 47, 48, 47/49 and 48/49, although for restricted cases the referral will come from the Secretary of State. The hospital will automatically refer the patient’s case to the Tribunal if the patients Community Treatment Order (CTO) was recalled then revoked, after the first six months of a CTO (or a combination of inpatient and CTO including anytime spent on S2). 2 A person detained on section 37 can make his first application to a tribunal during the second 6 months of his detention.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 7 of 65 Hospital Managers’ Hearings Policy V5 request dates in good time submitting the HQ1 form at the deadline requested by the Tribunal Office. (http://www.justice.gov.uk/forms/hmcts/ts- mh). A judge’s view will be sought as to whether the change of date request should be granted.
4.8.10 Patients aged 18 or over that are subject to a Community Treatment Order (CTO) and have their case referred to the Tribunal may state in writing that they do not wish to attend or be represented at a hearing for a reference, in which case the Tribunal can dispense with a hearing and a preliminary examination by the Tribunal doctor. In all cases involving a CTO patient whose case has been referred to the Tribunal, RC’s are asked to give the Tribunal their assessment of the patient’s capacity to decide whether or not to attend, or be represented at the hearing. It is only in the case of a patient with capacity that the tribunal will hold a paper hearing.
4.8.11 The Tribunal provides a significant safeguard for patients who have had their liberty curtailed under the Act. Those giving evidence at hearings should do what they can to enable Tribunal hearings to be conducted in a professional manner, which includes having regard to the patient’s wishes and feelings and ensuring that the patient feels as comfortable with the proceedings as possible.
4.8.12 It is for those who believe that a patient should continue to be detained or remain as 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 to detention or CTO. 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.
4.8.13 If the patients status changes from section 2 to section 3 during the appeal process they still have the right for the hearing to go ahead within the 7 days. If they are unsuccessful they will have the right to appeal against the section 3 straight away if they wish. The attendees will have to ensure that they evidence the change in section criteria to the Tribunal. This could be verbally on the day of the hearing or if there is time an additional written report. The same is true of section 3 patient’s transferring to section 17A (CTO), however the patient may wish to withdraw the case at that stage.
4.9 The Upper Tribunal (Mental Health)
4.9.1 The Trust or the patient may appeal to the Upper Tribunal (Administrative Appeals Chamber) if there is a legal mistake with the decision made in the First Tier Tribunal. More information can be obtained from the following website: www.gov.uk/administrative-appeals-tribunal/how-to-appeal.
5. ACCOUNTABILITIES AND RESPONSIBILITIES
5.1 DUTY OF RESPONSIBLE AUTHORITY 5.1.1 There is a statutory responsibility on the Responsible Authority to provide the Tribunal with a Statement for restricted and non-restricted cases3 (other than
3 This is taken from the old Rule 6 of MHRT Rules 1983.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 8 of 65 Hospital Managers’ Hearings Policy V5 section 2) within 3 weeks of receipt of the Tribunal’s request. This duty is the responsibility of the MHL Office.
5.1.2 In cases involving patients on a conditional discharge, there is a requirement that RC’s and social supervisors send their reports directly to the Tribunal, ensuring a copy is sent to the MHL Office.
5.1.3 Section 2 reports should be provided to the Mental Health Law Office at least an hour before the hearing is due to commence.
5.1.4 In a restricted case, if the opinion of the RC or social supervisor changes from what it was in the original Tribunal report(s), it is vital that this is communicated in writing, prior to the hearing, to the Tribunal office to allow the Secretary of State the opportunity to prepare a supplementary statement.
5.1.5 It is essential that all reports submitted to the Tribunal or to the Hospital Managers are signed4 by their author and dated. The report must be up-to- date, specifically prepared for the tribunal and have numbered paragraphs and pages.
5.1.6 If the Tribunal so directs copies of the following may have to be made available to the Tribunal:
a) the application, order or direction that constitutes the original authority for detention or guardianship together with supporting recommendations, reports and records made in relation to it under the Mental Health (Hospital Guardianship and Treatment) Regulations 2008
b) a copy of every Tribunal decision, and the reasons given, since the application, order or direction being reviewed was made or accepted:
and
c) where the patient is liable to be detained for treatment under section 3 of the Act a copy of any application for admission for assessment that was in force immediately prior to the making of the section 3 application.
5.2 AUTHORSHIP OF THE REPORT
5.2.1 The Clinicians report must include an up to date clinical report prepared specifically for the Tribunal. The report must be written by or countersigned by the patient’s RC unless it is not reasonably practical to do so. There is guidance in Appendix 13 about medical evidence for the Tribunal and attendees.
5.2.2 The social circumstances report should be prepared by the Care Co- ordinator/Social Supervisor. This may be the patient’s Community Psychiatric Nurse or Social Worker. If the patient is not open to a Community Mental
4 This may not be necessary in the case of reports electronically submitted, a signed copy must still be available within the file -See separate Guidance Appendix 8.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 9 of 65 Hospital Managers’ Hearings Policy V5 Health Team at the point of appeal/renewal of a patient’s detention then the guide in Appendix 7 should be followed by the patient’s clinical team where applicable and appropriate and the MHL Office must be updated in the first instance once a care co-ordinator has been allocated so that report requests can be made. The guide is an example local boroughs may have different procedures in place.
5.2.3 The qualified named nurse for the patient should prepare the nursing reports where possible. Where this is not possible, it is the responsibility of the charge nurse or ward manager to nominate another nurse who has worked with the patient to provide the report.5
5.2.4 If the person who should write the report is unavailable due to leave or sickness, the responsibility for ensuring that a report is completed will rest with their line manager.
5.2.5 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.
5.3 ATTENDANCE 5.3.1 Normally the patient will be present for the Tribunal hearing however; if it is considered that attendance at the hearing will adversely affect the patient’s health or welfare or the health and welfare of others a request can be made to the Tribunal that the patient be excluded from all or part of the proceedings. The patient’s legal representative will usually make the necessary arrangements if this is the case. All patients who do not have the capacity to understand the hearing process must have a legal representative allocated by the Tribunal Service from evidence supplied by the RC. The patient may also wish for an IMHA (Independent Mental Health Advocate) to be present at the hearing. This right does not affect a patient’s right to seek advice from a lawyer and an IMHA does not take the place of a legal representative.
5.3.2 The Tribunal will expect to see the RC or a deputy who knows the patient who, in the opinion of the RC, has sufficient knowledge and experience of the patient and psychiatry to assist the Tribunal in making their decision. It is desirable that the author of the report should attend the hearing. Please see guidance at Appendix 13 which states the advice for medical trainees.
5.3.3 The author of the inpatient nursing report or a suitable deputy should also be in attendance and be prepared to give evidence. The Tribunal will expect a nurse to accompany the patient to the hearing especially if the patient is unrepresented. The nurse will be expected to return for the decision.
5.3.4 It is essential that the Care Co-ordinator or an Approved Mental Health Professional attends the hearing to give further, up to date information about the patient, including information on their home circumstances and after care facilities in the event of a decision to discharge.
5 This does not apply to patients on CTO.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 10 of 65 Hospital Managers’ Hearings Policy V5 5.3.5 Hospital medical records and nursing notes should be made available to the Tribunal on the day.
5.3.6 The RC is permitted to represent the Responsible Authority in some circumstances. This would allow them to make opening and closing submissions like the patients representative and ask questions of the other witnesses including the patient. Permission to do this must be sought through the Mental Health Law Managers office in the first instance. If this is granted the Tribunal would need to be notified and this can be done in writing and included in the clinicians report. In most cases it would be a preferred option for the clinician to ask the Tribunals permission to ask questions during the hearing rather than represent.
6. PREPARATION FOR THE HEARINGS 6.1.1 Wherever possible, the staff that will be attending the hearing may have a pre-meeting to share information. In particular, they should discuss any submissions that are likely to be made by the patient’s representatives, or any independent reports and what response should be made to them. Whilst every effort should be made to resolve any differences of opinion between staff, this may not always be possible, and in such cases staff should express their differences openly and honestly in their initial evidence rather than allow them to emerge during cross-examination.
6.1.2 The Tribunal and Hospital Managers will expect to be provided with information from the professionals concerned on what after care arrangements might be made for them under section 117 if they were to be discharged. Some discussion of after care needs, involving LSSAs (Local Social Services Authorities) and other relevant agencies, should take place in advance of the hearing.
6.1.3 It is important that any risks or concerns about the patient attending their hearing are communicated to the panel and the Mental Health Law Office as soon as possible. An assessment of risk should always be completed taking into account any absconscion risk especially if the hearing room is a long distance away from the ward. Nursing staff must discuss with the RC any concerns following a risk assessment, this should then be communicated to the panel and the Mental Health Law Office.
7. REPORT COMPILATION 7.1.1 Information contained within the reports should comply with the Tribunal Practice Directions (refer to Appendix 1) which has the full force of the law and is legally binding, reports must be accurate and up to date as far as possible whilst complying with the submission requirements (refer to heading 8 below). It is in no one’s interest if cases have to be adjourned because reports are late or lack the crucial facts or the up-to-date information required. Please also refer to report writing guidance templates contained within Appendices 2, Medical Report – Inpatient, 3 Medical Report - Community, 4, Social Circumstances Report - Inpatient, 5 Social Circumstances Report – Community , 6 Nursing Report.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 11 of 65 Hospital Managers’ Hearings Policy V5 7.1.2 The Tribunal no longer allow addendums to reports unless they specifically ask for this following an adjournment.
7.1.3 Reports to the Tribunal should clearly state that they are to be submitted to the Tribunal and that they were prepared for that purpose on the front sheet. Hospital Managers do not require a separate report to be submitted and it is acceptable to use a report that has previously been used for a Tribunal as long as the information is still valid and this may be supplemented with a verbal update on the day.
7.1.4 As reports are often read by lay people, abbreviations and psychiatric terminology should be avoided as much as possible or if they are used, explained in full.
7.1.5 When preparing a report it is useful to avoid repeating information contained in other reports to be submitted and the reports must be co-ordinated in line with the Practice Directions in Appendix 1.
7.1.6 As far as possible, you should avoid un-attributed statement, information or opinions for which you do not have evidence. It is helpful to state the source of the statement, information or opinion or where possible attach the relevant document. Predications regarding a patient’s future behaviour should be supported by accounts of past behaviour. When including third party information the author must seek consent from the party before including in the report or refer to the non-disclosure procedure in 9.1.2.
7.1.7 Reports should be accompanied by any available CPA documentations, Risk Assessments and nursing care plans. Where appropriate this should include references to MAPPA (Multi Agency Public Protection Arrangements) for patients who are eligible. For further guidance on MAPPA please refer to Appendix 11.
7.1.8 The format of the reports should be in corporate style (Arial, size 12, left justified) and the paragraphs should be numbered and double line spacing used.
7.1.9 In some cases the Tribunal may request a skeleton argument to be submitted. It will not always be necessary to respond but if the request is made in the form of a direction then the clinician should seek further advice from the Mental Health Law Managers Office.
7.1.10 The authors of reports should have personally met and be familiar with the patient. If an existing report becomes out-of-date, or if the status or the circumstances of the patient changed after the reports have been written but before the tribunal hearing takes place, 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.
7.1.11 It is acknowledged that within the time constraints allowed it can be difficult for practitioners to complete a full report. The templates have been taken directly from the practice directions and this would be the minimum of information that would need providing to the Tribunal. It is possible on section 2 hearings to provide a verbal report although Tribunals do prefer a written report.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 12 of 65 Hospital Managers’ Hearings Policy V5 8. TIMESCALES FOR SUBMISSIONS OF REPORTS 8.1.1 The Mental Health Act 1983 (as amended by the Mental Health Act 2007) places a statutory responsibility on the Responsible Authority to provide the Tribunal with reports for restricted and non-restricted cases (other than Section 2) within 3 weeks of receipt of the Tribunal’s request. In the case of a section 2 appeal the reports must be provided as soon as possible but no later than an hour before the Tribunal takes place.
