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Coercion and Consent O N M I O Topics Covered Include: Monitoring the Mental Health Act 2007–2009 M I S S

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Coercion and Consent O N M I O Topics Covered Include: Monitoring the Mental Health Act 2007–2009 M I S S HEALT AL H T A N C E T . M In its thirteenth and final biennial report, the Mental Health Act Commission provides data and . C observations from its monitoring of the use of the Mental Health Act between 2007 and 2009. Coercion and consent O N M I O Topics covered include: monitoring the Mental Health Act 2007–2009 M I S S UÊÌ>Êw`}ÃÊÊÌ iÊÕÃiÊvÊiÜÊ«ÜiÀÃÊvÊ-Õ«iÀÛÃi`Ê ÕÌÞÊ/Ài>ÌiÌÊÊ UÊÌ iÊvÀVLiÊÌÀi>ÌiÌÊvÊ«>ÌiÌÃÊ`iÌ>i`ÊÕ`iÀÊÌ iÊiÌ>Êi>Ì ÊVÌÊ£nÎÊÊÊ consent and Coercion The Mental Health Act Commission UÊÌ iÊiÌ>Êi>Ì ÊVÌÊ>`ÊiÌ>ÞÊ`ÃÀ`iÀi`Êvvi`iÀÃÊ Thirteenth Biennial Report 2007–2009 UÊ`>Ì>ÊÊ`i>Ì ÃÊvÊ`iÌ>i`Ê«>ÌiÌÃÊLiÌÜiiÊÓääxÊ>`ÊÓään The report also highlights several areas for future research and monitoring, and draws these to the >ÌÌiÌÊvÊÌÃÊÃÕVViÃÃÀÊL`Þ]ÊÌ iÊ >ÀiÊ+Õ>ÌÞÊ ÃÃ°Ê monitoring the Mental Health Act 2007–2009 Act Health Mental the monitoring ÛiÀÊ«VÌÕÀiÊLÞÊ Àii]Ê>Ê«>ÌiÌÊÊÌ iÊ"/Ê`i«>ÀÌiÌÊvÊ-iÛiÀ>ÃÊëÌ>]Ê V iÃÌiÀ]Ê Ê£ÇÓ°Ê ÀiiÊ >`Ê >`ÊÌÜÊiÕVÌiÃÊÊÌ iÊ£xäÃ]Ê>ÌÊ>ÊÌiÊÜ iÊ iÀÊVÃÕÌ>ÌÊ «ÃÞV >ÌÀÃÌÊVÃ`iÀi`ÊLÀ>ÊÃÕÀ}iÀÞÊÌ iÊÌÀi>ÌiÌÊvÊV ViÊvÀÊÃV â« Ài>°Ê ISBN 978-0-11-322836-2 www.tso.co.uk 9 780113 228362 5991 MHAC Cover V0 3 indd 1 424987 Mental Health21/5/09 15:52:43 13th_C The Mental Health Act Commission Coercion and consent monitoring the Mental Health Act 2007–2009 MHAC Thirteenth Biennial Report 2007–2009 Presented to Parliament pursuant to Paragraph 13 of Schedule 4 to the Health and Social Care Act 2008 (Commencement No.9, Consequential Amendments and Transitory, Transitional and Saving Provisions) Order 2009. London: The Stationery Office Published by TSO (The Stationery Office) and available from: Online www.tsoshop.co.uk Mail, Telephone, Fax & E-mail TSO PO Box 29, Norwich, NR3 1GN Telephone orders/General enquiries: 0870 600 5522 Fax orders: 0870 600 5533 E-mail: [email protected] Textphone: 0870 240 3701 TSO@Blackwell and other Accredited Agents Customers can also order publications from: TSO Ireland 16 Arthur Street, Belfast BT1 4GD Tel 028 9023 8451 Fax 028 9023 5401 Published with the permission of the Care Quality Commission on behalf of the Controller of Her Majesty’s Stationery Office. © Crown Copyright 2009 All rights reserved. Copyright in the typographical arrangement and design is vested in the Crown. Applications for reproduction should be made in writing to Copyright applications, The Copyright Unit, Office of Public Sector Information, Information Policy Team, Kew, Richmond, Surrey TW9 4DU. E-mail: [email protected] First published 2009 ISBN 978 0 11 322836 2 The Care Quality Commission has arranged for publication of this report pursuant to paragraph 13(1) of Schedule 4 to the Health and Social Care Act 2008 (Commencement No.9, Consequential Amendments and Transitory, Transitional and Saving Provisions) Order 2009. Printed in the United Kingdom by The Stationery Office 6110497 C12 06/09 2 Acknowledgements The author of this report was Mat Kinton. Production was overseen by Ron Rushbrook and Vicki Eley of the MHAC Policy Unit. Generous reading time, support and comments were provided by Gemma Pearce, Acting Chief Executive of the MHAC, despite the pressures of overseeing the last days of the organisation and ensuring that its legacy was carried on within the Care Quality Commission. Many people helped with information, advice and discussion. Particular thanks to Janey Antoniou, Leanne Bacon, Professor Peter Bartlett (Nottingham University), William Bingley, Rob Brown, Jemma Ciplys, Luke Clapham, Jeff Cohen, Chris Conway, Chris Curran, Rowena Daw (RCPsych), Karen Early (Tribunal), Andy Evans, Professor Phil Fennell (Cardiff University), Claire Fife (Welsh Assembly Government), Pat Gregory, Professor Chris Heginbotham (University of Central Lancashire), Dr David Hewitt (Weightmans), John Horne (University of Northumbria), Phil Howes, Dr Peter Jefferies, Craig Jennings, Surrinder Kaur, Steve Klein, Sue McMillan, Professor Ronnie MacKay (De Montfort University), Christina Marriot, Camilla Parker, Francis Parker, Mike Partridge (Metropolitan Police), Rona Pickles, Richard Rook (Department of Health), Corrine Ryan (Institute of Mental Health Act Practitioners), Rose Sibley, Jo Simpson (Information Centre), Rebecca Stephens, Sue Turner, Denise Walker, Rhian Williams-Flew, and the MHAC Service User Reference Panel. Apologies to those we have not named. This report is based largely upon the visiting work of Mental Health Act Commissioners between 2007 and 2009. 