Hospital Managers Protocol (Under Section 23 Mental Health ...€¦ ·

DOCUMENT CONTROL:

Version: 2

Ratified by: Mental Health Legislation Operational Group

Date ratified: 8 May 2019

Name of originator/author: Mental Health Act Manager

Name of responsible committee/individual:

Mental Health Legislation Operational Group

Unique Reference Number: 83

Date issued: 26 November 2019

Review date: May 2022

Target Audience Hospital Managers / All Trust Staff

Hospital Managers Protocol

(Under Section 23 Mental Health Act 1983)

Version 2 May 2019 Page 2 of 58 Hospital Manager Protocol

1. INTRODUCTION Hospital Managers In England, NHS Hospitals are managed by NHS Trusts and NHS Foundation Trusts such as Rotherham Doncaster and South Humber NHS Foundation Trust. For these hospitals the Trusts themselves are defined as the “Hospital Managers” for the purposes of the Mental Health Act 1983 (MHA). Hospital Managers have the authority to detain patients under the MHA and have the primary responsibility for seeing that the requirements of the MHA are followed. In particular, they must ensure that patients are detained only as the MHA allows, that their treatment and care accord fully with its provisions and that they are fully informed of, and supported in exercising, their statutory rights. The Hospital Managers have equivalent responsibilities towards patients who are subject to Community Treatment Orders (CTO). In practice most of the responsibilities of the Hospital Managers, examples of which include admission and transfer of detained patients, provision of information and reference to the Mental Health Tribunal, are actually taken by individuals (or groups of individuals) on their behalf, such as, MHA Office staff and ward staff. Trust Associate Hospital Managers Consideration for and decisions about discharge from detention and CTO’s are taken by panels of people specifically selected for the role (Hospital Managers Panels). Hospital Managers’ Panels consist of 3 or more people and can include members, but not employees, of the Trust, e.g. Chair and Non-Executive Directors of the Trust, as well as people appointed by the Trust for this purpose. Those appointed for this purpose must not be employees of the Trust and are often referred to as Associate Hospital Managers. Within the Rotherham Doncaster and South Humber NHS Foundation Trust the role of Hospital Managers’ Panels is undertaken by Trust Associate Hospital Managers and for the purposes of this protocol will be referred to as Trust Associate Hospital Managers. The Chairs of the Panels is referred to as a Senior Trust Associate Hospital Manger.

2. PURPOSE The protocol aims to:

ensure that patients have their right to have their detention or CTO reviewed by the Trust Associate Hospital Managers

ensure that the Trust has sufficient Trust Associate Hospital Managers to meet the requirements of the MHA

provide guidance to Trust Associate Hospital Managers in performing their duties

ensure Trust Associate Hospital Managers and the Board of Directors have confidence in the procedures adopted by the Trust in ensuring that the functions of the Hospital Managers are discharged effectively and lawfully.

3. SCOPE

Although Hospital Managers have a range of authorities, duties and responsibilities


this protocol applies only to the power to discharge under Section 23 of the MHA. 4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 4.1 The Board of Directors

As Hospital Managers, the Trust is responsible for ensuring that the requirements of the MHA are fully met and that there are sufficient Trust Associate Hospital Managers to fulfil the requirements in terms of consideration for discharge. The Board of Directors have overall responsibility for the appointment of Trust Associate Hospital Managers.

4.2 Mental Health Act Manager

The MHA Manager will be responsible for the operational management of the MHA, including the functions of the Trust Associate Hospital Managers. They will:

Oversee a performance review of each Trust Associate Hospital Manager at least once every 3 years

Have overall responsibility for matters relating to the competence and conduct of Trust Associate Hospital Managers

Report, as required, to the Board of Directors or any of its designated Committees.

4.3 Mental Health Act Offices

The MHA Offices of the Trust will be responsible for the:

Planning and co-ordinating Hospital Managers Hearings to consider discharge of patients subject to detention or CTOs

Attending Hospital Managers Hearings.

4.4 Hospital Managers (under Section 23 MHA) Hospital Managers have important responsibilities in relation to detained patients, in particular, their duty to review and consider discharge from detention or CTOs and this protocol refers only to those powers delegated under Section 23 of the MHA (Power of Discharge). When holding a review, Trust Associate Hospital Managers are required to act in conformity with the MHA 1983 and the Code of Practice issued as set out in Section 118 of the MHA 1983. The most recent Code of Practice was issued in April 2015. The key chapters relating to Hospital Managers is Chapter 38 (the Hospital Managers’ Discharge Power).

5. PROCEDURE/IMPLEMENTATION 5.1 Eligibility to act as a Trust Associate Hospital Manager

The Chair of the Trust and the Non-Executive Directors of the Trust Board are all eligible but not required, to act as Trust Associate Hospital Managers for the Trust. The Trust also appoints a number of Trust Associate Hospital Managers who are also eligible to participate in Hospital Managers Panels.


Trust Associate Hospital Managers may not be employees of the Trust. 5.2 Appointment of Trust Associate Hospital Managers

The Trust will appoint a sufficient number of Trust Associate Hospital Managers, so that there is a sufficient pool of trained Trust Associate Hospital Managers for panels. Applicants will need to be able to demonstrate some, or all of the following:

• An interest and awareness of mental health issues; • An understanding of Health and Social Service organisations; • An understanding of equality issues; • A good understanding of confidentiality; • The ability to analyse complex problems; • The ability to read and comprehend detailed reports; • The ability to actively listen and question; • The confidence to question and challenge sensitively; • The ability to work as a member of a team; and • The ability to bring objectivity and an impartial approach to tasks.

When necessary, the Trust will advertise for Trust Associate Hospital Managers.

Trust Associate Hospital Manager Recruitment

Application Form completed

Interview MHA Manager / HR representative / Carer or Service User representative

Reference and CRB checks 2 references required

3 year Appointment confirmed by Trust Board

Appointment letter issued

Induction

Observation of 3 Panel Hearings

Applicants who are regarded as suitable and whose references are acceptable will then be subject to DBS Clearance procedures. Following an acceptable outcome a recommendation will be made to the Board of Directors who will have responsibility for making the appointment. Trust Associate Hospital Managers are not employees of the Trust, but appointment will be made subject to a formal agreement (APPENDIX 1). The Trust gives no undertaking of any minimum number of Hearings to be offered to each Trust Associate Hospital Manager, but it will take account of the need to ensure that all Trust Associate Hospital Managers have sufficient opportunity to sit in hearings. This is to both maintain their confidence and skills and to ensure that at least 12 hearings can be attended by each Trust Associate Hospital Manager, in a 12 month period.