8.1.2 Hospital Managers hearings do not have a set time period for submission but it will generally be either one week before renewal meetings or the day before the hearing in the case of appeals.
8.1.3 The Mental Health Law Offices are responsible for ensuring that the required date of submission is communicated to all relevant parties. It is the responsibility of the author to ensure that this date is complied with or to inform the Mental Health Law Office if there will be a delay.
8.1.4 Consideration should be given to preparation of an addendum where there is new information since the report was submitted.
8.1.5 The Human Rights Act leaves Trusts vulnerable to challenge where the statutory time scales and requirements as to the provision of reports are not met, particularly where the hearing is delayed or adjourned for late or non- receipt of reports. The Regional Tribunal Judge may direct Senior Managers to appear before the Tribunal to explain why reports are late.
8.1.6. It has been agreed that electronic submission is the most suitable way of dealing with reports submitted for Mental Health Act Hearings. There is an agreed process for this (see Appendix 8) which should be followed.
9. WITHHOLDING INFORMATION FROM PATIENTS 9.1.1 The person who is being detained has a right to see the reports prepared by their clinical team for the hearings. Authors of the reports should so far as practicable discuss the contents of the reports with the patient.
9.1.2 Patients will be notified of their right to access reports before a hearing and will be sent copies of the reports by the Mental Health Law Office or by the patient’s legal representative. If you do not want any document presented to the Tribunal not to be disclosed to the patient then you must ask the Tribunal for permission that the document is not to be disclosed. You should be aware that the Tribunal may take a different view and decide to disclose the document. Please note it is not acceptable to mark disclaimers on reports, which state words to the effect of “not to be disclosed without the authors consent”. Assuming that such reports are intended for use by the Tribunal, such disclaimers cannot be accepted by the Tribunal and will be ignored.
9.1.3 Where, in the opinion of the RC or the Social Supervisor, information is to be withheld from the patient on the grounds that its disclosure would be likely to
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 13 of 65 Hospital Managers’ Hearings Policy V5 cause that person or some other person serious harm, this should clearly be set out in a separate document from the main report. 6
9.1.4 It is the responsibility of the author of the report to clearly document and provide evidence of the reasons for the information being withheld from the patient or others7 which must comply with Rule 14 (see Appendix 9). This should be attached to the non-disclosure document and clearly marked “Not to be disclosed to the patient without the express permission of the Tribunal”.
9.1.5 The Tribunal may direct that the non-disclosure document(s) be provided to the patient’s representative but the document(s) must not be disclosed either directly or indirectly to any other person without the Tribunal’s consent8.
9.1.6 The Tribunal will only agree to non-disclosure where there are compelling reasons to do so, and where they are satisfied that disclosure would be likely to cause that person or some other person serious harm and they are satisfied that having regard to the interests of justice that it is proportionate to give such a direction.
9.1.7 If you are seeking the non-disclosure of evidence obtained from the patients family and or close friends they should be made aware that the Tribunal will make the decision as to whether or not it is evidence the patient should be aware of and there are no guarantees that the Tribunal will make an order for non-disclosure. Most solicitors will argue the case for disclosure of information within the remit of fairness and justice.
10. DECISION TO DISCHARGE 10.1 If the decision is to discharge the patient, and the staff caring for the patient have serious concerns about this in terms of possible risk to the patient and/or others, they should immediately notify the RC, who will consider what action needs to be taken to minimise that risk.
10.1.2 The RC may approach the Tribunal panel judge in the first instance to request a postponement to the discharge. This could be to allow suitable aftercare provisions to be in place or to consider appealing the decision9. If the judge refuses a postponement the RC should notify the Mental Health Law Office and ensure a full risk assessment is undertaken and documented.
10.1.3 A fresh recommendation for detention cannot be completed in these circumstances and there would need to be new information available before the patient could be detained again.
10.1.4 The Mental Health Act allows a Tribunal decision to be appealed to the Upper Tribunal; however, you can only appeal with permission from the Tribunal being appealed from or the Upper Tribunal. The grounds of appeal must relate to a point of law. In order to appeal against a decision of the Tribunal please contact your local Mental Health Law Office in the first instance.
6 Tribunal Rules, Rule 14 (7) (a) 7 ibid 8 Tribunal Rules, Rule 14 (3) (a) and (b) 9 Appeal to upper Tier-must seek approval to do this through Mental Health Law Manager in the first instance.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 14 of 65 Hospital Managers’ Hearings Policy V5 11. SPECIAL NOTES 11.1 In the case of Section 3/37 and CTO hearings, the Borough guarantees that someone will attend every hearing to advise on discharge arrangements, and it will be the responsibility of the appropriate Team Leader to ensure that this happens.
11.1.2 In the case of Section 2 hearings every effort will be made to ensure that the author of the report will be available, but as notice is short (within 7 days of appeal) this will not always be possible and it will be the responsibility of the line manager of the person concerned to allocate an alternative member of staff to attend.
11.1.3 If there is no Care Co-ordinator in place when an appeal is lodged, the ward should immediately contact the Mental Health Law Office with details of the most appropriate team to contact, the RC is ultimately responsible for ensuring the referral is made. The referral should be given priority, with a view to having a Care Co-ordinator in place before the hearing if possible.
11.1.4 If there continues to be difficulties in obtaining reports or identifying the correct personnel then the Mental Health Law Office should inform the Tribunal office.
11.1.5 Other than for Guardianship cases the burden of proof lies with the detaining authority. This means that it is for the clinical team to satisfy the Tribunal that a patient is detainable and not for the patient to prove they should be discharged.
12 Withdrawal Requests
12.1 A patient may choose to withdraw at any time in the process, even on the day of the hearing. Where the patient has legal representation they must be informed that the patient wishes to withdraw. The solicitor will then make the request that the tribunal withdraw the case as per rule 17 of the Tribunal Rules.
13 Monitoring of This Policy 13.1 The application of this policy will be monitored by the Mental Health Law Scrutiny Group. Local issues will be raised through the Mental Health Law Forums.
13.1.2 Trust wide figures on the number of hearings taking place will be included in the annual KP90 Report that is submitted to the Mental Health Law Forums and MHLSG.
13.1.3 The MHLSG will be responsible for ensuring an audit of the use of this policy is carried out at regular intervals.
13.1.4 As part of the review, monitoring and audit of this policy the MHLSG will consider any learning requirements for Trust Staff. This would include incorporation of this policy, and process in to the Mental Health Law training provided across the Trust.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 15 of 65 Hospital Managers’ Hearings Policy V5 14 Resources
Mental Health Act, Code of Practice 2015 Mental Health Act, Reference Guide 2015 Ministry of Justice: http://www.justice.gov.uk/ Tribunal Website: http://www.gov.uk/ Legal Services Commission: http://www.legalservices.gov.uk/ Care Quality Commission: http://www.cqc.org.uk/
The Appendices listed below are to be used as a guide when completing reports or arranging attendance at hearings. If you choose to deviate away from the information that the template expects you to provide you must be able to evidence in your own records or provide your reasons for doing so if the information within your report is challenged.
Appendix 1 – Practice Direction: First-Tier Tribunal Health Education and Social Care Chamber Statements and reports in Mental Health cases
Appendix 2 - Medical Report – Inpatient
Appendix 3 – Medical Report – Community
Appendix 4 - Social Circumstances Report – Inpatient
Appendix 5 - Social Circumstance Report - Community
Appendix 6 - Nursing Report
Appendix 7 - Flowchart for Authorship of Social Circumstance Reports & Attendance at Tribunal
Appendix 8 – Electronic Submission Guidance
Appendix 9 - Mental Health Law Team – Contact list
Appendix 10 Rule 14 of the Tribunal Procedure (2008) relating to use of Documents and Information
Appendix 11 – Guidance for MAPPA Referrals, Levels and Categories
Appendix 12 – Nearest Relative powers of discharge
Appendix 13 – Guidance for Detaining Authorities and Tribunal Panels about medical evidence for First Tier Tribunal – mental health
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 16 of 65 Hospital Managers’ Hearings Policy V5 Appendix 1
PRACTICE DIRECTION FIRST-TIER TRIBUNAL HEALTH EDUCATION AND SOCIAL CARE CHAMBER STATEMENTS AND REPORTS IN MENTAL HEALTH CASES
1. This Practice Direction is made by the Senior President of Tribunals with the agree- ment of the Lord Chancellor in the exercise of powers conferred by Section 23 of the Tribunals, Courts and Enforcement Act 2007. It applies to a “mental health case” as defined in Rule 1(3) the Tribunal Procedure (First-tier Tribunal) (Health, Education and Social Care Chamber) Rules 2008. Rule 32 requires that certain statements and re- ports must be sent or delivered to the tribunal (and, in restricted cases, to the Secret- ary of State) by the Responsible Authority, the Responsible Clinician and any Social Supervisor (as the case may be). This Practice Direction specifies the contents of such documents. It replaces the previous Practice Directions on mental health cases dated 30 October 2008 and 6 April 2012, with effect from 28 October 2013.
2. In this Practice Direction “the Act” refers to the Mental Health Act 1983 (as amended by the Mental Health Act 2007).
3. This Practice Direction contains five separate parts for the following categories of patient:
A. IN-PATIENTS (NON-RESTRICTED AND RESTRICTED) B. COMMUNITY PATIENTS C. GUARDIANSHIP PATIENTS D. CONDITIONALLY DISCHARGED PATIENTS E. PATIENTS UNDER THE AGE OF 18.
4. Responsible Authorities and authors of reports should refer to the relevant part of this Practice Direction, depending on the status of the patient under the Act.
SIR JEREMY SULLIVAN SENIOR PRESIDENT OF TRIBUNALS
28 October 2013
A. IN-PATIENTS (NON-RESTRICTED AND RESTRICTED)
5. For the purposes of this Practice Direction, a patient is an in-patient if they are detained in hospital to be assessed or treated for a mental disorder, whether admitted through civil or criminal justice processes, including a restricted patient (i.e. subject to special restrictions under the Act), and including a patient transferred to hospital from
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 17 of 65 Hospital Managers’ Hearings Policy V5 custody. A patient is to be regarded as an in-patient detained in a hospital even if they have been permitted leave of absence, or have gone absent without leave.
6. In the case of a restricted patient detained in hospital, the tribunal may make a provisional decision to order a Conditional Discharge. However, before it finally decides to grant a Conditional Discharge, the tribunal may defer its decision so that satisfactory arrangements can be made. The patient will remain an in-patient unless and until the tribunal finally grants a Conditional Discharge, so this part of the Practice Direction applies.
7. If the patient is an in-patient, the Responsible Authority must send or deliver to the tribunal the following documents containing the specified information in accordance with the relevant paragraphs below:
Statement of Information about the Patient. Responsible Clinician’s Report, including any relevant forensic history. Nursing Report, with the patient’s current nursing plan attached. Social Circumstances Report including details of any Care Pathway Approach (CPA) and/or Section 117 aftercare plan in full or in embryo and, where appropriate, the additional information required for patients under the age of 18, and any input from a Multi Agency Public Protection Arrangements (MAPPA) agency or meeting.
8. In all in-patient cases, except where a patient is detained under Section 2 of the Act, the Responsible Authority must send to the tribunal the required documents containing the specified information, so that they are received by the tribunal as soon as practicable and in any event within 3 weeks after the Authority made or received the application or reference. If the patient is a restricted patient, the Authority must also, at the same time, send copies of the documents to the Secretary of State (Ministry of Justice).
9. Where a patient is detained under Section 2 of the Act, the Responsible Authority must prepare the required documents as soon as practicable after receipt of a copy of the application or a request from the tribunal. If specified information has to be omitted because it is not available, then this should be mentioned in the statement or report. These documents must be made available to the tribunal panel and the patient’s representative at least one hour before the hearing is due to start.
