Mental Health Act 1983: Code of Practice Mental Health Act 1983: Code of Practice Presented to Parliament pursuant to section 118 of the Mental Health Act 1983 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 Crown copyright 2015 Applications for reproduction should be made in writing to The National Archives, Kew, Richmond, Surrey, TW9 4DU. e-mail: [email protected] First published 2015 ISBN 978 0 11 323006 8 9308 Mental Health RTP v0_1.indd 1 07/01/2015 15:01 “Everyone including carers and families needs to know about the Code and all communication channels — from bottom to top and vice versa including sideways — should remain open for the benefit of all.” Expert Reference Group carer Contents Ministerial foreword 6 The views of service users and carers 7 Acknowledgements 8 Executive summary 9 Introduction 12 Using the Act 21 Underlying principles for care, treatment and Chapter 1 Guiding principles 22 support under the Act and good practice which Chapter 2 Mental disorder definition 26 advances equality and protects human rights Chapter 3 Human rights, equality and health inequalities 29 Protecting patients’ rights and autonomy 35 Issues of importance when empowering Chapter 4 Information for patients, nearest relatives, carers and others 36 patients in relation to their care and treatment, Chapter 5 The nearest relative 49 rights and autonomy, and ensuring they are Chapter 6 Independent mental health advocates 54 treated with dignity and Chapter 7 Attorneys and deputies 61 respect Chapter 8 Privacy, dignity and safety 63 Chapter 9 Wishes expressed in advance 74 Chapter 10 Confidentiality and information sharing 78 Chapter 11 Visiting patients in hospital 83 Chapter 12 The Tribunal 87 Assessment, transport and admission to hospital 95 Guidance in relation to assessment, transport Chapter 13 Mental capacity and deprivation of liberty 96 and admission to hospital, detentions Chapter 14 Applications for detention in hospital 113 under the Act, and use of Chapter 15 Emergency applications for detention 136 the Mental Capacity Act Chapter 16 Police powers and places of safety 139 Chapter 17 Transport of patients 153 Chapter 18 Holding powers 159 Additional considerations for specific patients 167 Focus on the particular needs of specific Chapter 19 Children and young people under the age of 18 168 patients and the role of professionals responsible Chapter 20 People with learning disabilities or autistic spectrum disorders 206 for their care Chapter 21 People with personality disorders 220 Chapter 22 Patients concerned with criminal proceedings 224 Contents Care, support and treatment in hospital 245 Guidance on the application of the Chapter 23 The appropriate medical treatment test 246 appropriate medical treatment test and Chapter 24 Medical treatment 250 medical treatment Chapter 25 Treatments subject to special rules and procedures 265 Chapter 26 Safe and therapeutic responses to behavioural disturbance 281 Leaving hospital 315 Guidance on the circumstances when Chapter 27 Leave of absence 316 patients may leave hospital, including Chapter 28 Absence without leave 324 being fully discharged, on short-term leave Chapter 29 Community treatment orders 328 or to receive care Chapter 30 Guardianship 342 and treatment in the community Chapter 31 Guardianship, leave of absence or CTO? 349 Chapter 32 Detention and CTO: renewal, extension and discharge 352 Chapter 33 After-care 357 Chapter 34 Care programme approach 362 Professional responsibilities 369 Additional information for professionals with Chapter 35 Receipt and scrutiny of documents 370 specific responsibilities under the Act and Chapter 36 Allocating or changing a responsible clinician 373 information for victims Chapter 37 Functions of hospital managers 375 Chapter 38 Hospital managers’ discharge power 385 Chapter 39 Conflicts of interest 394 Chapter 40 Information for victims 397 Annexes 403 Annex A Key words and phrases used in this Code 404 Annex B List of policies and procedures 420 Annex C Related material 427 Annex D Flowcharts: written descriptions 434 Index 438 Foreword Ministerial foreword Since the last Mental Health Act 1983: Code of Practice was introduced in 2008 there have been substantial changes and updates in legislation, policy, case law, and professional practice. This revised Code reflects and embeds developments since then in areas including the use of restrictive interventions, seclusion, use of police powers to detain people in places of safety, and the use of community treatment orders. We promised to improve mental health services, and to protect the most vulnerable in society. This Code reflects our personal commitment to ensuring this improvement and protection applies to all. We remain committed to ensuring that high quality care is always provided for patients who are subject to the Act. Care and treatment should always be a means to promote recovery, be of the shortest duration necessary, be