Under the agreement

The Trust Associate Hospital Manager will:

The Trust will:

Maintain confidentiality at all times Provide training for the role of the Trust Associate Hospital Manager

Attend and participate in a minimum of 12 Hospital Managers Hearings annually

Insure the Trust Associate Hospital Manager whilst on Trust premises

Attend training and development sessions and at least 75% of formal Trust Associate Hospital Managers 4 annual meetings.

Indemnify the Trust Associate Hospital Manager in respect of performance of the role

Adhere to relevant Trust policies Provide necessary administrative support

Adhere by the principles of data security Provide necessary information resources

Participate in an annual review Reimburse all agreed fees and expenses incurred in the discharge of the role

Participate in a 3 yearly performance review

The initial appointment will be for a period not longer than 3 years, subject to an annual review and 3 yearly performance review. At the end of this period, the Trust Associate Hospital Manager will have a review of their continuing suitability, the outcome of which will be discussed with the Deputy Director of Nursing and Allied Health Professionals to decide whether to renew the appointment. The Trust may terminate the appointment with the Trust Associate Hospital Manager with one month’s notice and if there has been a substantial breech of the undertakings in the agreement, the agreement may be terminated without prior notice. Any such decision will be taken by the MHA Manager in consultation with the Director of Nursing and Allied Health Professionals. The Trust Associate Hospital Manager may also terminate the appointment immediately by notice in writing to the MHA Manager at any time.

5.3 Induction of Trust Associate Hospital Managers The Trust is committed to the provision of a high quality service to patients and recognises its responsibility to provide appropriate training and to monitor the effectiveness of the Trust Associate Hospital Managers. The Trust Associate Hospital Managers will receive the following training and sign an agreement on maintaining confidentiality before they have access to any patient information. The training will include:

• Familiarisation with key elements of the MHA and relevant sections; • Familiarisation with key elements of the Code of Practice; • Attendance / E-Learning for the following mandatory training sessions:

o MCA / DoLS (Leaflet) o Safeguarding – Adults (Leaflet) o Safeguarding – Children (Leaflet)


o Domestic Abuse (Leaflet) o Prevent (Leaflet) o Data Security (E-Learning/face to face) o Equality, Diversity & Human Rights (face to face) o Infection and Prevention Control o Introduction to MHA (face to face)

Support for the induction process will be achieved through: • Contact with the MHA Manager for advice and support; • Observations at Hospital Managers Hearings; • The opportunity to discuss with the panel chair and panel members following

observation at Hospital Managers Hearings;

No Trust Associate Hospital Manager will be allowed to sit as a member of a panel until completion of all the induction training.

5.4 Training

As well as the initial training the Trust will provide update training. The Trust considers that training events will assist in determining and maintaining consistency in the delivery of standards. The expectation of the Trust is that Trust Associate Hospital Managers will endeavour to attend all training events provided. Training will include:

• Developments in mental health; • Developments in mental health law; • Skills development, (particularly in relation to chairing panels for those looking to

assume this role); • Equality, Diversity and Human Rights training; and • Data Security training. Trust Associate Hospital Managers will not be expected to chair Hospital Managers Hearings until they have sufficient experience of participating in reviews and have received training in chairmanship. Those who are approved to Chair will be known as Senior Trust Associate Hospital Managers but otherwise the same obligations, duties and responsibilities for Trust Associate Hospital Managers will apply to them.

5.5 Annual review

The MHA Manager will undertake an annual review with each Trust Associate Hospital Manager which will be a paper review (APPENDIX 2) and will include: • Training undertaken • Number of hearings available for • Number of hearings attended • Number of meetings chaired (where appropriate) • Specific strengths • Feedback from peers • Learning and development needs.

5.6 Three year review

The MHA Manager will hold three yearly formal performance review meetings with each Trust Associate Hospital Manager (APPENDIX 3).


Those meetings will review:

• the on-going commitment to the role of Trust Associate Hospital Manager; • attendance at training sessions; • review of personal training and development needs; • consideration of any problems encountered; • feedback of Trust performance over previous 3 years; and • any issues which an individual Trust Associate Hospital Manager wishes to bring

to the attention of the Trust.

Nothing in the review process precludes the MHA Manager convening an early discussion with a Trust Associate Hospital Manager in the event of any issues being raised which give rise to concerns about good practice. The Trust will reimburse expenses in respect of attendance at a review meeting.

5.6 Confidentiality

Although Trust Associate Hospital Managers are not RDaSH employees, they have the same duty as employees to maintain and protect the confidentiality of information relating to patients, colleagues and business information. The Health and Social Care Information Centre (HSCIC) has established four confidentiality rules that must be followed:

1) Confidential information about patients should be treated confidentially and

respectfully. 2) Members of a care team should share confidential information when it is needed

for the safe and effective care of an individual. 3) Information that is used for the benefit of the community should be anonymised. 4) An individual’s right to object to the sharing of confidential information about them

should be respected.

Prying and gossiping are unethical. Trust Associate Hospital Managers must not discuss personal confidential information about patients or colleagues. If there is a potential conflict of interest, e.g. a Trust Associate Hospital Manager has been asked to sit on a panel for someone they know, they must inform the MHA Office immediately. If a Trust Associate Hospital Manager needs to refer to another case they have been involved in, e.g. if it is a difficult decision and they have been involved in a similar case, they must do so in a way that does not identify the patient concerned.

5.7 Complaints about Trust Associate Hospital Managers

If there are any concerns raised about the practice or conduct of a Trust Associate Hospital Manager, the nature of the issue will be investigated by the MHA Manager in the first instance. Dependent upon the seriousness of the issue, the outcome may be that a letter highlighting concern will be sent from the MHA Manager to the Trust Associate Hospital Manager. More serious issues will require further investigation and may necessitate a meeting


between the Trust Associate Hospital Manager, Deputy Director of Nursing and Allied Health Professionals and the MHA Manager. The findings from this meeting will be reported by the Deputy Director of Nursing and Allied Health Professionals to the Director of Nursing and Allied Health Professionals. The Director of Nursing and Allied Health Professionals will then make a decision regarding any further action which could include further training, suspension of the Trust Associate Hospital Manager or even termination of the agreement as a Trust Associate Hospital Manager. Any Trust Associate Hospital Manager who is unhappy with the decision of the Director of Nursing and Allied Health Professionals will have the opportunity to formally raise this with the Chief Executive.

5.8 Conduct of Hospital Managers Hearings

Refer to the Procedure for Hospital Managers Hearings (APPENDIX 4).