3 4 Contents Paragraph Page Foreword Simon Armson & Lord Patel of Bradford 11 The last 23 years in mental health Janey Antoniou 15 1 The Mental Health Act in Context Introduction 1.1 19 Data collection and the Mental Health Act 1.4 20 The attractions of acute care 1.7 21 Service user involvement 1.13 22 General trends in admission under the Mental Health Act 1.17 24 The balance between hospital and community based services 1.20 26 The increasing relevance of the independent sector 1.25 27 Characteristics of the detained population 1.28 29 The gender mix of the detained population 1.28 29 The ethnicity of detained patients 1.36 33 Patients with learning disability 1.42 36 Children and adolescents 1.48 40 Secure services for adolescents 1.59 43 Acute ward environments 1.61 44 Locked doors 1.64 45 Bed occupancy 1.68 47 The physical environment of wards 1.71 48 Staffing 1.78 50 Activity on wards 1.86 53 The recovery model and coercive environments 1.91 55 Restrictions on smoking 1.95 56 Patient involvement and support 1.99 58 Providing patients with information about their care and treatment 1.106 60 Independent Mental Health Advocacy 1.111 62 Access to communications 1.114 63 Mobile telephones 1.114 63 Ward-based telephones 1.118 64 Access to computers and the internet 1.120 64 Patients’ mail 1.123 65 Appeals against withholding of mail in High Security Hospitals 1.125 66 Access to pornography 1.128 68 Telephone monitoring in the High Security Hospitals 1.131 69 The policing of patients’ mail in the High Security Hospitals 1.133 69 Observation and restraint 1.136 70 Restraint and safety 1.145 75 Police presence on wards 1.151 77 Seclusion 1.154 78 5 2 The Mental Health Act in Practice The use and outcome of holding powers 2.1 82 Section 2 as a community order 2.4 86 Professional roles 2.9 87 The Responsible Clinician 2.9 87 Identifying the Responsible Clinician 2.12 87 Section 12 Approved Doctors 2.17 89 Avoidable illegal detention due to lapses of s.12 approval 2.19 89 Approved Mental Health Professionals 2.21 90 AMHPs and professional specialisation 2.22 90 Problems with assessments 2.24 90 The uncooperative patient 2.24 90 Problems with conveyance 2.28 92 Leave of absence and absence without leave 2.30 92 The planning and recording of leave of absence from hospital 2.30 92 Leave and risk assessment 2.35 94 Resource limitations and section 17 leave 2.37 95 Administering leave for restricted patients 2.41 98 Liaison with victims over leave 2.47 99 Ground leave 2.52 101 Absence without leave 2.56 102 Returning AWOL patients to hospital 2.60 104 Long-term s.17 leave 2.62 105 De facto detention 2.65 106 Supervised Community Treatment under the revised Mental Health Act 2.67 107 The impact of supervised community treatment 2.74 109 The impact on patients: MHAC experiences of SCT patients 2.77 111 The gender, age and ethnicity of SCT patients 2.79 112 SCT and deprivation of liberty 2.82 114 Residence requirements for SCT patients: the uncertain boundaries of hospital and commuunity 2.86 115 Some initial difficulties with the administration of SCT 2.89 117 Appealing against detention and SCT 2.91 117 Managers’ hearings for detained patients 2.91 117 The Tribunal 2.96 119 The effects of administrative delays 2.99 120 The role of detaining authorities in adjournments of Tribunal hearings 2.101 121 Provision of social circumstances reports to Tribunal hearings 2.102 122 In-patient nursing reports 2.104 122 Informing patients about their rights to a Tribunal 2.106 123 Legal aid and Tribunal representation 2.108 123 Outcomes of Tribunal Hearings 2.111 124 The care and treatment of detained patients in acute hospitals 2.121 128 Responsibility for treatment in acute hospitals under the revised Mental Health Act 2.127 129 6 Police powers to remove mentally disordered persons to a place of safety under s.136 2.129 130 Defining a public place 2.138 134 Information about the use of s.136 2.140 135 Aftercare under s.117 2.141 135 3 Consent to treatment Consent to treatment safeguards 3.1 138 The reality of consent 3.2 139 Recording consent and capacity 3.7 141 The reach of the statutory second opinion system: second opinions for consenting patients and the three month rule 3.17 145 Advance decisions 3.18 146 Access to psychological treatment 3.23 147 Safety and the administration of medication 3.24 147 Electronic records and medication management 3.27 148 The operation of the second opinion service 3.28 148 Second opinions to consider treatment with medication: patient characteristics 3.30 149 The effect of second opinion visits 3.35 154 High-dose medication 3.37 155 Concurrent certification of consent and absence of consent in detained patients 3.38 155 Emergency powers and medication 3.43 157 Electro-convulsive therapy 3.44 157 The Mental Health Act 2007’s restriction on legal powers to authorise ECT without consent 3.50 161 Magnetic seizure therapy and transcranial magnetic stimulation – future treatments? 3.59 166 Neurosurgery for mental disorder 3.61 167 Deep brain stimulation 3.63 167 Consent to treatment and Supervised Community Treatment 3.64 168 The consent
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