Welcome to the world – kind of new (if you count amendments as new) Mental Health Act 1983 (as amended 2007) – a large bulk became operational at midnight. Snappy, huh? It’s a been a pretty painful gestation period and here are still a few pieces here and there that haven’t yet seen the light but the bulk of the amendments pass into practice today.
Some of the main points (as they affect me.. )
Goodbye ASW – hello AMHP
I’ve written about this extensively and no doubt, will again, so I don’t want to bore people to tears about it!
Goodbye RMO – hello AC/RC (I know, it’s hard not to make the RC joke.. it hasn’t got old yet but it hasn’t entered wider usage – until today)
Interesting to note that the Responsible Clinician no longer needs to be a doctor though. Again, similarly to the changes with the Approved Mental Health Professionals no longer needing to be Social Workers, there is likely to be slow progress on the actual implementation but it’ll be interesting to see if it happens.
Goodbye Supervised Discharge – Hello Supervised Community Treatment
I think I’ll come back to this another day. Too much for a paragraph! (I know, that’s a cop-out!).
Goodbye ‘treatability’ test – Hello ‘suitable treatment’ test.
This might seem very subtle as a change – actually it is crucial. No-one can be detained under one of the longer sections unless suitable treatment is available but the disorder does not have to be ‘treatable’. Treatment is a very broad term and it seems that one of the aims of this change is to account for people with some kinds of personality disorders which are seen to be ‘untreatable’. It does mean that a place of treatment (hospital!) will have to be identified on the section papers, specifically. Personally, I expect this to be one of the first parts of the Act to be challenged in Court. Hopefully some case law will provide more clarification than is present in the Act.
Goodbye four classifications of mental disorder – Hello er.. unified classification.
Makes things a little less complicated. But now that Learning Disabilities are included as the same classification, there are some seperate protections for people with Learning Disabilities built into the Act so someone can’t be detained just because they have a learning disability.
Some of the other changes that I thought were quite interesting to note:
New regulations are enforced relating to victims of particular sexual or violent offences (named under the Domestic Violence, Crime and Victims Act 2004) who will now have the right to ask to be informed when a patient is to be discharged and will be able to make representations to the Responsible Clinician and AMHP regarding conditions which may be attached to a Community Treatment Order.
This applies now to both restricted and unrestricted patients.
Displacement of Nearest Relative can now be initiated by the patient themselves – although they still have to go to County Court to do so.
Exclusions from the Act remain in place for drug and alcohol users, namely someone cannot be detained on the grounds that they are dependent on drugs or alcohol if there is no other mental disorder. References to the exclusions based on promiscuity and sexual deviancy have been removed. Promiscuity on the basis that it is no longer relevant. Sexual Deviancy because.. well, forgive the cynicism but the government now has a place to act for those who are avowed but unconvicted paedophiles. Can they be placed in hospital? Possibly. Watch this space – let’s just say I wouldn’t want to be called out on that one. Another one I expect to reach the Courts for clarification before long.
ECT cannot be given now if a patient does not give consent or has made a valid advanced directive stating that they do not wish to be given ECT. This can be overridden in an emergency. Emergency will, again, probably be clarified through the courts before long.
There are, of course, other changes. Some like some of the changes in the Tribunal services and time limits will be operational immediately.
Some, like the implementation of the statutory Independent Mental Health Advocates (IMHAs) are slated for next year. Similarly the guidelines and assessments related to those who are being deprived of liberty will roll out in the Spring.
Age appropriate services for younger people is given a little longer so the new wards and bed can be identified but it is a good move.
And there’s probably a few more bits and pieces that haven’t sprung to the top of my mind yet. Still, it’s not like I won’t have time to get used to it…