10. The authors of reports should have personally met and be familiar with the patient. If an existing report becomes out-of-date, or if the status or the circumstances of the patient change after the reports have been written but before the tribunal hearing takes 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.
Statement of Information about the Patient – In-Patients
11. The statement provided to the tribunal must be up-to-date, specifically prepared for the tribunal, signed and dated, and must include: a) the patient’s full name, date of birth, and usual place of residence; b) the full official name of the Responsible Authority; c) the patient’s first language/dialect and, if it is not English, whether an interpreter is required and, if so, in which language/dialect;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 18 of 65 Hospital Managers’ Hearings Policy V5 d) if the patient is deaf, whether the patient will require the services of British Sign Language Interpreters and/or a Relay Interpreter; e) a chronological table listing: the dates of any previous admissions to, discharge from, or recall to hospital, stating whether the admissions were compulsory or voluntary; the date when the current period of detention in hospital originally commenced, stating the nature of the application, order or direction that is the authority for the detention of the patient; the dates of any subsequent renewal of, or change in, the authority for the patient’s detention, and any changes in the patient’s status under the Act; dates and details of any hospital transfers since the patient’s original detention; the date of admission or transfer to the hospital where the patient now is; the dates and outcomes of any tribunal hearings over the last three years; f) the name of the patient’s Responsible Clinician and the date when the patient came under the care of that clinician; g) the name and contact details of the patient’s Care Co-ordinator, Community Psychiatric Nurse, Social Worker/AMHP or Social Supervisor; h) where the patient is detained in an independent hospital, details of any NHS body that funds, or will fund, the placement; i) the name and address of the local social services authority which, were the patient to leave hospital, would have a duty to provide Section 117 after-care services; j) the name and address of the NHS body which, were the patient to leave hospital, would have a duty to provide Section 117 after-care services; k) the name and address of any legal representative acting for the patient; l) except in the case of a restricted patient, the name and address of the patient’s Nearest Relative or of the person exercising that function, whether the patient has made any request that their Nearest Relative should not be consulted or should not be kept informed about the patient’s care or treatment and, if so, the details of any such request, whether the Responsible Authority believes that the patient has capacity to make such a request and the reasons for that belief; m) the name and address of any other person who plays a significant part in the care of the patient but who is not professionally involved; n) details of any legal proceedings or other arrangements relating to the patient’s mental capacity, or their ability to make decisions or handle their own affairs.
Responsible Clinician’s Report – In-Patients
12. The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The report should be written or counter-signed by the patient’s Responsible Clinician. The sources of information for the events and incidents described must be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, or recite medical records, but must briefly describe the patient’s recent relevant medical history and current mental health presentation, and must include: a) whether there are any factors that may affect the patient’s understanding or ability to cope with a hearing and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly; b) details of any index offence(s) and other relevant forensic history; c) a chronology listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital; d) reasons for any previous admission or recall to hospital; e) the circumstances leading up to the patient’s current admission to hospital; f) whether the patient is now suffering from a mental disorder and, if so, whether a diagnosis has been made, what the diagnosis is, and why;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 19 of 65 Hospital Managers’ Hearings Policy V5 g) whether the patient has a learning disability and, if so, whether that disability is associated with abnormally aggressive or seriously irresponsible conduct; h) depending upon the statutory criteria, whether any mental disorder present is of a nature or degree to warrant, or make appropriate, liability to be detained in a hospital for assessment and/or medical treatment; i) details of any appropriate and available medical treatment prescribed, provided, offered or planned for the patient’s mental disorder; j) the strengths or positive factors relating to the patient; k) a summary of the patient’s current progress, behaviour, capacity and insight; l) the patient’s understanding of, compliance with, and likely future willingness to accept any prescribed medication or comply with any appropriate medical treatment for mental disorder that is or might be made available; m) in the case of an eligible compliant patient who lacks capacity to agree or object to their detention or treatment, whether or not deprivation of liberty under the Mental Capacity Act 2005 (as amended) would be appropriate and less restrictive; n) details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage; o) whether (in Section 2 cases) detention in hospital, or (in all other cases) the provision of medical treatment in hospital, is justified or necessary in the interests of the patient’s health or safety, or for the protection of others; p) whether the patient, if discharged from hospital, would be likely to act in a manner dangerous to themselves or others; q) whether, and if so how, any risks could be managed effectively in the community, including the use of any lawful conditions or recall powers; r) any recommendations to the tribunal, with reasons.
Nursing Report – In-Patients
13. The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The sources of information for the events and incidents described must be made clear. This report should not recite the details of medical records, or be an addendum to (or reproduce extensive details from) previous reports, although the patient’s current nursing plan should be attached. In relation to the patient’s current in-patient episode, the report must briefly describe the patient’s current mental health presentation, and must include: a) whether there are any factors that might affect the patient’s understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly; b) the nature of nursing care and medication currently being made available; c) the level of observation to which the patient is currently subject; d) whether the patient has contact with relatives, friends or other patients, the nature of the interaction, and what community support the patient has; e) strengths or positive factors relating to the patient; f) a summary of the patient’s current progress, engagement with nursing staff, behaviour, cooperation, activities, self-care and insight; g) any occasions on which the patient has been absent without leave whilst liable to be detained, or occasions when the patient has failed to return as and when required, after having been granted leave; h) the patient’s understanding of, compliance with, and likely future willingness to accept any prescribed medication or treatment for mental disorder that is or might be made available; i) details of any incidents in hospital where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 20 of 65 Hospital Managers’ Hearings Policy V5 j) any occasions on which the patient has been secluded or restrained, including the reasons why such seclusion or restraint was necessary; k) whether (in Section 2 cases) detention in hospital, or (in all other cases) the provision of medical treatment in hospital, is justified or necessary in the interests of the patient’s health or safety, or for the protection of others; l) whether the patient, if discharged from hospital, would be likely to act in a manner dangerous to themselves or others; m) whether, and if so how, any risks could be managed effectively in the community, including the use of any lawful conditions or recall powers; n) any recommendations to the tribunal, with reasons.
Social Circumstances Report – In-Patients
14. The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The sources of information for the events and incidents described must be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, but must briefly describe the patient’s recent relevant history and current presentation, and must include: a) whether there are any factors that might affect the patient’s understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly; b) details of any index offence(s) and other relevant forensic history; c) a chronology listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital; d) the patient’s home and family circumstances; e) the housing or accommodation available to the patient if discharged; f) the patient’s financial position (including benefit entitlements); g) any available opportunities for employment; h) the patient’s previous response to community support or Section 117 aftercare; i) so far as is known, details of the care pathway and Section 117 after-care to be made available to the patient, together with details of the proposed care plan; j) the likely adequacy and effectiveness of the proposed care plan; k) whether there are any issues as to funding the proposed care plan and, if so, the date by which those issues will be resolved; l) the strengths or positive factors relating to the patient; m) a summary of the patient’s current progress, behaviour, compliance and insight; n) details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage; o) the patient’s views, wishes, beliefs, opinions, hopes and concerns; p) except in restricted cases, the views of the patient’s Nearest Relative unless (having consulted the patient) it would inappropriate or impractical to consult the Nearest Relative, in which case give reasons for this view and describe any attempts to rectify matters; q) the views of any other person who takes a lead role in the care and support of the patient but who is not professionally involved; r) 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; s) 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;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 21 of 65 Hospital Managers’ Hearings Policy V5 t) in the case of an eligible compliant patient who lacks capacity to agree or object to their detention or treatment, whether or not deprivation of liberty under the Mental Capacity Act 2005 (as amended) would be appropriate and less restrictive; u) whether (in Section 2 cases) detention in hospital, or (in all other cases) the provision of medical treatment in hospital, is justified or necessary in the interests of the patient’s health or safety, or for the protection of others; v) whether the patient, if discharged from hospital, would be likely to act in a manner dangerous to themselves or others; w) whether, and if so how, any risks could be managed effectively in the community, including the use of any lawful conditions or recall powers; x) any recommendations to the tribunal, with reasons.
B. COMMUNITY PATIENTS
15. The Responsible Authority must send to the tribunal the following documents, containing the specified information, so that the documents are received by the tribunal as soon as practicable and in any event within 3 weeks after the Authority made or received the application or reference:
Statement of Information about the Patient
Responsible Clinician’s Report, including any relevant forensic history.
Social Circumstances Report including details of any Section 117 aftercare plan and, where appropriate, the additional information required for patients under the age of 18, and any input from a Multi Agency Public Protection Arrangements (MAPPA) agency or meeting.
16. The authors of reports should have personally met and be familiar with the patient. If an existing report becomes out-of-date, or if the status or the circumstances of the patient change after the reports have been written but before the tribunal hearing takes place (e.g. if a patient is recalled, or again discharged into the community), 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.
Statement of Information about the Patient – Community Patients
17. The statement provided to the tribunal should be up-to-date, signed and dated, specifically prepared for the tribunal, and must include: a) the patient’s full name, date of birth, and current place of residence; b) the full official name of the Responsible Authority; c) the patient’s first language/dialect and, if it is not English, whether an interpreter is required and, if so, in which language/dialect; d) if the patient is deaf, whether the patient will require the services of British Sign Language Interpreters and/or a Relay Interpreter; e) a chronological table listing: the dates of any previous admissions to, discharge from, or recall to hospital, stating whether the admissions were compulsory or voluntary, and including any previous instances of discharge on to a Community Treatment Order (CTO); the date of the underlying order or direction for detention in hospital prior to the patient’s discharge onto the current CTO; the date of the current CTO; the dates of any subsequent renewal of, or change in, the authority for the patient’s CTO, and any changes in the patient’s status under the Act;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 22 of 65 Hospital Managers’ Hearings Policy V5 the dates and outcomes of any tribunal hearings over the last three years; f) the name of the patient’s Responsible Clinician and the date when the patient came under the care of that clinician; g) the name and contact details of the patient’s Care Co-ordinator, Community Psychiatric Nurse, and/or Social Worker/AMHP; h) the name and address of the local social services authority which has the duty to provide Section 117 after-care services; i) the name and address of the NHS body which has the duty to provide Section 117 after-care services; j) the name and address of any legal representative acting for the patient; k) the name and address of the patient’s Nearest Relative or of the person exercising that function, whether the patient has made any request that their Nearest Relative should not be consulted or should not be kept informed about the patient’s care or treatment and, if so, the details of any such request, whether the Responsible Authority believes that the patient has capacity to make such a request and the reasons for that belief; l) the name and address of any other person who plays a significant part in the care of the patient but who is not professionally involved; m) details of any legal proceedings or other arrangements relating to the patient’s mental capacity, or their ability to make decisions or handle their own affairs.