5.9 Remuneration

The remuneration provided to each Trust Associate Hospital Manager is set by the Trust and reviewed periodically. Sessions will attract remuneration plus travel expenses. When a Managers Hearing has to be cancelled within 24 hours of the planned hearing the Trust will endeavour to provide Hospital Managers with as much notice as possible. However when a Managers Hearing is cancelled within 1 working day of

Complaint and / or concern raised

Initial investigation by the MHA Manager

MHA Manager reports to Deputy Director of Nursing & Allied Health Professional

Deputy Director of Nursing & Allied Health Professionals recommends any action required

Further investigation and, if necessary, meeting between Trust Associate Hospital Manager, Deputy Director of N&AHP and MHA Manager

Report from Deputy Director N&AHP to Director of N&AHP

Decision from Director of N&AHP re action

Opportunity to formally raise objection to outcome with Chief Executive

Letter from Deputy Director N&AHP to Trust Associate Hospital Manager


the original hearing the Trust will offer remuneration for this. Such instances must be recorded on the Trust Associate Hospital Managers Claim Form.

6. LINKS TO OTHER TRUST PROCEDURAL DOCUMENTS

Procedure for Hospital Managers Hearings

7. REFERENCES MHA 1983 Code of Practice – Published 2015

8. APPENDICES

APPENDIX 1 – Letter of Appointment APPENDIX 2 – Annual Review APPENDIX 3 – 3 year Performance Review APPENDIX 4 – Procedure for Hospital Managers Hearings


APPENDIX 1

Woodfield House Tickhill Road Site

Balby Doncaster DN4 8QN

Tel: 01302 796400 Ref: HM Date Dear XXXX Letter of Appointment for the role of Trust Associate Hospital Manager Further to our previous communications I write to provide for you the terms and conditions relevant to your appointment until the end of your term of office which will be XXXX. It is important that you read these carefully and contact me should you have any queries. Please indicate your acceptance of these terms and conditions by signing one copy and returning it to me – a return slip is included at the end of this letter. This appointment does not create any contract of employment or contract for services between you and the Trust, and is not within the jurisdiction of the employment tribunals. Appointment This appointment is made by the Board of Directors. The appointment is for a fixed period of three years from XXXX to XXXX. Trust Associate Managers are eligible for reappointment at the end of their period of office, but they have no absolute right to be reappointed. Decisions about reappointments will be made by the Board of Directors after due consideration of the appraised performance of the individual, the number of Trust Associate Managers needed in relation to the current demand at that time and any other circumstances considered by the Board of Directors to be relevant. Termination The Board of Directors can terminate the appointment with 1 months’ notice prior to the end of the planned term of office. The grounds for such a decision do not have to be declared. The Trust Associate Manager may also terminate the appointment immediately by notice in writing to the MHA Manager at any time.

http://nww.intranet.rdash.nhs.uk/home/corporate-templates/rotherham-doncaster-and-south-humber-nhs-foundation-trust-rgb-blue/


Time Commitment Hearings and Appeals The Trust anticipates the need for hearings and appeals to be scheduled on a monthly basis in Rotherham and Doncaster and from time to time and in Scunthorpe and other localities across the area covered by the Trust’s activities. You will be expected to attend a minimum of 12 hearings and appeals per year and you are expected to attend 75% of the Trust Associate Managers Forum meetings to which you are invited in any year. Training Training will be provided by way of an initial induction involving review of educational leaflets, educational taught courses and the attendance at panel hearings as an observer. This initial induction will be planned with you and should normally take no longer than three months to complete. The induction training is mandatory. Further ongoing training will be provided as and when necessary and will cover any new legislation or feature refresher training as appropriate. The ongoing training is mandatory. The Trust will endeavour to be as flexible as possible in the provision of the training but failure to undertake the required training will lead to a termination of your appointment. Role Within the definitions expressed within section 23 of the Mental Health Act 1983, RDASH appoints "Trust Associate Hospital Managers" who by way of managers panels have the power to discharge most patients from their detention or from Community Treatment Orders and to see that in doing so the law is observed. The Mental Health Act 1983 contains the core legislation governing the formal detention and care of mentally disordered people in hospital and in the community. Certain other legislation also applies, in particular the Mental Capacity Act 2005 and in acting in a quasi-judicial capacity you are bound to observe the rules and principles of common law and natural justice. Fees Trust Associate Managers receive a payment of £40.00 for each session that they attend and Senior Trust Associate Managers who chair panel hearings receive a payment of £50.00. Both can claim the related travel expenses at rates determined by the Trust from time to time. Presently the travel cost reimbursement is at the following rate:

Mileage Rate Inland Revenue Approved Mileage rate 45p per mile

A session for this purpose is a half day consisting of a morning or afternoon or part of morning or afternoon. For this purpose the morning ends and the afternoon begins at 1pm. Sessions cancelled within 1 working day of a scheduled hearing will be reimbursed. There is no entitlement to compensation for loss of office and you will not be entitled to any pension, bonus or other benefits apart from those specifically identified in this letter.


Your fees and remuneration will be subject to applicable UK statutory deductions. This will include deductions for income tax, national insurance and any other similar liabilities deductible at source. Outside interests It is accepted and acknowledged that you have interests outside of your connection with the Trust and any conflicts of interest should be declared to the MHA Manager as soon as they become apparent to you. Obvious examples are that a patient is known to or related to you or a clinical or other professional involved in a hearing is known to you other than on a professional basis. If you have any doubt about a situation which you feel may involve a conflict you should speak about the matter with the MHA Manager at the earliest opportunity. Confidentiality All information acquired during your appointment is confidential to the Trust and should not be used except for the benefit of the Trust or disclosed or released, either during your appointment or following termination other than if required by law. Communication in any form with external third parties including the media is not permitted under any circumstances. Review process Your performance will be evaluated from time to time and there will be an informal review annually and a formal review at least every 3 yearly basis. If, in the interim, there are any matters which cause you concern about your role you should discuss them with the MHA Manager. Insurance / Indemnity Trust Associate Hospital Managers/Senior Trust Associate Hospital Managers who act honestly and in good faith and in accordance with the law and the directions of the Trust will not have to meet out of their personal resources any personal civil liability which is incurred in the execution or purported execution of their functions. The Trust has directors’ and officers’ liability insurance as part of the arrangements in place with NHSLA which provides cover for Trust Associate Hospital Managers/Senior Trust Associate Hospital Managers as ‘relevant persons’. Smoking Policy The Foundation Trust operates a No Smoking Policy in all of its premises or grounds. Health and Safety at Work Act 1974 You have a duty to comply with the Act and to take reasonable care to avoid injury to themselves and others. Removal of Trust Property You must not remove any material or goods which belong to the Foundation Trust from Foundation Trust premises unless this is in the normal course of the conduct of Foundation Trust business or the office held. All Trust property you hold should be returned on termination of appointment or on demand.


