Guernsey's proposed new Mental Health Law

Guernsey's Proposed New Mental Health Law

Current Mental Health Law (1939)

Guernsey’s current mental health law dates from 1939. The new law is modelled very much on the UK’s 1983 Mental Health Law, whilst maintaining the simplicity of Guernsey’s current law. At the moment (August 2006) it is a “draft law” and may be subject to further changes prior to enactment.

The following information is taken from a 2006 presentation by Chris Ellyatt (Senior Manager, Acute Service, Mental Health) and Gary Ayres (Lecturer Practitioner in Mental Health Nursing).

The following abbreviations have been used:

A&E	Accident & Emergency Department
ASW	Approved Social Worker
CMHN	Community Mental Health Nurse (CPN)
HSSD	Health & Social Services Department
MHRP	Mental Health Review Panel
MHRT	Mental Health Review Tribunal
OT	Occupational Therapist
RMN	Registered Mental Health Nurse
RMO	Responsible Medical Officer
SW	Social Worker

Outline of new roles

Approved Social Worker

A fully qualified and registered Social Worker who has undertaken further intensive training in mental health.

	Make applications for compulsory admission to hospital. (Currently undertaken by a Parish Constable or relative)
	Make application for Community Treatment Orders if appropriate, and act as Named Supervisor.
	Present reports to Mental Health Review Panel
	Powers of entry and inspection

Nominated Person

The client has the right to choose a person whom they wish to act in their interests and with whom they give consent for information about their care and treatment to be shared.

	May be family member, carer, friend, neighbour, clergyman etc
	Have capacity to object to use of compulsory powers
	Receive information about treatment plans
	Make application to Mental Health Review Panel on behalf of client
	Encouraged to attend Aftercare Meetings and Mental Health Review Panels
	Can be displaced by a court should the ASW or RMO feel the choice of Nominated Person is inappropriate

Mental Health Law Administrator

Will provide a comprehensive, accurate and professional administration of detained clients

	Ensure documentation is scrutinised and maintained within statutory guidelines
	Co-ordinate Mental Health Review Panel process, liasing between RMO, ASW, legal representative, panel members, ward managers and client’s nearest relative
	Take minutes of MHRP
	Responsible for training

Named Mental Health Professional (“Named Supervisor”)

In respect of Community Treatment Order, a Named Mental Health Professional will be appointed

	May be SW, CMHN, OT or Psychologist
	Will monitor client’s compliance
	Support client in community

Mental Health Nurse

RMNs will have power to detain an in-patient for up to 6 hours

Mental Health Review Panel

Will consist of 3 persons: the Chair (a qualified legal practitioner), an independent Consultant Psychiatrist and one lay member.

	Discharge patients from Assessment, Treatment or Community Treatment Orders
	Recommend periods of leave from hospital
	Decide on delayed discharge or transfer to another location
	Order transfer from a Treatment Order to a Community Treatment Order or vice-versa
	Will receive reports from the patient’s RMO, SW, Ward Manager, CMHN and any other mental health practitioner involved.
	The patient will be entitled to free legal representation (hopefully under an extension of the legal aid scheme)
	The Panel Chair will personally communicate the decision to the patient, and the Mental Health Administrator will ensure communication within a 5 day period
	(It is proposed that Guernsey will use an independent Consultant Psychiatrist from Jersey - and Jersey will use Guernsey’s)

Compulsory Orders

	Assessment
	Treatment
	Police Urgency
	Medical Holding
	Nurse Holding
	Community Treatment

Assessment Order

	Application to be made by ASW or Nominated Person
	Compulsory admission for up to 28 days (replaces current 7 day Urgency Order, and equivalent to Section 2 of the UK 1983 Mental Health Act)
	Grounds for detention:

	Patient is suffering from mental disorder of a nature or degree that warrants detention for a limited period; and
	Patient needs to be detained for his own health or safety or for the protection of others

One medical recommendation required, preferably patient’s GP, who will consult with Consultant Psychiatrist before making a recommendation
Admission will take place within 7 days

	The patient or Nominated Person may make application to Mental Health Review Panel after a period of 5 days from order being made.
	Patient can be discharged by the RMO prior to the expiry of the 28 days
	The Assessment Order cannot be reviewed. Upon expiry, the patient will revert to Voluntary status, or an application be made for a Treatment Order

Treatment Order

	Will allow compulsory detention for up to 6 months. It can be renewed, in the first instance for 6 months, then subsequently, for periods of 12 months. (Replaces current Certification Order)
	Two medical recommendations required, one of which must be Consultant Psychiatrist
	Not more than 5 days must elapse between the 2 medical examinations
	Grounds for admission under Treatment Order:

	Patient is formally diagnosed as suffering from mental disorder; and
	Mental disorder is of a nature or degree that makes it appropriate for the patient to receive treatment in hospital
	It is necessary for his/her health and safety, or the protection of others that he/she should receive such treatment, and it cannot be provided unless he/she is detained

Application made by ASW or Nominated Person

Applicant will have seen the patient within 7 days

Application can only be signed after the 2 medial recommendations are complete

Patient or Nominated Person may make application to the MHRP once during each (6 month) period of detention

RMO can discharge patient from this order before expiry

RMO has responsibility to convene an aftercare meeting (via Mental Health Act Administrator)

Police Urgency Order

	Allows for compulsory admission to a Place of Safety for up to 72 hours, allowing the patient to be interviewed by an ASW and medical officer
	Replaces the existing Police Urgency Order (7 days)
	The Police Officer has ‘right of entry’ without a warrant if concerned there is imminent risk to patient’s life, health or safety, or for the protection of others
	Grounds for detention:

	Patient appears to be suffering from mental disorder of a nature or degree that warrants detention for a limited period: and
	The patient needs to be detained for his/her own health or safety, or for the protection of others

A medical officer can discharge the patient before the 72 hour expiry

Treatment should only be administered with the patient’s valid consent

Medical Holding Power

Allows for the detention of a voluntary patient for a period not exceeding 72 hours (replaces the existing 31.5 holding order)

	Extended (from only Consultant Psychiatrist) to the doctor in charge of the patient’s care at the time, e.g. A&E doctor
	Would usually be applied to voluntary patient who has expressed desire to leave hospital before there is time to complete an assessment or treatment order – based on concerns for the safety of the patient and/or others
	This order cannot be renewed
	Treatment should only be administered with the patient’s valid consent
	The RMO (or another doctor to whom this responsibility has been delegated) can discharge the patient before the expiry of the 72 hours

Nurse Holding Power

	Will allow a Registered Nurse to detain a voluntary patient who is already being treated for mental disorder, for up to 6 hours
	Grounds for detaining a patient under this power:

	The patient is suffering from a mental disorder to a degree and of a nature that makes it necessary for his/her health or safety, or for the protection of others, for him/her to be immediately restrained from leaving hospital.
	Can only be applied if the patient is either indicating verbally or otherwise that he/she wishes to leave hospital; and
	It is not possible to immediately obtain a doctor for the purpose of applying a Medical Holding Power

	Will commence after the Nurse has recorded their opinion, in the form prescribed, and end 6 hours later, or on application of a Medical Holding Power
	The Nurse exercising this power must be registered on the NMC Register sub-part 1, Registration code RN3 or RNMH (Mental Health) or RN5 RNLD (Learning Disabilities)
	This order cannot be renewed

Community Treatment Order

	Allows for compulsory treatment in a community setting for up to 6 months. It is renewable, in the first instance for a further 6 months, and thereafter each 12 months
	Grounds for a Community Treatment Order:

	The patient is suffering from a mental disorder of a nature or degree that warrants supervision in the community; and
	The patient needs to be supervised for his own health or safety, or for the protection of others, or to prevent exploitation by others

Community Treatment Order will confer the following powers:

	Power to require the patient to reside at a specified place and convey them there if necessary
	Power to require the patient to attend at places and times specified for the purpose of medical treatment, occupation, education or training
	Power to require that access to the patient is given, at any place where the patient is residing, to any registered medical practitioner, ASW or other person so specified
	The power to convey and admit to hospital
	The power to enforce compliance with prescribed treatment

If a patient subject to a Community Treatment Order is admitted to hospital, then the order will remain valid for 10 days, then if deemed necessary, transfer for Treatment Order or discharge.

Named Supervisor will be appointed, with the authority to exercise powers conferred by the Order in person, or with assistance from the police, who will act on the advice of the Named Supervisor, or other Officers of the HSSD.

If a Community Treatment Order is applied to someone who is currently subject to a Treatment Order, it would have the effect of a new order.

Two medical recommendations will be required, less than 5 days apart. RMO, and GP who knows the patient.

Application for Community Treatment Order can be made by an ASW or Nominated Person.

If a patient fails to comply with the terms of the Order, then further powers come into effect (‘paragraph 75’)

A patient subject to a Community Treatment Order can be required to attend any form of therapeutic intervention prescribed by the RMO in conjunction with the multi-disciplinary team.

The patient can request (RMO or Mental Health Review Panel) a discharge from the Order.

A patient can request that the MHRT consider the continued need for the Order during each 6 month period of detention. The Mental Health Law Administrator will assist in completing the application form.

An ASW or Nominated Person can apply for renewal of the Community Treatment Order. The RMO will be required to recommend.

Criminal Justice Orders

Three Orders will be available to the Courts