Responsible Clinician’s Report – Community Patients
18. The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. This report should be written or counter-signed by the patient’s Responsible Clinician. The sources of information for the events and incidents described must be made clear. The report should not be an addendum to (or reproduce extensive details from) previous reports, or recite medical records, but must briefly describe the patient’s recent relevant medical history and current mental health presentation, and must include: a) where the patient is aged 18 or over and the case is a reference to the tribunal, whether the patient has capacity to decide whether or not to attend or be represented at a tribunal hearing; b) whether, if there is a hearing, there are any factors that may affect the patient’s understanding or ability to cope with it, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly; c) details of any index offence(s) and other relevant forensic history; d) a chronology listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital; e) reasons for any previous admission or recall to hospital; f) the circumstances leading up to the patient’s most recent admission to hospital; g) the circumstances leading up to the patient’s discharge onto a CTO; h) any conditions to which the patient is subject under Section 17B, and details of the patient’s compliance; i) whether the patient is now suffering from a mental disorder and, if so, what the diagnosis is and why; j) whether the patient has a learning disability and, if so, whether that disability is associated with abnormally aggressive or seriously irresponsible conduct; k) whether the patient has a mental disorder of a nature or degree such as to make it appropriate for the patient to receive medical treatment; l) details of any appropriate and available medical treatment prescribed, provided, offered or planned for the patient’s mental disorder; m) the strengths or positive factors relating to the patient; n) a summary of the patient’s current progress, behaviour, capacity and insight;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 23 of 65 Hospital Managers’ Hearings Policy V5 o) the patient’s understanding of, compliance with, and likely future willingness to accept any prescribed medication or comply with any appropriate medical treatment for mental disorder that is or might be made available; p) details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage; s) whether it is necessary for the patient’s health or safety, or for the protection of others, that the patient should receive medical treatment and, if so, why; t) whether the patient, if discharged from the CTO, would be likely to act in a manner dangerous to themselves or others; u) whether, and if so how, any risks could be managed effectively in the community; v) whether it continues to be necessary that the Responsible Clinician should be able to exercise the power of recall and, if so, why; w) any recommendations to the tribunal, with reasons.
Social Circumstances Report – Community Patients
19. The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The sources of information for the events and incidents described must be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, but must briefly describe the patient’s recent relevant history and current presentation, and must include: a) whether there are any factors that might affect the patient’s understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly; b) details of any index offence(s), and other relevant forensic history; c) a chronology listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital; d) the patient’s home and family circumstances; e) the housing or accommodation currently available to the patient; f) the patient’s financial position (including benefit entitlements); g) any employment or available opportunities for employment; h) any conditions to which the patient is subject under Section 17B, and details of the patient’s compliance; i) the patient’s previous response to community support or Section 117 aftercare; j) details of the community support or Section 117 after-care that is being, or could be made available to the patient, together with details of the current care plan; k) whether there are any issues as to funding the current or future care plan and, if so, the date by which those issues will be resolved; l) the current adequacy and effectiveness of the care plan; m) the strengths or positive factors relating to the patient; n) a summary of the patient’s current progress, behaviour, compliance and insight; o) details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage; p) the patient’s views, wishes, beliefs, opinions, hopes and concerns; q) the views of the patient’s Nearest Relative unless (having consulted the patient) it would inappropriate or impractical to consult the Nearest Relative, in which case give reasons for this view and describe any attempts to rectify matters; r) the views of any other person who takes a lead role in the care and support of the patient but who is not professionally involved; s) whether the patient is known to any Multi Agency Public Protection Arrangements (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;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 24 of 65 Hospital Managers’ Hearings Policy V5 t) 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; u) whether it is necessary for the patient’s health or safety, or for the protection of others, that the patient should receive medical treatment and, if so, why; v) whether the patient, if discharged from the CTO, would be likely to act in a manner dangerous to themselves or others; w) whether, and if so how, any risks could be managed effectively in the community; x) whether it continues to be necessary that the Responsible Clinician should be able to exercise the power of recall and, if so, why; y) any recommendations to the tribunal, with reasons.
C. GUARDIANSHIP PATIENTS
20. If the patient has been received into guardianship the Responsible Authority must send to the tribunal the following documents, containing the specified information, so that they are received by the tribunal as soon as practicable and in any event within 3 weeks after the Authority made or received a copy of the application or reference:
Statement of Information about the Patient
Responsible Clinician’s Report, including any relevant forensic history.
Social Circumstances Report including details of any Care Pathway Approach (CPA) and, where appropriate, the additional information required for patients under the age of 18, and any input from a Multi Agency Public Protection Arrangements (MAPPA) agency or meeting.
21. The authors of reports should have personally met and be familiar with the patient. If an existing report becomes out-of-date, or if the status or the circumstances of the patient change after the reports have been written but before the tribunal hearing takes place, 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.
Statement of Information about the Patient – Guardianship Patients
22. The statement provided to the tribunal should be up-to-date, signed and dated, specifically prepared for the tribunal, and must include: a) the patient’s full name, date of birth, and current place of residence; b) the full official name of the Responsible Authority; c) the patient’s first language/dialect and, if it is not English, whether an interpreter is required and, if so, in which language/dialect; d) if the patient is deaf, whether the patient will require the services of British Sign Language Interpreters and/or a Relay Interpreter; e) a chronological table listing: the dates of any previous admissions to, discharge from or recall to hospital, stating whether the admissions were compulsory or voluntary; the dates of any previous instances of reception into guardianship; the date of reception into current guardianship, stating the nature of the application, order or direction that constitutes the original authority for the guardianship of the patient; the dates and outcomes of any tribunal hearings over the last three years;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 25 of 65 Hospital Managers’ Hearings Policy V5 f) the name and address of any private guardian; g) the name of the patient’s Responsible Clinician and the date when the patient came under the care of that clinician; h) the name and contact details of the patient’s Care Co-ordinator, Community Psychiatric Nurse, and/or Social Worker/AMHP; i) the name and address of any legal representative acting for the patient; j) the name and address of the patient’s Nearest Relative or of the person exercising that function, whether the patient has made any request that their Nearest Relative should not be consulted or should not be kept informed about the patient’s care or treatment and, if so, the details of any such request, whether the Responsible Authority believes that the patient has capacity to make such a request and the reasons for that belief; k) the name and address of any other person who plays a significant part in the care of the patient but who is not professionally involved; l) details of any legal proceedings or other arrangements relating to the patient’s mental capacity, or their ability to make decisions or handle their own affairs.
Responsible Clinician’s Report – Guardianship patients
23. The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The report should be written or counter-signed by the patient’s Responsible Clinician. The sources of information for the events and incidents described must be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, or recite medical records, but must briefly describe the patient’s recent relevant medical history and current mental health presentation, and must include: a) whether there are any factors that may affect the patient’s understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly; b) details of any index offence(s), and other relevant forensic history; c) a chronology listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital, and any previous instances of reception into guardianship; d) the circumstances leading up to the patient’s reception into guardianship; e) any requirements to which the patient is subject under Section 8(1), and details of the patient’s compliance, f) whether the patient is now suffering from a mental disorder and, if so, what the diagnosis is and why; g) whether the patient has a learning disability and, if so, whether that disability is associated with abnormally aggressive or seriously irresponsible conduct; h) details of any appropriate and available medical treatment prescribed, provided offered or planned for the patient’s mental disorder; i) the strengths or positive factors relating to the patient; j) a summary of the patient’s current progress, behaviour, capacity and insight; k) the patient’s understanding of, compliance with, and likely future willingness to accept any prescribed medication or comply with any appropriate medical treatment for mental disorder that is, or might be, made available; l) details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage; m) whether, and if so how, any risks could be managed effectively in the community; n) whether it is necessary for the welfare of the patient, or for the protection of others, that the patient should remain under guardianship and, if so, why; o) any recommendations to the tribunal, with reasons.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 26 of 65 Hospital Managers’ Hearings Policy V5 Social Circumstances Report – Guardianship Patients
24. The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The sources of information for the events and incidents described should be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, but must briefly describe the patient’s recent relevant history and current presentation, and must include: a) whether there are any factors that might affect the patient’s understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly; b) details of any index offence(s), and other relevant forensic history; c) a chronology listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital, and any previous instances of reception into guardianship; d) the patient’s home and family circumstances; e) the housing or accommodation currently available to the patient; f) the patient’s financial position (including benefit entitlements); g) any employment or available opportunities for employment; h) any requirements to which the patient is subject under Section 8(1), and details of the patient’s compliance, i) the patient’s previous response to community support; j) details of the community support that is being, or could be, made available to the patient, together with details of the current care plan; k) the current adequacy and effectiveness of the care plan; l) whether there are any issues as to funding the current or future care plan and, if so, the date by which those issues will be resolved; m) the strengths or positive factors relating to the patient; n) a summary of the patient’s current progress, behaviour, compliance and insight; o) details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage; p) the patient’s views, wishes, beliefs, opinions, hopes and concerns; q) the views of the guardian; r) the views of the patient’s Nearest Relative unless (having consulted the patient) it would inappropriate or impractical to consult the Nearest Relative, in which case give reasons for this view and describe any attempts to rectify matters; s) the views of any other person who takes a lead role in the care and support of the patient but who is not professionally involved; t) 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; u) 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; v) whether, and if so how, any risks could be managed effectively in the community; w) whether it is necessary for the welfare of the patient, or for the protection of others, that the patient should remain under guardianship and, if so, why; x) any recommendations to the tribunal, with reasons.
D. CONDITIONALLY DISCHARGED PATIENTS
25. A conditionally discharged patient is a restricted patient who has been discharged from hospital into the community, subject to a condition that the patient will remain
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 27 of 65 Hospital Managers’ Hearings Policy V5 liable to be recalled to hospital for further treatment, should it become necessary. Other conditions may, in addition, be imposed by the tribunal, or by the Secretary of State (Ministry of Justice).
26. This part only applies to restricted patients who have actually been granted a Conditional Discharge and who are living in the community. In the case of a restricted patient detained in hospital, the tribunal may make a provisional decision to order a Conditional Discharge. Before it finally grants a Conditional Discharge, the tribunal may defer its decision so that satisfactory arrangements can be put in place. Unless and until the tribunal finally grants a Conditional Discharge, the patient remains an in- patient, and so the in-patient part of this Practice Direction (and not this part) applies.
27. Upon being notified by the tribunal of an application or reference, the Responsible Clinician must send or deliver the Responsible Clinician’s Report, and any Social Supervisor must send or deliver the Social Circumstances Report. If there is no Social Supervisor, the Responsible Clinician’s report should also provide the required social circumstances information.
28. The required reports, which must contain the specified information, are:
Responsible Clinician’s Report, including any relevant forensic history.
Social Circumstances Report from the patient’s Social Supervisor, including details of any Section 117 aftercare plan and, where appropriate, the additional information required for patients under the age of 18, and any input from a Multi Agency Public Protection Arrangements (MAPPA) agency or meeting.
29. The reports must be sent or delivered to the tribunal so that they are received by the tribunal as soon as practicable and in any event within 3 weeks after the Responsible Clinician or Social Supervisor (as the case may be) received the notification.
30. The Responsible Clinician and any Social Supervisor must also, at the same time, send copies of their reports to the Secretary of State (Ministry of Justice).
31. The authors of reports should have personally met and be familiar with the patient. If an existing report becomes out-of-date, or if the status or the circumstances of the patient change after the reports have been written but before the tribunal hearing takes place (e.g. if a patient 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.
Responsible Clinician’s Report – Conditionally Discharged Patients
32. The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The report should be written or counter-signed by the patient’s Responsible Clinician. If there is no Social Supervisor, the Responsible Clinician’s report should also provide the required social circumstances information. The sources of information for the events and incidents described must be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, or recite medical records, but must briefly describe the patient’s recent relevant medical history and current mental health presentation, and must include:
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 28 of 65 Hospital Managers’ Hearings Policy V5 a) whether there are any factors that might affect the patient’s understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly; b) details of the patient’s index offence(s), and any other relevant forensic history; c) details and details of the patient’s relevant forensic history; d) a chronology listing the patient’s involvement with mental health services including any admissions to, discharge from and recall to hospital; e) reasons for any previous recall following a Conditional Discharge and details of any previous failure to comply with conditions; f) the circumstances leading up to the current Conditional Discharge; g) any conditions currently imposed (whether by the tribunal or the Secretary of State), and the reasons why the conditions were imposed; h) details of the patient’s compliance with any current conditions; i) whether the patient is now suffering from a mental disorder and, if so, what the diagnosis is and why; j) whether the patient has a learning disability and, if so, whether that disability is associated with abnormally aggressive or seriously irresponsible conduct; k) details of any legal proceedings or other arrangements relating to the patient’s mental capacity, or their ability to make decisions or handle their own affairs; l) details of any appropriate and available medical treatment prescribed, provided, offered or planned for the patient’s mental disorder; m) the strengths or positive factors relating to the patient; n) a summary of the patient’s current progress, behaviour, capacity and insight; o) the patient’s understanding of, compliance with, and likely future willingness to accept any prescribed medication or comply with any appropriate medical treatment for mental disorder; p) details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage; q) an assessment of the patient’s prognosis, including the risk and likelihood of a recurrence or exacerbation of any mental disorder; r) the risk and likelihood of the patient re-offending and the degree of harm to which others may be exposed if the patient does re-offend; s) whether it is necessary for the patient’s health or safety, or for the protection of others, that the patient should receive medical treatment and, if so, why; t) whether the patient, if absolutely discharged, would be likely to act in a manner harmful to themselves or others, whether any such risks could be managed effectively in the community and, if so, how; u) whether it continues to be appropriate for the patient to remain liable to be recalled for further medical treatment in hospital and, if so, why; v) whether, and if so the extent to which, it is desirable to continue, vary and/or add to any conditions currently imposed; w) any recommendations to the tribunal, with reasons.