Criminal Matters The appointment to Trust Associate Hospital Managers/Senior Trust Associate Hospital Managers is subject to a satisfactory Disclosure and Barring Services check. Trust Associate Managers/Senior Trust Associate Hospital Managers are required to declare immediately and in writing if they are arrested, have prosecutions pending or convictions (including driving offences) and any cautions. Failure to disclose the fact of an arrest, a caution, pending prosecution or conviction may result in termination of the appointment. Prevention and Control of Healthcare Associated Infections To ensure the Trust is fully compliant with the Health Act 2006: Code of practice for the prevention and control of healthcare associated infections (HCAI), emphasis is to be placed on achieving full compliance in the area of Infection Prevention and Control. It is the responsibility of everybody at the Trust and those visiting or working within the Trust's premises to prevent and control the spread of infection by following the Trust's infection control policies. I would very much appreciate it if you could complete and return to me the acknowledgement of receipt and confirmation of your acceptance of the Terms of Appointment which is attached at the back of this letter. If anything is unclear, please contact me before returning or signing the confirmation. I can be contacted on 01302 796400. Yours sincerely HELEN MORAN MHA Manager


SENIOR / TRUST ASSOCIATE HOSPITAL MANAGER APPOINTMENT

ACKNOWLEDGEMENT OF RECEIPT OF LETTER OF APPOINTMENT SENIOR/TRUST ASSOCIATE HOSPITAL MANAGER: XXXX DATE OF APPOINTMENT: Appointed for a three year period from XXXX I confirm that I have received my letter of appointment dated XXXX from Miss Helen Moran, MHA Manager, Rotherham Doncaster and South Humber NHS Foundation Trust. I have read the aforementioned letter and can confirm my acceptance of the terms of appointment contained in the letter. Signed: Date: ______________________________ _______________________ Name:



APPENDIX 2

Informal Annual Review Pro-forma for: Reviewer: Date:

1 Training undertaken since last review (to be completed by MHA Manager)

2 Availability & Attendance at Hearings (to be completed by MHA Manager)

Renewal Hearings

Available Booked Attended Cancelled by us Cancelled by TAM

Q1

Q2

Q3

Q4

Ad-Hoc Hearings


Q1

Q2

Q3

Q4

3 Specific Strengths (to be completed by TAM)

4 Comments from the TAM



5 Comments from MHA Manager

6 Learning & Development Needs (to be jointly agreed)

7 Follow up action required

Signature of TAM:………………………………………………. Date: ……………………….

Signature of Reviewer: ………………………………………… Date: ……………………….


Post holder details Name: …………………….……. Post: … …………...………… Pay Band: ……… Reviewer details Name: ………………………………..…………………… Post: ..………………… Name: ……………………………………………………… Post: …………………… Review details Date: ……………..… Time: ……………… Venue: …………………………….

Trust Associate Managers Review Documentation

APPENDIX 3


SECTION A Self-Assessment

This is an opportunity to summarise your contributions over the last 12 months. Please briefly incorporate the following: areas of concern / development, consideration of your own performance during hearings


SECTION B

Please indicate the number of hearings that you have attended since the last Review

Renewal Hearings


Q1

Q2

Q3

Q4

Ad-Hoc Hearings


Q1

Q2

Q3

Q4

Please record all training sessions that you have attended since the last review


SECTION C Reviewers Assessment

Please use this space to summarise the achievements and other more general areas of contribution or factors affecting performance. The following questions can be used as a guide: What preparation is done prior to the hearing? Would you like to see changes to the preparatory process? How do you ensure you communicate effectively as a panel member? Describe an example where you have attended a hearing that had a difficult or unusual situation that had to be dealt with Discussion points raised from hearings

SECTION D PERSONAL DEVELOPMENT PLAN

Development that can be acquired within the

role/Trust

Development that requires 3

rd Party support


SECTION E

Summary

In this section, both the Trust Associate Manager and the Reviewers have the opportunity to summarise the review.

Trust Associate Manager comments:

Reviewers comments:

This is to confirm that the Review is mutually agreed and this documentation reflects an accurate record of the Review and on-going areas of development

Post holder Sign: Date:

Reviewer Sign: Date: Sign: Date:

Review details

Date of next Review: ..……….…………


APPENDIX 4

MENTAL HEALTH ACT

Procedure for Hospital Managers’ Hearings

Document Control

Version 7

Ratified by Mental Health Legislation Operational Group

Date Ratified

Name of originator MHA Manager

Name of responsible committee Mental Health Legislation Operational Group

Date issued

Review date

Target audience Trust Associate Hospital Managers / All Trust Staff


Contents

1. Introduction 2. Objectives 3. When to hold a Review 4. Principles underpinning Reviews 5. Procedure for Renewal of Authority 6. Procedure for Renewal Review Hearing 7. Procedure for an Appeal to Hospital Managers Appendices A. Form 14c B. Report requirements for the Responsible Clinician C. Report requirements for the SCT D. Social Circumstances Report for Hospital Managers Template E. Nursing Report Template F. Renewal Review Admin Checklist G. Attendance Sheet H. Background Information I. Decision forms – Section 2 J. Decision forms – Treatment Sections K. Decision forms - SCT L. Decision forms – Sec 25 Barring Sec 2 by NR M. Sec 25 Barring Sec 3 by NR N. Sec 25 Barring SCT by NR O. Hearing Flowchart


1 Introduction The MHA 1983 provides the legislative framework within which Hospital Managers are

expected to operate in order to ensure that any actions they take fulfil legal requirements. The Mental Health Act Code of Practice 2015 provides guidance to Hospital Managers on how they should proceed when undertaking duties under the MHA 1983 (Chapter 38 the Hospital Managers Discharge Power).

These procedures contain a summary of the relevant rules applicable to this part of the

MHA 1983. It is by no means exhaustive and is not intended to replace the Hospital Managers need to be aware of the relevant provisions of the Code of Practice and Reference Guide and the MHA 1983 together with relevant case law.

2 Objectives Section 23 of the MHA 1983 gives the Hospital Managers the power to discharge an

unrestricted patient from detention and patients subject to Supervised Community Treatment (SCT).

The Trust has appointed a number of Hospital Managers to undertake the functions of

the Hospital Managers to discharge patients under Section 23 of the MHA 1983. The appointees are known collectively as the ‘Trust Associate Hospital Managers’ and those who Chair the Panel Hearing are known as ‘Senior Trust Associate Hospital Managers’.