the least restrictive option, and keep the patient and other people safe. The Act affects the lives and liberty of many people, impacting upon them, their families and community. In 2013-14 there were more than 53,000 detentions in England under the Act. This reinforces how important it is to ensure that this document is as up to date, robust, and as accessible as possible. The Code safeguards patients’ rights, ensures compliance with the law and must be considered by health and social care professionals. The Code is used by patients in hospital and those in the community, their families, carers and advocates. It is there to help make sure that anyone experiencing mental disorder and being treated under the Act gets the right care, treatment and support. Each draft of the Code has been read and commented on by a wide range of people and organisations. We are particularly proud to say that this included our ‘experts-by- experience’ group of patients, former patients and carers, who worked with us from the very beginning. We’d like to thank everyone who shared their ideas and their practical experience to ensure that this document is as comprehensive, clear and compassionate as possible. We are confident that we have succeeded in producing a revised Code which meets the needs of patients, families, carers and professionals, and presents information in a straightforward and accessible way for all who use it. The Rt Hon Jeremy Hunt MP The Rt Hon Norman Lamb MP Secretary of State for Health Minister of State for Care and Support 6 Foreword The views of service users and carers You could ask almost anyone using mental health services, or their relative caring for them, what really matters to them and they would say the same: ‘The one thing that makes a difference is knowing that your voice is being heard and that we feel listened to by others.’ Expert Reference Group service user Too many times in the past, people have tried to speak up about their concerns. They are ignored, their concerns are not acted upon and allowed to escalate until a person has the courage to acknowledge what they are saying, or blow the whistle, and awful failings and abuse are exposed, as in the case of Winterbourne View. The Code is designed to stimulate the best possible care, ensure patients’ rights are protected, and prevent atrocities happening. We hope the Code will do just that. There is no doubt that being in a mental health crisis yourself, or trying to support a distressed individual, is incredibly stressful. Knowing what your rights are can save a great deal of distress. The information needs to be straightforward and presented in a way that everyone understands, especially in acute situations. The Expert Reference Group and Government officials have worked hard to make the Code more accessible and available to service users and carers, as well as professionals. Those of us who are service users, or support someone who is, know from personal experience what works well within mental health services, and what needs improving. Having the opportunity to share these views in the consultation for the revised Code was very important – it reassured us that decision-makers were listening. ‘This Code of Practice has been co-produced by us all collectively. This is what real engagement is.’ Expert Reference Group service user supporter One of the most common themes has been the issue of practitioner training. We know that best practice, throughout all the different scenarios in mental healthcare, is detailed in the Code. These guidelines now need to be enforced, without exception, and for this to happen, training has to be consistent and robust across the board. Finally we have one shared objective: ‘Everyone including carers and families needs to know about the Code and all communication channels — from bottom to top and vice versa including sideways — should remain open for the benefit of all.’ Expert Reference Group carer Code of Practice Expert Reference Group (nine service users and six carers with current or recent experience of care and treatment under the Mental Health Act 1983). 7 Acknowledgements Acknowledgements A great many people have contributed to the development and content of this Code of Practice – far too many to thank personally for their contributions, comments, suggestions, queries and observations. Of especial importance are the contributions of the patients, former patients, carers and support workers on our expert reference group and the professionals on our steering group, who have worked with us since 2013 in identifying areas to address, and working through what additional guidance was required. We are particularly grateful to the many patients, former patents, their relatives, carers, supporters and advocates who participated in consultation events, responded in writing during the consultation or entered our artwork completion to design the new front cover and design for the Code.