Social Circumstances Report – Conditionally Discharged Patients
33. The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The sources of information for the events and incidents described should be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, but must briefly describe the patient’s recent relevant history and current presentation, and must include: a) the patient’s full name, date of birth, and current address; b) the full official name of the Responsible Authority;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 29 of 65 Hospital Managers’ Hearings Policy V5 c) whether there are any factors that might affect the patient’s understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly; d) details of the patient’s index offence(s), and any other relevant forensic history; e) a chronology listing the patient’s involvement with mental health services including any admissions to, discharge from and recall to hospital; f) any conditions currently imposed (whether by the tribunal or the Secretary of State), and the reasons why the conditions were imposed; g) details of the patient’s compliance with any past or current conditions; h) the patient’s home and family circumstances; i) the housing or accommodation currently available to the patient; j) the patient’s financial position (including benefit entitlements); k) any employment or available opportunities for employment; l) details of the community support or Section 117 after-care that is being, or could be made available to the patient, together with details of the current care plan; m) whether there are any issues as to funding the current or future care plan and, if so, the date by which those issues will be resolved; n) the current adequacy and effectiveness of the care plan; o) the strengths or positive factors relating to the patient; p) a summary of the patient’s current progress, compliance, behaviour and insight; q) details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage; r) the patient’s views, wishes, beliefs, opinions, hopes and concerns; s) the views of any partner, family member or close friend who takes a lead role in the care and support of the patient but who is not professionally involved; t) whether the patient is known to any Multi Agency Public Protection Arrangements (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; u) 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; v) in the case of an eligible compliant patient who lacks capacity to agree or object to their detention or treatment, whether or not deprivation of liberty under the Mental Capacity Act 2005 (as amended) would be appropriate and less restrictive; w) whether the patient, if absolutely discharged, would be likely to act in a manner harmful to themselves or others, whether any such risks could be managed effectively in the community and, if so, how; x) whether it continues to be appropriate for the patient to remain liable to be recalled for further medical treatment in hospital and, if so, why; y) whether, and if so the extent to which, it is desirable to continue, vary and/or add to any conditions currently imposed; z) any recommendations to the tribunal, with reasons. E. PATIENTS UNDER THE AGE OF 18
34. All the above requirements in respect of statements and reports apply, as appropriate, depending upon the type of case.
35. In addition, for all patients under the age of 18, the Social Circumstances Report must also state: a) the names and addresses of any people with parental responsibility, and how they acquired parental responsibility; b) which public bodies either have worked together or need to liaise in relation to after- care services that may be provided under Section 117 of the Act;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 30 of 65 Hospital Managers’ Hearings Policy V5 c) the outcome of any liaison that has taken place; d) if liaison has not taken place, why not – and when liaison will take place; e) the details of any multi-agency care plan in place or proposed; f) whether there are any issues as to funding the care plan and, if so, the date by which those issues will be resolved; g) the name and contact details of the patient’s Care Co-ordinator, Community Psychiatric Nurse, Social Worker/AMHP or Social Supervisor; h) whether the patient’s needs have been assessed under the Children Act 1989 or the Chronically Sick and Disabled Persons Act 1970 and, if not, the reasons why such an assessment has not been carried out and whether it is proposed to carry out such an assessment; i) if there has been such an assessment, what needs or requirements have been identified and how those needs or requirements will be met; j) if the patient is subject to or has been the subject of a Care Order or an Interim Care Order: the date and duration of any such order; the identity of the relevant local authority; the identity of any person(s) with whom the local authority shares parental responsibility; whether there are any proceedings which have yet to conclude and, if so, the court in which proceedings are taking place and the date of the next hearing; whether the patient comes under the Children (Leaving Care) Act 2000; whether there has been any liaison between, on the one hand, social workers responsible for mental health services to children and adolescents and, on the other hand, those responsible for such services to adults; the name of the social worker within the relevant local authority who is discharging the function of the Nearest Relative under Section 27 of the Act; k) if the patient is subject to guardianship under Section 7 of the Act, whether any orders have been made under the Children Act 1989 in respect of the patient, and what consultation there has been with the guardian; l) if the patient is a Ward of Court, when the patient was made a ward of court and what steps have been taken to notify the court that made the order of any significant steps taken, or to be taken, in respect of the patient; m) whether any other orders under the Children Act 1989 are in existence in respect of the patient and, if so, the details of those orders, together with the date on which such orders were made, and whether they are final or interim orders; n) if a patient has been or is a looked after child under Section 20 of the Children Act 1989, when the child became looked after, why the child became looked after, what steps have been taken to discharge the obligations of the local authority under Paragraph 17(1) of Schedule 2 of the Children Act 1989, and what steps are being taken (if required) to discharge the obligations of the local authority under Paragraph 10 (b) of Schedule 2 of the Children Act 1989; o) if a patient has been treated by a local authority as a child in need (which includes a child who has a mental disorder) under Section 17(11) of the Children Act 1989, the period or periods for which the child has been so treated, why they were considered to be a child in need, what services were or are being made available to the child by virtue of that status, and details of any assessment of the child; p) if a patient has been the subject of a secure accommodation order under Section 25 of the Children Act 1989, the date on which the order was made, the reasons it was made, and the date it expired; q) if a patient is a child provided with accommodation under Sections 85 and 86 of the Children Act 1989, what steps have been taken by the accommodating authority or the person carrying on the establishment in question to discharge their notification responsibilities, and what steps have been taken by the local authority to discharge their obligations under Sections 85, 86 and 86A of the Children Act 1989.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 31 of 65 Hospital Managers’ Hearings Policy V5 ______
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 32 of 65 Hospital Managers’ Hearings Policy V5 Appendix 2 Responsible Clinician’s Report – In-Patients
Reference: NHS number: Department: Ask for: Direct Line:
Private and Confidential
Clinicians Report to the Tribunal
Patient : DoB: Address: Mental Health Act Status: Section Detained on:
Diagnosis: Working: Paranoid Schizophrenia (ICD-10 F20.0) Differential:
Date of admission:
Report Prepared by
Responsible Clinician
Report Dated:
Current Inpatient Name and Address of Ward
The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The report should be written or counter-signed by the patient’s Responsible Clinician. The sources of information for the events and incidents described must be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, or recite medical records, but must briefly describe the patient’s recent relevant medical history and current mental health presentation, and must include:
1) Are there are any factors that may affect the patient’s understanding or ability to cope with a hearing and are there any adjustments that the tribunal may consider in order to deal with the case fairly and justly;
2) Details of any index offence(s) and other relevant forensic history;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 33 of 65 Hospital Managers’ Hearings Policy V5 3) A chronology listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital;
4) Reasons for any previous admission or recall to hospital;
5) Circumstances leading up to the patient’s current admission to hospital;
6) Is the patient now suffering from a mental disorder and, if so, whether a diagnosis has been made, what the diagnosis is, and why;
7) Does the patient have a learning disability and, if so, is that disability associated with abnormally aggressive or seriously irresponsible conduct;
8) Depending upon the statutory criteria, is a mental disorder present which is of a nature or degree to warrant, or make appropriate, liability to be detained in a hospital for assessment and/or medical treatment;
9) Details of any appropriate and available medical treatment prescribed, provided, offered or planned for the patient’s mental disorder;
10) The strengths or positive factors relating to the patient;
11) A summary of the patient’s current progress, behaviour, capacity and insight;
12) The patient’s understanding of, compliance with, and likely future willingness to accept any prescribed medication or comply with any appropriate medical treatment for mental disorder that is or might be made available;
13) in the case of an eligible compliant patient who lacks capacity to agree or object to their detention or treatment, whether or not deprivation of liberty under the Mental Capacity Act 2005 (as amended) would be appropriate and less restrictive;
14) Details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage;
15) Does (in Section 2 cases) detention in hospital, or (in all other cases) the provision of medical treatment in hospital, justify or necessitate the interests of the patient’s health or safety, or for the protection of others;
16) If the patient were to be discharged from hospital, would they be likely to act in a manner dangerous to themselves or others;
17) Could any risks be managed effectively in the community, and how, including the use of any lawful conditions or recall powers;
18) Any recommendations to the tribunal, with reasons.
I am a Staff Grade/ Specialist Registrar/ Consultant Psychiatrist in [specialty]
approved under section 12(2) of The Mental Health Act 1983.’
Signed …………………………………… Date ….../…../……..
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 34 of 65 Hospital Managers’ Hearings Policy V5 Staff Grade/ Specialist Registrar/ Consultant Psychiatrist
MB ChB MRCPsych [other qualifications]
Patient Name………………………………………… DOB…………………….
Information not to be disclosed to the patient
This information should be on a separate sheet (i.e. not stapled or otherwise attached to the original report.)
Give reasons why you think the Managers/ Tribunal should not disclose this information.
Explain how disclosure may cause serious harm for the patient/ others.
Third party information should be detailed here.
Signed …………………………………… Date ….../….../……..
Consultant Psychiatrist MB ChB MRCPsych [other qualifications]
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 35 of 65 Hospital Managers’ Hearings Policy V5 Appendix 3 Responsible Clinician’s Report – Community Patients
Reference: NHS number: Department: Ask for: Direct Line:
Private and Confidential
Clinicians Report to the Tribunal
Patient : DoB: Address: Mental Health Act Status: Section Detained on:
Diagnosis: Working: Paranoid Schizophrenia (ICD-10 F20.0) Differential:
Date of admission:
Report Prepared by
Responsible Clinician
Report Dated:
The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The report should be written or counter-signed by the patient’s Responsible Clinician. The sources of information for the events and incidents described must be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, or recite medical records, but must briefly describe the patient’s recent relevant medical history and current mental health presentation, and must include
1) If the patient is 18 or over and this is a referral to the tribunal, do they have the capacity to decide whether or not to attend or be represented at the hearing;
2) Are there are any factors that may affect the patient’s understanding or ability to cope with a hearing and are there any adjustments that the tribunal may consider in order to deal with the case fairly and justly;
3) Details of any index offence(s) and other relevant forensic history;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 36 of 65 Hospital Managers’ Hearings Policy V5 4) A chronology listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital;
5) Reasons for any previous admission or recall to hospital;
6) Circumstances leading up to the patient’s most recent admission to hospital;
7) Circumstances leading up to the patient’s discharge onto a CTO;
8) The conditions the patient is subject to under section 17B, and details of the patient’s compliance;
9) Is the patient now suffering from a mental disorder and, if so, whether a diagnosis has been made, what the diagnosis is, and why;
10) Does the patient have a learning disability and, if so, is that disability associated with abnormally aggressive or seriously irresponsible conduct;
11) Depending upon the statutory criteria, is a mental disorder present which is of a nature or degree to warrant, or make appropriate, for the patient to receive medical treatment;
12) Details of any appropriate and available medical treatment prescribed, provided, offered or planned for the patient’s mental disorder;
13) The strengths or positive factors relating to the patient;
14) A summary of the patient’s current progress, behaviour, capacity and insight;
15) The patient’s understanding of, compliance with, and likely future willingness to accept any prescribed medication or comply with any appropriate medical treatment for mental disorder that is or might be made available;
16) Details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage;
17) Whether it is necessary for the patient’s health or safety, or for the protection of others, that the patient should receive medical treatment and, if so why;
18) If the patient were to be discharged from the CTO, would they be likely to act in a manner dangerous to themselves or others;
19) How are any risks being managed effectively in the community;
20) State the reasons why it continues to be necessary for the responsible clinician to be able to exercise the power of recall.