The legislation does not define the procedure for reviewing a patient’s detention or

SCT; however, the Trust Associate Hospital Managers’ conduct of reviews must satisfy the fundamental legal requirements of fairness, reasonableness and lawfulness:

• They must adopt and apply a procedure which is fair and reasonable; • They must not make irrational decisions, that is, decisions which no body of Trust

Associate Hospital Managers properly directing themselves as the law, and on the available information, could have made;

• They must not act unlawfully, that is, contrary to the provisions of the MHA 1983, any other legislation (including the Human Rights Act 1998 and relevant equality and anti-discrimination legislation).

The Guidance set out below on the conduct of meetings and procedures should be

followed. In exceptional circumstances, however, it may be necessary to deviate from the suggested conduct/procedure. In such circumstances, advice must be taken from the Mental Health Act Office.

The decision by the members of the panel must be unanimous. 3 When to hold a Review Hospital Managers:

may undertake a review at any time at their discretion;

must undertake a review if the patient’s Responsible Clinician (RC) submits to them a report under section 20 of the MHA 1983 renewing detention or under section 20A extending CTO;

should consider holding a review when they receive a request from (or on behalf of) a patient; and


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.

In the last two cases, when deciding whether to consider the case, Trust Associate Hospital Managers are entitled to take into account whether a Tribunal has recently considered the patient’s case or is due to do so in the near future.

Whilst it is desirable for Trust Associate Hospital Managers to consider a report renewing a detention or extending an CTO before the current detention period or CTO ends, the RC’s report made under section 20 or 20A provides authority for the patient’s continued detention or CTO until the Trust Associate Hospital Managers can consider the case and reach a decision.

4 Principles underpinning Reviews

The Trust will ensure that all relevant patients are aware that they may ask to be discharged by the Trust Associate Hospital Managers and of the distinction between this and their right to apply for a Tribunal hearing.

The exercise of Trust Associate Hospital Managers’ functions under Section 23 MHA 1983 is also subject to the general law in that the conduct of the review must conform to the legal requirements of fairness, reasonableness and lawfulness (see 2 above). The procedure adopted must conform to the principles of natural justice and the Trust Associate Hospital Managers must not make decisions that are irrational or outside their powers. Where a review is to take place, Trust Associate Hospital Managers must consider whether the grounds for continued detention of the patient under the MHA are satisfied. Generally the Trust Associate Hospital Managers must consider the questions below, in the order stated:

For Section 2: • is the patient is still suffering from a mental disorder? • if so, is the disorder of a nature or degree which warrants the continued

detention of the patient in hospital for assessment or for assessment followed by medical treatment?

• ought the detention to continue in the interests of the patient’s health or safety or for the protection of other people?

For other detained patients: • is the patient still suffering from a mental disorder? • If so, is the disorder of a nature or degree which makes treatment in a

hospital appropriate? • Is continued detention for medical treatment necessary for the patient’s

health or safety or for the protection of other people? • Is appropriate medical treatment available for the patient?

For patients on CTO: • is the patient is still suffering from a mental disorder? • if so, is the disorder of a nature or degree which makes it appropriate for the

patient to receive medical treatment? • if so, is it necessary in the interests of the patient’s health or safety or the

protection of other people that the patient should receive such treatment?


• is appropriate medical treatment available for the patient? • is it still necessary for the RC to be able to exercise the power to recall the

patient to hospital, if that is needed? • is appropriate medical treatment available for the patient?

If the RC has made a report under section 25 barring a nearest relative’s attempt to discharge the patient, the Hospital Managers should also consider the following question:

• Would the patient, if discharged, be likely to act in a manner that is dangerous to

other people or themselves? This last question provides a more stringent test for continuing detention or CTO.

If the Panel unanimously disagree with the RC and decide that the answer to this question is “no”, the panel should usually discharge the patient. However, the Trust Associate Hospital Managers retain a residual discretion not to discharge in these cases, so panels should always consider whether there are exceptional reasons why the patient should not be discharged.

In all cases, Trust Associate Hospital Managers have discretion to discharge patients

even if the criteria for continued detention or CTO are met. Hospital Managers’ panels must therefore always consider whether there are other reasons why the patient should be discharged despite the answers to the questions set out above.

5 Procedure for the Renewal of Authority for Detention

5.1 The MHA Office will advise the RC eight weeks prior to the date of renewal. 5.2 The RC will complete the appropriate paperwork (Form H5 or Form CTO7) 5.3 The named nurse (for inpatients) will ensure that the patient is advised of his/her

rights and will complete the Form 14c (APPENDIX A). The Care Co-ordinator (for community patients) will ensure that the patient is advised of his/her rights and will complete the Form 14c.

5.4 The Form14c together with the Form H5 or CTO7 will be forwarded to the MHA

Office. 5.5 The Trust Associate Hospital Managers must hold a renewal review hearing i.e.

a full Managers Hearing with all the care team present, for each renewal of detention / extension of CTO.

5.6 The MHA Office will arrange the Renewal Review Hearing.

6 Procedure for a Renewal Review Hearing

6.1 The MHA administrator will write to the patient advising them of the recommendation for the renewal and subject to the patient’s wishes, the nearest relative will be informed in writing.

6.2 The MHA Office will invite the patient and professionals involved in the patients

care to attend a Renewal Review Hearing. 6.3 Follow 7.2 – 7.18 for the process to be undertaken.


7 Procedure for an Appeal to the Hospital Managers

7.1 The relevant MHA Office will acknowledge receipt of the appeal application from the patient in writing.

7.2 A report, addressing all the issues will be requested, from the Responsible

Clinician (APPENDIX B or C), AMHP/Care Co-ordinator (APPENDIX D), named nurse (APPENDIX E).

7.3 These reports should be timely and up to date, or, a written addendum

submitted or verbal update given, at the hearing. One week prior to the hearing the MHA office will contact the report writers to ascertain if an addendum is required.

7.4 The relevant MHA office will convene a panel of 3 Trust Associate Hospital

Managers including a Senior Trust Associate Hospital Manager who will act as Chair, ensuring all the professionals, and or nearest relative are available to attend the Managers Hearing.

7.5 The panel of Trust Associate Hospital Managers must consist of at least three members, one of whom will be a Senior Trust Associate Hospital Manager. The panel will not be able to sit unless there are 3 members present. In the event of only two being present the hearing should be adjourned and re-convened.

7.6 The relevant MHA office will confirm in writing the arrangements for the

Managers Hearing to all participants. The time of the Hearing will be arranged to enable all participants to attend directly from the ward or offices. Every effort will be made to put the patient and the nearest relative or supporter at ease.

7.7 The relevant MHA office will, one week in advance of the hearing, scrutinise all

the relevant documentation to be put before the Panel Hearing and will complete the administration checklists (APPENDIX F - H).

7.8 The reports from the RC, AMHP/care co-ordinator, named nurse and

professionals involved, will be given to the panel members on the day of the hearing.

7.9 The panel will be supported by the relevant MHA Administrator who will provide

them with copies of:

Form H5 Renewal of Authority for Detention; or

Form CTO7 Report extending the community treatment period;

Form 14c Section 132 advice to a detained patient of their Rights under the MHA 1983;

Copies of all the professional reports;

Copy of an up to date Care Plan; and

Hospital Managers Decision Form. The panel will meet in private, at least 1 hour prior to the start of the hearing, to

read the reports and to identify any matters contained in the reports that require further explanation/clarification. In the event of there being reports with items for non-disclosure, the panel must discuss the relevance of this prior to the start of the hearing, if necessary, with the professionals concerned and decide if it is appropriate to withhold this information.


7.10 The Trust Associate Hospital Managers will, prior to the start of the hearing, establish via the patient, if they wish to speak to them privately.

7.11 All participants will attend the Managers Hearing as a group. 7.12 In reviewing the patient’s continued detention the Trust Associate Hospital

Managers will ensure that the Responsible Clinician, AMHP/care co-ordinator, named nurse and other professionals involved are actively and positively questioned.

7.13 In the event of the patient not wishing to be accompanied to the Managers

Hearing but subject to consent, the views of the nearest relative will be sought and represented by the appropriate professional e.g. AMHP/care co-ordinator.

7.14 At the conclusion of the Managers Hearing the Chair of the panel will ensure

the decision and reasons for it are communicated orally to the patient, to the accompanying nearest relative or supporter, to the other professionals involved and documented in the patient’s case notes via the appropriate decision form (APPENDIX I - N).

7.15 If the patient does not wish to return to the room to hear the decision then the

communication of the decision may be delegated to the Care Co-ordinator or Named Nurse.

7.16 A decision to discharge the patient can only be made if 3 or more members of

the panel (who between them make up a majority) are satisfied from the evidence presented to them that the answer to any of the criteria is ‘No’, the patient should be discharged, unless there is an exercise by the Panel of its discretionary power referred to in 4 above.

7.17 Should the Hospital Managers discharge from detention, this is effective

immediately although the patient may have expressed willingness to remain in hospital informally.

7.18 The relevant MHA Office will confirm the decision in writing to the patient and will communicate that information to any non-attending relative who has expressed views, with the consent of the patient.

7.19 In the event of the panel making recommendations, the relevant MHA Office will

ensure that the recommendation is passed onto the relevant professional or undertake the action as necessary. The MHA Office will then record this action and report on this via the local Mental Health Legislation Monitoring Groups and then quarterly to the Mental Health Legislation Operational Group. The MHA Office will report the outcome of any recommendation to the panel members in a safe and secure manner.

7.20 Copies of the record of the Managers Hearing together with the Hospital

Managers confirmation letter will be placed in the patient’s mental health act file.


Appendix A This is only to be used when a Section 3, 37 is being renewed or a CTO is being extended FORM 14c Rotherham Doncaster and South Humber NHS Foundation Trust Mental Health Services MENTAL HEALTH ACT 1983 Section 132 advice to a detained patient of their Rights under the Mental Health Act, 1983 Name of Patient: ------------------------------------------------------------------------------------------------- Consultant: ------------------------------------------------------------------------------------------------- Ward: ------------------------------------------------------------------------------------------------- I confirm that leaflet number …… was given to the patient and a verbal explanation of their rights has been given to them YES/ NO I confirm that the IMHA leaflet was given to the patient and a verbal explanation of their rights has been given to them YES/NO Has the patient indicated that they understand the contents of the leaflet YES/NO Patient’s signature to indicate they understood their Rights ...………………………………….. Or is the patient unwilling/unable to sign? YES/NO

If No, indicate why ……………………………………………………………………………….. Is a further attempt indicated? YES/NO Date Patient Seen ----------------------------- Date Patient Seen -----------------------------

The patient’s nearest relative, under the terms of the Mental Health Act, 1983, is: Name --------------------------------------------------------------------------------------------------------------- Address ---------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- Relationship --------------------------------------------------- Does the patient want their nearest relative to be informed of the admission under the Mental Health Act, 1983? YES/NO

Has all of the above been documented in the patient’s nursing notes? YES/NO Signed -------------------------------------- Print Name -------------------------------------- Designation -------------------------------------- Date: -------------------------------------- WHEN YOU ARE READING THE RIGHTS FOR RENEWAL OF SECTION PLEASE ESTABLISH WHETHER THE PATIENT IS CONTESTING THE RENEWAL PATIENT CONTESTING THE RENEWAL YES/NO If contesting, does the patient want their nearest relative informed of the date and time of the hearing? YES/NO


Appendix B

Report requirements for the Responsible Clinician This report must describe the patient’s relevant medical history, to include: 1. Full details of the patient’s mental state, behavior and treatment for mental

disorder. 2. In so far as it is within the knowledge of the person writing the report, a

statement as to whether the patient has ever neglected or harmed himself, or has ever harmed other persons or threatened them with harm, at a time when he was mentally disordered, together with details of any neglect, harm or threats of harm.

3. An assessment of the extent to which the patient or other persons would be

likely to be at risk if the patient is discharged by the Managers and how any such risks could best be managed.

4. An assessment of the patient’s strengths and any other positive factors that

the Managers should be aware of in coming to a view on whether he should be discharged; and

5. If appropriate, the reasons why the patient might be treated in the community

without continued detention in hospital, but should remain subject to recall on supervised community treatment.

I am asked to remind you that a copy of the Authority’s Statement, including medical reports, will be sent to the patient unless submitted as a separate document and endorsed: “NOT TO BE DISCLOSED TO THE APPLICANT”. However, it should be noted that unless this is going to cause “serious harm to the patient” the managers will normally ask for disclosure. The Managers draw attention to the fact that all documents must be disclosed to the patient’s representative if he/she is a solicitor, doctor or in the Managers opinion is otherwise suitably qualified.


Appendix C Report requirements for the Responsible Clinician (Community Treatment Order) CTO reports must include the following information: 1. Details of the original authority for the patient’s supervised community treatment

under the Mental Health Act 1983.

2. The name of the patient’s responsible clinician and the length of time the patient has been under their care.

3. Full details of the patient’s mental state, behavior and treatment for mental disorder,

and relevant medical history.

4. In so far as it is within the knowledge of the person writing the report, a statement as to whether the patient has ever neglected or harmed himself, or has ever harmed other persons or threatened them with harm, at a time when he was mentally disordered, together with details of any neglect, harm or threats of harm.

5. An assessment of the extent to which the patient or other persons would be likely to

be at risk if the patient is discharged by the Managers and how any such risks could best be managed.