21) Any recommendations to the tribunal, with reasons.
Add ‘I am a Staff Grade/ Specialist Registrar/ Consultant Psychiatrist in
[specialty] approved under section 12(2) of The Mental Health Act 1983.’
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 37 of 65 Hospital Managers’ Hearings Policy V5 Signed …………………………………… Date ….../…../……..
Staff Grade/ Specialist Registrar/ Consultant Psychiatrist
MB ChB MRCPsych [other qualifications]
Patient Name………………………………………… DOB…………………….
Remember to include any not for disclosure information on a separate page with heading “Information not to be disclosed to the patient” and inform the MHL Office when you submit the report.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 38 of 65 Hospital Managers’ Hearings Policy V5 Appendix 4 Social Circumstances Report – In-Patients
Tribunal Service Mental Health - Social Circumstances Report – In-Patients
Patient’s Name and Address:
Date of Birth:
Mental Health Act Status: Section
Date of Detention:
Hospital (if applicable):
Ethnic Origin:
Language:
Nearest Relative (if applicable) (name and address):
Other Significant Person(s) (name and address):
GP (name and address):
Responsible Clinician:
Care Coordinator:
Date of Report
Author of report:
Current Inpatient Name and Address of Hospital and Ward
Author’s knowledge of patient:
Report based on interviews with:
Records accessed:
The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The sources of information for the events and incidents described must be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, but must briefly describe the patient’s recent relevant history and current presentation,
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 39 of 65 Hospital Managers’ Hearings Policy V5 1. Introduction
1.1. Are there any factors that may affect the patient’s understanding or ability to cope with a hearing, and are there any adjustments that the tribunal may consider in order to deal with the case fairly and justly.
1.2. A summary of the patient’s current progress, behaviour, compliance and insight.
2. Psychiatric History
2.1. A chronological listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital.
2.2. Details of any index offence(s) and other relevant forensic history.
2.3. Details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage.
2.4. Whether (in Section 2 cases) detention in hospital, or (in all other cases) the provision of medical treatment in hospital, is justified or necessary in the interests of the patient’s health or safety, or for the protection of others.
3. Home and Family Circumstances
3.1. The patient’s home and family circumstances.
3.2. The housing or accommodation available to the patient if discharged.
3.3. The patient’s financial position (including benefit entitlements)
3.4. Any available opportunities for employment.
4. Community Support / Care Planning
4.1. The patient’s previous response to community support or Section 117 aftercare.
4.2. So far as is known, details of the care pathway and Section 117 after- care to be made available to the patient, together with details of the proposed care plan.
4.3. The likely adequacy and effectiveness of the proposed care plan.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 40 of 65 Hospital Managers’ Hearings Policy V5 4.4. Whether there are any issues as to the funding the proposed care plan and, if so, the date by which those issues will be resolved.
4.5. The strengths and positive factors relating to the patient.
4.6. 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.
4.7. 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 may be attached to the report); and where relevant , a copy of the Police National Computer record of previous convictions should be attached.
5. Views of others
5.1. The patient’s views, wishes, beliefs, opinions, hopes and concerns.
5.2. Except in restricted cases, the views of the patient’s nearest relative unless (having consulted the patient) it would be inappropriate or impractical to consult the nearest relative, in which case give reasons for this view and describe any attempts to rectify matters.
5.3. The views of any other person who takes a lead role in the care and support of the patient but who is not professional involved.
6. Conclusion and Summary
6.1 Whether, and if so how, any risks could be managed effectively in the community, including the use of any lawful conditions or recall conditions (ie.CTO).
6.2 Whether the patient, if discharged from hospital, would be likely to act in a manner dangerous to themselves or others. The report needs to clearly specify about what alternative community care support services will be available if the patient is discharged by the Tribunal on that day and whether this would be appropriate to meet identified needs.
6.3 In the case of an eligible compliant patient who lacks capacity to agree or object to their detention or treatment, whether or not deprivation of liberty (DoLS) under the Mental Capacity Act 2005 would be appropriate or less restrictive.
6.4 Any recommendation to the tribunal, with reasons.
Dated:
Signed:
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 41 of 65 Hospital Managers’ Hearings Policy V5 Professional Status
Qualifications:
Remember to include any not for disclosure information on a separate page with heading “Information not to be disclosed to the patient” and inform the MHL Office when you submit the report.
Appendix 5 Social Circumstances Report – Community Social Circumstances re Tribunal Service Mental Health - Social Circumstances Report – Community
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 42 of 65 Hospital Managers’ Hearings Policy V5 Patient’s Name and Address:
Date of Birth:
Mental Health Act Status: Section
Date of Detention:
Hospital (if applicable):
Ethnic Origin:
Language:
Nearest Relative (if applicable) (name and address):
Other Significant Person(s) (name and address):
GP (name and address):
Responsible Clinician:
Care Coordinator:
Date of Report
Author of report:
Current Inpatient Name and Address of Hospital and Ward
Author’s knowledge of patient:
Report based on interviews with:
Records accessed:
The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. It should be signed and dated. The sources of information for the events and incidents described must be made clear. This report should not be an addendum to (or reproduce extensive details from) previous reports, but must briefly describe the patient’s recent relevant history and current presentation,
1. Introduction
1.1. Are there any factors that may affect the patient’s understanding or ability to cope with a hearing, and are there any adjustments
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 43 of 65 Hospital Managers’ Hearings Policy V5 that the tribunal may consider in order to deal with the case fairly and justly.
1.2. A summary of the patient’s current progress, behaviour, compliance and insight.
2. Psychiatric History
2.1. A chronological listing the patient’s previous involvement with mental health services including any admissions to, discharge from and recall to hospital.
2.2. Details of any index offence(s) and other relevant forensic history.
2.3. Details of any incidents where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage.
2.4. Whether (in Section 2 cases) detention in hospital, or (in all other cases) the provision of medical treatment in hospital, is justified or necessary in the interests of the patient’s health or safety, or for the protection of others.
3. Home and Family Circumstances
3.1. The patient’s home and family circumstances.
3.2. The housing or accommodation available to the patient if discharged.
3.3. The patient’s financial position (including benefit entitlements)
3.4. Any available opportunities for employment.
4. Community Support / Care Planning
4.1. The patient’s previous response to community support or Section 117 aftercare.
4.2. So far as is known, details of the care pathway and Section 117 after- care to be made available to the patient, together with details of the proposed care plan.
4.3. The likely adequacy and effectiveness of the proposed care plan.
4.4. Whether there are any issues as to the funding the proposed care plan and, if so, the date by which those issues will be resolved.
4.5. The strengths and positive factors relating to the patient.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 44 of 65 Hospital Managers’ Hearings Policy V5 4.6. 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.
4.7. 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 may be attached to the report); and where relevant , a copy of the Police National Computer record of previous convictions should be attached.
5. Views of others
5.1. The patient’s views, wishes, beliefs, opinions, hopes and concerns.
5.2. Except in restricted cases, the views of the patient’s nearest relative unless (having consulted the patient) it would be inappropriate or impractical to consult the nearest relative, in which case give reasons for this view and describe any attempts to rectify matters.
5.3. The views of any other person who takes a lead role in the care and support of the patient but who is not professional involved.
6. Conclusion and Summary
6.1 Whether, and if so how, any risks could be managed effectively in the community, including the use of any lawful conditions or recall conditions (ie.CTO).
6.2 Whether the patient, if discharged from hospital, would be likely to act in a manner dangerous to themselves or others. The report needs to clearly specify about what alternative community care support services will be available if the patient is discharged by the Tribunal on that day and whether this would be appropriate to meet identified needs.
6.3 In the case of an eligible compliant patient who lacks capacity to agree or object to their detention or treatment, whether or not deprivation of liberty (DoLS) under the Mental Capacity Act 2005 would be appropriate or less restrictive.
6.4 Any recommendation to the tribunal, with reasons.
Dated:
Signed:
Professional Status
Qualifications:
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 45 of 65 Hospital Managers’ Hearings Policy V5 Remember to include any not for disclosure information on a separate page with heading “Information not to be disclosed to the patient” and inform the MHL Office when you submit the report.
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 46 of 65 Hospital Managers’ Hearings Policy V5 Appendix 6 – Nursing report
Guidance for Nursing Reports
Since nursing staff spend the most time with clients on a daily basis they are usually the best members of the team to comment on a client’s behaviour on the ward. A nursing report is required to ensure that the correct information from the ward is available to the panel so that an informed decision may be made regarding the detention. The report should focus on the nursing perspective and should include the following information:
The report must be up-to-date, specifically prepared for the tribunal and have numbered paragraphs and pages. The report should to be written in plain English, avoiding jargon and needs to be signed and dated at the foot of the report, indicating status and ward. The sources of information for the events and incidents described must be made clear. This report should not recite the details of medical reports, or be an addendum to (or reproduce extensive details from) previous reports, although the patient’s current nursing plan must be attached.
Report from Named Nurse for Tribunal Service Mental Health / Hospital Managers Hearing
(delete as applicable) to be heard on …..
Name of patient:
Date of birth:
Hospital / Ward / Date of Admission:
Responsible Clinician:
Legal status:
Sources of Information Include how long you have known the patient and been their named nurse, who you have spoken to, what access you have had to patient notes etc. Include a copy of the patient’s current nursing plan
1. Current situation
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 47 of 65 Hospital Managers’ Hearings Policy V5 1.1. Please give a summary of the patient’s current progress engagement with nursing staff, behaviour, cooperation, activities, self care and insight; Also indicate whether there are any factors that might affect the patient’s understanding or ability to cope with a hearing, and whether there are any adjustments that the tribunal may consider in order to deal with the case fairly and justly.
1.2. Describe the nature of nursing care and medication currently being made available, include use of PRN
1.3. What level of observation is the patient currently being nursed on within the ward?
1.4. Document any occasions on which the patient has been absent without leave whilst liable to be detained, or occasions when the patient has failed to return as and when required, after having been granted leave;
1.5. Detail any incidents in hospital where the patient has harmed themselves or others, or threatened harm, or damaged property, or threatened damage;
1.6. Document any occasions on which the patient has been secluded or restrained, including the reasons why such seclusion or restrain was necessary;
2. Factors that would support / delay discharge
2.1. The patient’s understanding of, compliance with, and likely future willingness to accept any prescribed medication or treatment for mental disorder that is or might be available;
2.2. Whether the patient has contact with relatives, friends or other patients, the nature of the interaction, and what community support the patient has;
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 48 of 65 Hospital Managers’ Hearings Policy V5 2.3. Strengths or positive factors relating to the patient;
2.4. Whether (in Section 2 cases) detention in hospital, or (in all other cases) the provision of medical treatment in hospital, is justified or necessary in the interests of the patient’s health or safety, or for the protection of others;
2.5. Whether, and if so how, any risks could be managed effectively in the community, including the use of any lawful conditions or recall powers;
2.6. Whether the patient, if discharged from hospital, would be likely to act in a manner dangerous to themselves or others;
3. Conclusions and summary of recommendations The author’s opinion (with reasons) as to the need for continuation or otherwise of detention under the Mental Health Act and any recommendations to the tribunal “I (and the nursing team) consider …”
Signed: Date:
Print Name and position / qualification
Attach: Nursing Care Plan Dated:
CL33 Report Writing and Attendance at (Mental Health) Tribunals and Page 49 of 65 Hospital Managers’ Hearings Policy V5 It is noted that this flowchart will not be applicable in all boroughs and would need to be amended locally – THIS WOULD BE USED AS A GUIDE
Appendix 7 AUTHORSHIP OF SOCIAL CIRCUMSTANCE REPORTS & ATTENDANCE AT MENTAL HEALTH REVIEW TRIBUNALS No Yes Does the patient have a care co-ordinator
Care Co-ordinator to prepare Is AMHP who made application Yes No report and attend MHT based with Out-of-Hours team NB: If Care Co-ordinator not or from out of area LA? available, line manager responsible for ensuring report prepared/attendance arranged AMHP who made application to provide the full LSSA AMHP Report.