6. An assessment of the patient’s strengths and any other positive factors that the

Managers should be aware of in coming to the view on whether he should be discharged.

7. The reasons why the patient can be treated as a community patient without

continued detention in hospital, and why it is necessary that the responsible clinician should be able to exercise the power under section 17E(1) of the Mental Health Act 1983 to recall the patient to hospital; and

8. Details of any specific conditions in force regarding the patient under section 17B of

the Mental Health Act 1983. I am asked to remind you that a copy of the Authority’s Statement, including medical reports, will be sent to the patient unless submitted as a separate document and endorsed: “NOT TO BE DISCLOSED TO THE APPLICANT”. However, it should be noted that unless this is going to cause “serious harm to the patient” the managers will normally ask for disclosure. The Managers draw attention to the fact that all documents must be disclosed to the patient’s representative if he/she is a solicitor, doctor or in the Managers opinion is otherwise suitably qualified.


Appendix D

SOCIAL CIRCUMSTANCES REPORT FOR HOSPITAL MANAGERS HEARINGS

Name:

Address:

Date of Birth Legal Status:

Date of Detention:

Nearest Relative: Address:

Telephone No:

Responsible Clinician:

Contact Details

Care Coordinator: Contact Details:

GP: Contact Details:

Approved Mental Health Professional:

Contact Details

1. BACKGROUND INFORMATION 2. The patients home and family circumstances 3. In so far as it is practicable, and except in restricted cases, a summary of the views of

the patient’s nearest relative, unless (having consulted the patient) the person compiling the report thinks it would be inappropriate to consult the nearest relative

4. The views of any person who plays a substantial part in the care of the patient 5. The views of the patient, including his concerns, hopes and beliefs in relation to the

Hospital Managers proceedings and their outcome 6. The opportunities for employment and the housing facilities available to the patient 7. What (if any) community support is or will be, made available to the patient and its

effectiveness, if the patient is discharged from hospital On discharge from hospital [patients name] will require aftercare support in the community. As

such he/she will be assigned a care-co-coordinator from one of the specialist treatment teams in order to ensure the effective development and management of an appropriate package of care. It is envisaged that this support will include [insert components] which will enhance [patients name] ability to maintain his ability him/herself in the community.

or


If the Hospital Managers decide to discharge the patient prior to the appointment of care co-ordinator, the Access/Home Treatment team would support and monitor [Patients Name] initially. Longer term support would be provided by one of the specialist community treatment teams. Support would also be given in regard to prompting and facilitating access to non-statutory mental health services.

8. The patient’s financial circumstances (including his entitlement to benefits). 9. An assessment of the patient’s strengths and any other positive factors that the Hospital

Managers should be aware of in coming to a view on whether he should be discharged 10. An assessment of the extent to which the patient or other persons would be likely to be

at risk if the patient is discharged by the Hospital Managers, and how any such risks could best be managed.

11. Concluding Comments Signature:

………………………………………. Date: …………………………………

Print Name:

……………………………………….


Appendix E

[Patient Name] [D.O.B]

[Patient Number] [Section]

Nursing Report for the ………………

[Responsible Clinician] [Ward] [Hospital] Report prepared by: [name of staff nurse]


[Patient Name] [D.O.B]

[Patient Number] Reason for Admission Compliance with treatment Level of observation Level of interaction/engagement Section 17 Leave/Absence without leave Incidents of seclusion or restraint Incidents of Self Harm/threats of harm to self or others Medication


Family contact Conclusion Signed: ………………………………………. Date: ……………………… Name in full: ……………………………………….


Appendix F RENEWAL REVIEW ADMIN CHECKLIST

Yes No Date (where applicable)

Availability of Managers

1. Have you received confirmation of who the managers are and whether they have received confirmation?

Date that managers received confirmation:

Paperwork within the pack

2. Is there a completed attendance sheet?

3. Is there a completed background information sheet?

4. Is there a completed RC’s contact details sheet?

5. Is there a copy of the Renewal Review Protocol?

Renewal Paperwork

6.

Is there a copy of the renewal paper (Form H5 or CTO7)?

7. Is there a copy of the Form 14c?

8. Is the patient contesting their renewal / extension?

9. Have we discussed / confirmed with the patient that they understand what contesting / un-contesting means?

Date: Name:

10. Is the patient still stating that their decision is un-contested?

Date:

Points for clarification on paperwork

11. Is there anything to clarify in respect of dates in relation to the renewal paperwork?

Clarification:

Responsible Clinician Report

12. Is the RC’s report available?

13. Is the report signed and dated?

14. Did we check with the RC one week prior to the hearing date, whether an update to the report was needed?

Date:

15. Did the RC provide an update? Date:

Has the patient been provided with a copy of the RC’s report? (indicate date given to patient)

Date:

Care Plan

16. Is the Care Coordinator/Nurse/AMHP attending the renewal review?

17. Is a copy of their Care Plan available?

18. Have we confirmed with them that this is the up to date version?

Date:

19. Is the Care Plan signed and dated?

20. Has the patient signed it?

Mental Health Act Support

21. Who has scrutinised the paperwork?

22. Date of scrutiny? Date:

23. Who will be in attendance at the Renewal Review?

24. Role of this person? Mental Health Act Administrator


Appendix G

ATTENDANCE SHEET Date: Scheduled Start Time: Actual Start time: Actual End Time: Venue:

Patient’s Name: Date of birth: Section: Ward: Responsible Clinician:

Attendees: RC Care Coordinator Nurse …………………………………………………….. Patient Attending YES Nearest Relative: NO IMHA: NO Solicitor

Manager’s Attending: Chair: 2nd Manager 3rd Manager


Appendix H

BACKGROUND INFORMATION

NAME: DATE OF BIRTH: CONSULTANT: WARD: SECTION:

SECTION 17 LEAVE (current section)

From Until Destination

N/a

ABSENT WITHOUT LEAVE (current section)

From Until Destination

N/a

SECTION HISTORY

Section (current section

first)

Start Date End Date Outcome

APPEALS HISTORY (current detention history)


Appendix I

ROTHERHAM DONCASTER and SOUTH HUMBER NHS FOUNDATION TRUST

HOSPITAL MANAGERS REVIEW OF DETENTION Section 2 (Assessment)

Patient’s Name:

Ward:

Section: 2

Reason for the Meeting:

Consultant:

Date of hearing:

THE CRITERIA The panel has reached the following conclusions based on the evidence presented:

i) Is the patient is still suffering from mental disorder

And

ii) Is the disorder of a nature or degree, which warrants the continued detention of the patient in hospital

And

iii) Is detention still necessary in the interests of the patient’s health or safety, or for the protection of other people

Where the answer to statements i, ii, iii is “yes”, the patient fulfils the criteria for continued detention under Section 2 of the Mental Health Act 1983;

If the panel is satisfied from the evidence presented to them that the answer to any of these questions is “NO” they should usually discharge the patient

Hospital Managers retain a residual discretion not to discharge patients even when the answer is “NO”

Yes No

Findings Having read the available reports and heard from those attending the review meeting, the panel came to their decision based on the reasons stated below:


HOSPITAL MANAGER’S DECISION cont/…….