Clinical team to identify the most appropriate team below for a representative to prepare and attend hearing.
If patient aged 65+, If patient has If patient presents If patient has Patient is under 18 refer to manager of Learning Disability, with psychosis and is history of then must involve CMHT for Older refer to manager of aged < 35 years, psychosis > 3 CAMHS People Learning Disability refer to manager of years and is aged Inreach/Outreach Team Early Interventions 16-65, refer to team and report to Team manager of be provided by Rehab/Enhanced most suitably Care Team experienced professional
Policy on Report Writing and Attendance at Tribunals and Hospital Managers’ Hearings
Page 50 of 65 Appendix 8
Tribunal Service Secure Email System Guidance Document
This guidance supports the Tribunals Service Protocol for the exchange of documents and information between the Tribunal Secretariat and its Professional Parties via Secure E-mail (Version 1.0 October 2007).
The SES involves Pennine Care exchanging patient identifiable information with the Tribunals service when a patient has a Tribunal appeal/referral ongoing. This guidance confirms the Trusts internal practices and processes for using the SES.
1. Staff Affected
Mental Health Law Administrators Responsible Clinicians Specialist Registrars Medical Secretaries Nursing Staff Community Staff
2. Process
2.1 Responsible Clinicians, Specialist Registrars, Nursing Staff, Community Staff and Medical Secretaries
Information Governance procedures now allow patient identifiable information to be securely sent from and to nhs.net accounts. Reports can be sent via this method.
If there is information not to be disclosed to the patient this should be clearly highlighted.
51 of 65 Appendix 9
Mental Health Law Team
1. Trust: Mia Majid MH Law Manager Trust Headquarters St Petersfield, 225 Old Street Ashton Under Lyne, OL6 7SR Tel: 0161 716 3008 Fax: 0161 716 3037 [email protected]
2. Bury: Carolyn Davis/ Helen Reid Irwell Unit Fairfield General Hospital, Rochdale Old Road Bury, BL9 7TD Tel: 0161 778 3681 Fax: 0161 272 0214 [email protected] / [email protected]
3. Oldham: Gemma Rose / Cynthia Soka Parklands House Royal Oldham Hospital, Rochdale Road Oldham, OL1 2JH Tel: 0161 778 5753 Fax: 0161 778 5754 [email protected] / [email protected]
4. Rochdale: Diane Birchall / Patricia Shaw Laurence Burns House Birch Hill Hospital Rochdale, OL12 9QB Tel: 01706 676 156 Tel: 01706 676 155 Fax: 01706 676 181 [email protected] / [email protected]
5. Stockport: Jan Broomhead Mental Health Law Office Stepping Hill Hospital, Poplar Grove Stockport, SK2 7JE Tel: 0161 716 5745 Fax: 0161 419 4972 [email protected] /
Deborah Arrell MHL Coordinator Tel: 0161 419 5349 [email protected]
6. Tameside: Kim Oakman / Gemma Fairbrother Mental Health Unit Tameside General Hospital, Fountain Street Ashton-under-Lyne, OL6 9RW Tel: 0161 716 3777 Fax: 0161 716 3773
[email protected] / [email protected]
52 of 65 Appendix 10
Rule 14 of the Tribunal Procedure (2008) Use of documents and information 14.—(1) The Tribunal may make an order prohibiting the disclosure or publication of— (a) specified documents or information relating to the proceedings; or (b) any matter likely to lead members of the public to identify any person whom the Tribunal considers should not be identified. (2) The Tribunal may give a direction prohibiting the disclosure of a document or information to a person if— (a) the Tribunal is satisfied that such disclosure would be likely to cause that person or some other person serious harm; and (b) the Tribunal is satisfied, having regard to the interests of justice, that it is proportionate to give such a direction. (3) If a party (“the first party”) considers that the Tribunal should give a direction under paragraph (2) prohibiting the disclosure of a document or information to another party (“the second party”), the first party must— (a) exclude the relevant document or information from any documents that will be provided to the second party; and (b) provide to the Tribunal the excluded document or information, and the reason for its exclusion, so that the Tribunal may decide whether the document or information should be disclosed to the second party or should be the subject of a direction under paragraph (2). (4) The Tribunal must conduct proceedings as appropriate in order to give effect to a direction given under paragraph (2). (5) If the Tribunal gives a direction under paragraph (2) which prevents disclosure to a party who has appointed a representative, the Tribunal may give a direction that the documents or information be disclosed to that representative if the Tribunal is satisfied that— (a) disclosure to the representative would be in the interests of the party; and (b) the representative will act in accordance with paragraph (6). (6) Documents or information disclosed to a representative in accordance with a direction under paragraph (5) must not be disclosed either directly or indirectly to any other person without the Tribunal’s consent. (7) Unless the Tribunal gives a direction to the contrary, information about mental health cases and the names of any persons concerned in such cases must not be made public.
53 of 65 Appendix 11
Guidance for MAPPA Referrals
Further to guidance issued by the Ministry of Justice regarding MAPPA (Multi Agency Public Protection Arrangements) for patients who may be eligible for a MAPPA referral it has become necessary to put in place guidance for managing this process.
The Ministry of Justice produced a document called ‘MAPPA Guidance 2009’. This document sets out a number of requirements on Mental Health Trusts. The key requirement is to make a MAPPA notification of patients who are MAPPA eligible but not currently managed as MAPPA Level 2 or 3 cases.
This requirement has always been in place but it is only recently that guidance has clarified what this means in practice. The Trust needs to complete Form G with information about such patients including where they currently live and who their CPN is and submit this to the MAPPA Support Unit (MSU).
MAPPA eligible patients are patients discharged form hospital conditionally under Section 37/41 and also patients discharged from hospital under a Section 37 and who can then become subject to a Community Treatment Order. Other patients may be eligible for a referral to MAPPA if it is felt that they pose a significant risk.
The formal list of who is MAPPA eligible based on offence is to be found in schedule 15 of the Criminal Justice Act (2003).
Pennine Care NHS Foundation Trust been guided by the response to the MAPPA guidance from Greater Manchester West Adult Forensic Mental Health Services who will have a high number of MAPPA eligible patients.
The various terms and language used within this guidance may be specific to MAPPA and a key of terms is included with this document. There is also a supporting document clarifying the level and category of offenders.
54 of 65 Ministry of Trust Action Responsibility Resource Justice Requirement Requirement to identify A process to do this This will mean a change Discharge Planning paperwork all eligible offenders wold be difficult to to discharge planning within 3 days of initiate and would not documents. This could Form G if needed admission or transfer necessarily relevant at be in the form of a tick discharge. Trust will box or the MAPPA assume all patients are referral criteria to enable MAPPA eligible and will the MDT to initiate the then check patients referral process. against MAPPA criteria as part of discharge planning.
As above with Alternative is for MHL Responsibility of MHL MHL Office as initial point of alternative actions etc. Office to write to RC on Office to flag and RC to contact and recording admission/transfer of respond. Recording for resource. new patient and check if MHL Office and then RC as assessing criteria. patient is MAPPA flagging at point of eligible. If so completion discharge. of Form G, forward to Criteria will need to be MAPPA support unit re-assessed at point of Admission and record on register. discharge. (MAPPA).doc
Requirement for RC to make MHL Office RC to notify and MHL MHL Office and RC. inpatients that MAPPA aware of upcoming Office to flag up MAPPA Form G is submitted to discharges and MHL referral. Letter to RC relevant MAPPA co- Office to write to RC ordinator 6 months prior requesting completion to planned of Form G if patient is Discharge release/discharge or MAPPA eligible. Record (MAPPA).doc with as much notice as notifications on register. possible. As above alternative Changes to Discharge MDT upon completion Changes needed to discharge planning paperwork will of discharge planning planning paperwork. allow MDT to flag up paperwork. any eligible patients. If Letter to RC informed of planned MHL Office to notify on discharge for patients who are Conditionally defined by MAPPA as Discharge Discharged patient or eligible. (MAPPA).doc Hospital order patients.
Requirement to report MHL Administrators to MHL Offices to record Discharged MAPPA eligible the total number of identify any patients and update figures on patient register. MAPPA eligible who meet this criteria annual basis. offenders in the and record on register. After initial data MHL Offices community and to Figures to be updated collection figures should provide a monthly and forwarded annually. be available for figure. Statistical return Monthly figures can be collection from register. only. Report should be provided if requested. Category 2 offenders conditionally discharged and managed at level 1.
Offenders already in the RC’s for Community MHL Office to flag up Form G community or about to patients identified as need to for Form G be discharged should above will be requested following initial data have Form G completed to complete Form G by collection. and forwarded to MSU. MHL Office for sending to MSU. 55 of 65 56 of 65 Ministry of Trust Action Responsibility Resource Justice Requirement Where offender is being Tribunals do sometimes RC and MHL Office to Form G considered for discharge against the work together to ensure discharge into the advice of RC. However, that all eligible patients community, or the RC a 6 month time frame is are referred. considers that a not possible as this Tribunal hearing is likely does not match the time For restricted patients to order discharge, the frame for Tribunal who are applying fro MAPPA meeting should appeals. If in the case of conditional discharge take place no later than an unrestricted patient with support from MDT, 6 months before the discharge is granted by RC can complete Form planned date of Tribunal then the G prior to hearing. discharge or hearing MAPPA referral should date take place as soon as possible. If the MDT are approaching a Tribunal Hearing to ask for conditional discharge of a restricted patient, then the MAPPA referral can be made in advance of the hearing.
Guidance on Categories and Levels of Offenders and Management
Further to guidance issued by the Ministry of Justice regarding MAPPA (Multi Agency Public Protection Arrangements) for patients who may be eligible for a MAPPA referral it has become necessary to put in place guidance for managing this process.
There are varying levels and Categories of offenders who meet criteria for referral to MAPPA. These are outlined below. However, if you have concerns about the level of risk posed by a patient who does not fulfil any of the below, please contact the Mental Health Law Office, who will be able to advise you. MAPPA will accept referrals if there is felt to be a need for ongoing Public Protection Management.
MAPPA Eligible
In this context “offenders” generally means that there is an offence for which the individual is currently subject to a prison sentence or Hospital order and not simply people who have committed offences in the past (with the exception of sex offenders).
Relevant offenders for Mental Health are MAPPA eligible offenders
Section When S.41 Conditional Referral can be made up to six months prior to discharge or
57 of 65 Discharge as soon as discharge is planned. following restricted Hospital Order S.37 Hospital Order Referral to be made as soon as discharge is planned. Any patient required When discharge is planned within the next six months. to register with the police including S.47 S.7 Guardianship When discharge is planned within the next six months. Order
In practice, almost all patients on Section 37/41 will be MAPPA eligible as they will be have been convicted of violent or sexual offences.
There will be significantly less patients detained on Section 37 who are MAPPA eligible as typically the conviction is for an acquisitive offence.
If any eligible patient above is discharge from detention by the Tribunal service or Hospital Managers, a referral should be made to MAPPA as soon as possible.
Patients who are detained on civil sections will also not usually be eligible unless that are also on the sex offender register.
Categories of Offender
MAPPA eligible offenders are divided into 3 categories are listed below.
Category 1 Offenders
Registered Sexual Offenders (RSO’s)
Category 2 Offenders
Mainly violent offenders sentenced to 12 months custody or more and includes Those convicted of a relevant offence (violent or sexual offence) who receive a sentence of a hospital order (with or without restrictions) or guardianship order Those found not guilty of a relevant offence by reason of insanity or to be under a disability (unfit to stand trial) and to have done the act charged who receive a hospital order (with or without restrictions)
Category 3 Offenders
Other dangerous offenders. This could be offenders who have previously been managed at MAPPA level 2 or 3 under category 1 or 2 and still pose a risk of harm or other persons, who by reason of offences committed by them (wherever committed) are considered by the Responsible Authority to be persons who may cause serious harm to the public.
Other young offenders or health service users may be eligible for MAPPA referral under category 3. Alerting the Responsible authority about these offenders should be dealt with by referral to level 2 or 3. This is a matter of professional judgement and is not a
58 of 65 requirement. If a patient is considered at a high risk of serious offending it can be referred to MAPPA even if not MAPPA eligible based on current offence.
Levels of Management
MAPPA eligible offenders are managed at 3 levels and this distinction is important Level 1: Ordinary Agency Management Level 2: Active Multi-Agency Management Level 3: Active Multi-Agency Management
Although Level 1 is not a term used in Mental Health services it can be understood as meaning “a patient managed by our service without it involving other agencies”. This is still valid if Social workers are involved in the care.
The below is taken from ‘Guidance notes for social supervisors’
Although all cases should be notified, it is considered unlikely that referral of a patient for active MAPPA management will be required in the majority of cases.
Arrangements agreed under Care Programme Approach will generally provide the most effective management plan, although in cases of doubt it is best to refer.
Where a patient has been discharged from hospital this will generally mean that they have been assessed as having a level of risk which is manageable in the community and the expectation is that most psychiatric patients who are MAPPA eligible will be managed as Level 1 cases.
Periods of eligibility
The period an offender remains MAPPA eligible varies significantly and will be dependent upon the offence and the sentence imposed.
Offenders will cease to be eligible in the following circumstances Category 1 offenders: Registered Sexual Offenders; when their period of registration expires, in most serious cases, registration is for life Category 2 offenders: Violent and Sexual Offenders; when the licence expires, the offender is discharged from the hospital order or guardianship order of the disqualification order is revoked. Category 3 offenders: other dangerous offenders; when a level 2 or 2 MAPP meeting decides that the risk of harm has reduced sufficiently and the case no longer requires active multi-agency management.
This document is intended to provide guidance on the referral process to MAPPA.
Other documents that may be of assistance are listed below: Ministry of Justice MAPPA Guidance 2009 Mental Health Act 1983 Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 Domestic Violence, Crime and Victims Act 2004
59 of 65 Criminal Justice Act 2003 (in particular schedule 15 which identifies offences relevant to MAPPA referral)
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Nearest relative powers of discharge
There are four possible outcomes of a nearest relative’s request for discharge10:
The RC considers the request and decides to end the section by completing the s.23 order of discharge form.
The RC considers the request and allows the 72 hours to pass in which case the patient is no longer detained.
The RC considers the request and issues a barring report during the 72 hours. If they do so they must certify this on statutory form M2.
The nearest relative withdraws the request for discharge; they have the right to do so but can only do so within the 72 hour period in the event of the RC not issuing a barring report.
Meaning of ‘dangerousness’ The RC cannot bar discharge simply because they believe the patient continues to meet the statutory criteria for detention. Dangerousness constitutes a much higher threshold than the references in the statutory criteria to ‘health and safety of the patient or for the protection of others’.
The MHA code of practice explains the difference by stating that the question the RC needs to focus on is the ‘probability of dangerous acts, such as causing serious physical injury or lasting psychological harm not merely on the patient’s general health or safety and others’ general need for protection’. It is submitted that the dangerousness test may also be satisfied if it was considered that it would be likely that the patient, if discharged, would suffer serious harm to his physical and/or mental health through self neglect or the neglect of others.
It is suggested that best practice would always be for the RC to make a risk assessment before deciding to bar the discharge or not.
If a barring order is completed by the RC a Hospital Managers’ hearing will need to take place to review the decision made by the RC and it is important therefore that the RC submits a written report and attends the hearing in person to explain the manner in which the patient is ‘likely’ to act ‘dangerously’ if the barring order were to be lifted.
10 Section 25 of the MHA states that a patient’s nearest relative must give 72 hours’ notice to the hospital managers of his or her intention to order discharge of the patient from detention or from a community treatment order (CTO) (but not from guardianship) and that the order for discharge when made, will have no effect if in the meantime the responsible clinician (RC) has reported to the managers by completing the statutory barring report (form M2) that in his or her opinion, the patient, if discharged, would be likely to act in a manner dangerous to other persons or his or herself.
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FIRST TIER TRIBUNAL (HEALTH, EDUCATION AND SOCIAL CARE) MENTAL HEALTH
Guidance for Detaining Authorities and Tribunal Panels about medical evidence for First Tier Tribunal –mental health 1.0 Background: The increasing number of medical trainees obtaining experience in Psychiatry is a very positive initiative. This guidance, produced jointly by the Royal College of Psychiatrists and FTT-mental health/HMCTS is to ensure all Registered Medical Practitioners (referred to as doctors throughout the document) who give evidence to tribunals are qualified to do so. It should be noted that the Certificate of Completed Training in psychiatry usually acquired at the end of ST6 (see below), fulfils the requirement for evidence of attainment of the competencies required to apply to become an Approved Clinician. It is essential, therefore, that Higher Trainees attain the required experience under supervision. The requirement for experience under supervision applies to both trainees and Staff Grades and Associate Specialists (referred to as SAS doctors in the document). 2.0 Grades of trainee: 2.1 A range of trainees may gain experience of psychiatry at different stages of training 2.2 This section describes the different levels of training and the experience of trainees at different stages. FY1 : provisionally GMC registered doctors in the first year after qualification. Typically have a 4 month training post as part of a rotation. FY2 : doctors are fully registered with the GMC and in the second year after qualification. Typically have a 4 month training post as part of a rotation. GPVTS trainees: these are doctors intending a career in General Practice and who have a post in psychiatry as part of their GP training rotation. Core Trainees CT1-3; these are doctors who have decided on a career in psychiatry. They work in different posts for 6 months each. The number specifies the number of years training e.g. CT2 is in the second year of training. Speciality Trainees ST 4-6; these are doctors who have passed the psychiatry examinations (MRCPsych) and are Members of the Royal College of Psychiatrists. They are also known as ‘higher trainees’. Most trainees will become Section 12
62 of 65 approved doctors on entry to higher training. On successful completion of ST6 the doctor is eligible to apply for Consultant posts. 2.3 All trainees have a Consultant Psychiatrist (who, in relation to detained patients and evidence to the Tribunal, will be the Responsible Clinician unless the patient has a non-medical RC) in each post who supervises their training and performance. 3.0 Guidance on Medical Report writing 3. 1 All medical reports must be written or countersigned by the Patient’s Responsible Clinician, according to the Senior President of Tribunal’s Practice Direction 3.2 RCs should consider in which cases trainees may be able to write the report, allowing for the trainee’s experience and the complexity of the case 3.3 F1 trainees are only provisionally registered and should not write reports. 3.4 FY2, GPVTS, and Core trainees 1-3 should be fully supervised by their RC in writing reports. The amount of supervision will vary depending on the experience of the trainee and the complexity of the case. 3.5 More experienced trainees (ST4 – 6) will require less supervision to write reports. It is essential that trainees at this stage gain experience in report writing. 3.6 RCs should consider in which cases SAS doctors are be able to write the report, allowing for the doctor’s experience and the complexity of the case: SAS doctors may still require RC supervision. 4.0 Experience required to give oral evidence at a tribunal hearing 4.1 RCs should consider in which cases trainees can give oral evidence. In restricted cases for example, the RC may be best placed to give evidence. 4.2 Trainees can only give oral evidence as witnesses on behalf of the RC if they have completed the following stages: - have supervised experience of writing the medical report, and - have observed a hearing, and - have given oral evidence supervised by the RC at a hearing*, and -the RC has assessed their ability to give evidence and is satisfied that they are competent -have agreed with the RC that this is an appropriate case for them to give evidence. * If it is clear to the trainee, the RC or the tribunal panel that the trainee requires assistance to expand /clarify their answers, then the RC can take over the role of giving evidence 4.3 FY1 and FY2 doctors are not expected to give oral evidence at a tribunal. 4.4 For Core trainees 1-3 and GPVTS trainees, the amount of supervision at a hearing will depend on the experience of the trainee and the complexity of the case. 4.5 ST 4-6 trainees must demonstrate that they are able to give evidence at a tribunal hearing in preparation for applications for Consultant posts. 4.6 SAS doctors can only give oral evidence as witnesses on behalf of the RC if they have completed the following stages: - have supervised experience of writing the medical report, and - have observed a hearing, and - have given oral evidence supervised by the RC at a hearing*, and
63 of 65 -the RC has assessed their ability to give evidence and is satisfied that they are competent -have agreed with the RC that this is an appropriate case for them to give evidence. 4.7 It is important that, where appropriate, the RC attends the hearing, in line with the guidance in the Mental Health Act Code of Practice (“It is important that the patient’s responsible clinician/s attend the Tribunal, supported by other staff involved in the patient’s care, where appropriate, as their evidence is crucial for making the case for a patient’s continued detention or CTO under the Act”). 5.0 Observations of tribunal hearings 5.1 Observation of tribunal hearings is an essential part of the training for all trainee psychiatrists of any grade and essential experience for SAS doctors. 5.2 Although trainees are team members and actively involved in the patient’s care, current protocol within the tribunal service is that they should apply to observe the patient’s hearing if they are not directly giving evidence. 5.3 FY doctors may find it helpful, in addition to discussing with their RC, to refer to the section in the FY handbook which describes the process of a tribunal. 6.0 Arranging Observations 6.1 Send an email requesting observation giving details of the case: the name of the patient, the date of the hearing and stating why observation is being requested (e.g. for training purposes). [email protected] 6.2 Please give 3 working days notice to allow the request to be processed. 6.3 Please note that only one observer is allowed at any one time so check that other trainee members of the clinical team (student nurses etc.) are not requesting observation at the same time. 6.4 Ask the patient for their permission to observe, on the understanding that the observer is a member of their clinical team. It is likely to be less stressful for the patient if this is done prior to the day of the tribunal hearing. 6.5 Notify the MHA administrator that a request has been made to the tribunal to observe and that the patient has agreed 6.6 Ensure you have a response that the observation request has been granted. 6.7 On the day for the hearing, check that the patient’s legal representative agrees with the observation. 6.8 Finally, ensure that the tribunal panel are aware of the observation request and that the above steps have been complied with. Be aware however, that even if the patient and their representative agree, the tribunal panel have the final decision. 7.0 References 7.1 Contents of reports http://www.judiciary.gov.uk/publications/practice-direction-first-tier-tribunal- health-education-and-social-care-chamber-statements-and-reports-in-mental- health-cases/ 7.2 Mental Health Act 1983 Code of Practice, Department of Health 2015
64 of 65 7.3 Information for FY Doctors about Tribunal hearings in FY handbook: http://www.rcpsych.ac.uk/pdf/A%20Guide%20to%20Psychiatry%20in%20the %20Foundation%20Programme.pdf . June 2015 Joan Rutherford Julie Chalmers Tony Zigmond Wendy Burn
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