HOSPITAL MANAGER’S DECISION cont/…….

Decision Having considered all the evidence presented, the panel’s decision is that the patient should:

Continue to be detained OR Be discharged from detention

Or that a further review should be held in ……. weeks’ time with the same/a different panel (please delete as appropriate) and our reason for this decision is:

Comments/Recommendations to be considered [if required] ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ And request that these be considered by:

Service Manager RC Care Coordinator Signed: Panel Chair: Date: Panel Member 2: Date: Panel Member 3: Date:

Decision communicated to patient by:

Signed: Date:


Appendix J


HOSPITAL MANAGERS REVIEW OF DETENTION Treatment Sections

Patient’s Name:

Ward:

Section: 3 or 37 or 47 (delete as appropriate)


Consultant:

Date of hearing:



And

ii) Is the disorder is of a nature or degree, which makes treatment in hospital appropriate

And

iii) Is continued detention for medical treatment necessary for the patient’s health or safety, or for the protection of other people

And iv) Is appropriate medical treatment available for the patient

Where the answer to statements i, ii, iii, iv is “yes”, the patient fulfils the criteria for continued detention under Section……. of the Mental Health Act 1983



Yes No



HOSPITAL MANAGERS REVIEW OF DETENTION cont/…….


HOSPITAL MANAGERS REVIEW OF DETENTION cont. /…….




Comments/Recommendations to be considered [if required] ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ And request that these be considered by:

Service Manager RC Care Coordinator Signed: Panel Chair: Date: Panel Member 2: Date: Panel Member 3:

Decision communicated to patient by:

Signed: Date:


Appendix K


HOSPITAL MANAGERS REVIEW Community Treatment Order

Patient’s Name:

Care coordinator:

Team:


Consultant:

Date of hearing:



And ii) Is the disorder of a nature or degree, which makes it

appropriate for the patient to receive medical treatment

And iii) Is it necessary in the interests of the patient’s health or safety,

or for the protection of other people that the patient should receive such treatment

And

iv) Is it still necessary for the responsible clinician to be able to exercise the power to recall the patient to hospital, if that is needed

And v) Is appropriate medical treatment available for the patient

Where the answer to statements i, ii, iii, iv, v is “yes”, the patient fulfils the criteria for continued detention under the Mental Health Act 1983 to continue to be subject to CTO



Yes No



HOSPITAL MANAGERS REVIEW cont/…….

HOSPITAL MANAGERS REVIEW cont. /…….


Continue to be subject to CTO OR Be discharged from CTO


Decision communicated to patient by: Signed: Date:



Service Manager RC Care Coordinator Signed: Panel Chair: Date: Panel Member 2: Date: Panel Member 3: Date:


Appendix L


HOSPITAL MANAGERS REVIEW OF DETENTION Section 25 Barring Discharge of Section 2 by Nearest Relative

Patient’s Name:

Ward:

Section:


Consultant:

Date of hearing:


i) Is the patient still suffering from mental disorder

And

ii) Is the disorder of a nature or degree, which warrants the continued detention in hospital appropriate

And

iii) Is detention in hospital still necessary in the interests of the patient’s health or safety, or for the protection of other people

AND

iv) If discharged would the patient be likely to act in a manner dangerous to other persons or themselves

Where the answer to statements i,ii,iii, iv is yes the patient fulfils the criteria for continued detention under the Mental Health Act 1983



Yes No



HOSPITAL MANAGERS REVIEW OF DETENTION cont/…….







Service Manager RC Social Worker Signed: Panel Chair: Date: Panel Member 2: Date: Panel Member 3: Date:



Appendix M


HOSPITAL MANAGERS REVIEW OF DETENTION Section 25 Barring Discharge of Section 3 by Nearest Relative

Patient’s Name:

Ward:

Section: 3


Consultant:

Date of hearing:



And

ii) Is the disorder of a nature or degree, which makes treatment in hospital appropriate

And


AND

iv) Is appropriate medical treatment available for the patient AND

v) If discharged would the patient be likely to act in a manner dangerous to other persons or themselves

Where the answer to statements i,ii,iii,iv,v is yes the patient fulfils the criteria for continued detention under the Mental Health Act 1983



Yes No



HOSPITAL MANAGERS REVIEW OF DETENTION cont. /……..







Service Manager RC Social Worker Signed: Panel Chair: Date: Panel Member 2: Date: Panel Member 3: Date:



Appendix N


HOSPITAL MANAGERS REVIEW Section 25 Barring Discharge of a Community Treatment Order by Nearest Relative

Patient’s Name:

Ward:

Section: SCT


Consultant:

Date of hearing:



And

ii) Is it of a nature or degree, which makes treatment in hospital appropriate

And


AND

iv) It is still necessary for the responsible clinician to be able to exercise the power to recall the patient to hospital, if that is needed

AND

v) Is appropriate medical treatment available for the patient

AND vi) If discharged, would the patient, be likely to act in a manner

dangerous to other person or themselves

Where the answer to statements i,ii,iii,iv,v,vi is yes the patient fulfils the criteria for continued detention under the Mental Health Act 1983



Yes No









Service Manager RC Social Worker Signed: Panel Chair: Date: Panel Member 2: Date: Panel Member 3:



No

Appendix O

Hearings Flowchart

No Yes Yes

Introductions Panel, professionals, solicitor, patient

How does the Patient wish to be addressed?

Explain purpose and format of hearing

No Solicitor / IMHA representing Solicitor / IMHA representing

Patient wishes to proceed? Has Patient seen reports?

Adjourn for appointment of Solicitor

Allow Patient time to look through reports

Medical Report Social Circs Report Nursing Report

Panel questions Panel questions Panel questions

Patient/Solicitor questions Patient/Solicitor questions Patient/Solicitor questions

Summary statement by Patients solicitor

Panel makes decision

Panel unable to make decision

Decision Form and Feedback Form completed

Patient and/or Solicitor informed Patient and/or Solicitor informed

Convene further hearing

Consult with the Patient whether they want the opportunity to speak privately

Patient/Professionals retire

Documents

Hospital Managers Protocol (Under Section 23 Mental Health ...€¦ ·