Mental Health Act 1983:Section 132 Informing patients and nearest relatives of their rights under the Mental Health Act 1983/November 2015
Clinical
Mental Health Act 1983:Section 132 Informing patients and nearest relatives of their rights under the Mental Health Act 1983 - Standard Operating Procedure
Document Control SummaryStatus: / Replacement.
Replaces:
C-YEL-mh-ca-07 Section 132 Informing patients of their rights under the Mental Health Act 1983
Version: / v1.0 / Date: / 30.09.2015
Author/Owner: / Dawn Crowther, Mental Health Legislation Manager
Approved by: / Policy and Procedures Committee / Date: / 19/11/12
Ratified: / Policy and Procedures Committee / Date: / 19/11/12
Related Trust Strategy and/or Strategic Aims / Provide high quality recovery focused services.
Deliver regulatory, financial, performance and quality standards
Implementation Date: / November 2015
Review Date: / November 2018
Key Words: / Mental Health Act, MHA, Code of Practice, Section, Detention, Formal, Informal, Hospital Managers, Admission
Associated Policy or Standard Operating Procedures / Policies
Conveyance
Information Governance
Mental Health Act 1983
Section 135
Section 136
Standard Operating Procedures (SOPs)
Admission to hospital
Community Treatment Orders
Hospital Managers handbook
Independent Mental Health Advocates
Mental Health Tribunals
Receipt of MHA documentation
Renewal of detention
Scheme of delegation
Section 4 Emergency Admissions
Section 5
Section 58
Visits to patients in hospital
Contents
1. Introduction 3
2. Purpose 3
3. Scope 3
4 Information for patients 5
5. Explanation and Understanding………………………………………………………....5
6. Written Information – detained patients in hospital…………………………….…..6
7. Verbal Explanation – detained patients in hospital…………………………………..7
8. Written Information - patients on CTOs………………………………………………..8
9. Verbal Explanation – patients on CTOs……………………………………………..…8
10. Information about recall and revocation whilst on CTO……………………..……10
11. Information about recall to hospital for Conditionally Discharged patients..….10
12. Information for Nearest Relatives…………………………………………………..….10
13. Process for Monitoring Compliance and Effectiveness…………………………………….11
14. References……………………………………..…………………………………..………12
Appendix 1 Mental Health Act 1983 Leaflets
Appendix 2 Multi-Lingual Mental Health Act 1983 Leaflets
Appendix 3 Nearest Relative – Do Not Contact Form
Change Control – Amendment History
Version / Dates / Amendments1. Introduction
1.1 All patients, irrespective of their status must be informed of their rights. It is good practice for patients to be kept fully informed of and involved in their treatment and care plans.
1.2 Detained patients have a legal right under the Mental Health Act 1983 (MHA) to be informed of their legal situation and rights. There is also a legal duty under Article 5 (2) of the Human Rights Act 1998 to inform a patient of the reasons for their detention.
1.3 Chapter 4 of the MHA Code of Practice and chapters 9, 10, 26, 27 and 28 of the Reference Guide contain further guidance.
1.4 This procedure supersedes the policy detailed on the cover page to this document and must be read in conjunction with the statutory references at 14 below and the Trust Policies and Standing Operating Procedures on the Document Control Summary on the front pages of this document. Trust guidance on the use of interpreters should also be consulted when appropriate.
2. Purpose
2.1 The purpose of this document is to detail the statutory and other information that must be provided to patients and nearest relatives under the MHA.
3. Scope
3.1 The MHA and MCA policies should be referred to for the wider Trust roles in respect of the legislation.
3.2 This standard operating procedure relates to all staff working in inpatient areas of the Trust caring for patients detained under the MHA, those in the community involved in the care of patients subject to community treatment orders (CTOs), and to staff in the Mental Health Legislation Department. It also informs staff from other agencies involved in the care and treatment of these patients. All staff caring for patients should be familiar with the requirements of the MHA and related documents, and with procedures detailed in the Trust’s SOPs. They must pay due regard to the MHA Code of Practice, apply the Code’s Guiding Principles when carrying out their work, and ensure they keep up to date with MHA practice commensurate with their role
3.3 Specifically this document relates to the following groups:
3.3.1 Team Leaders / Departmental Heads / Ward and Unit Managers
are responsible for ensuring all staff are conversant with the MHA Code of Practice, this procedure and related policies and SOPs. They must be aware of and ensure implementation of the processes and actions that are required to be taken in relation to patients in their service area and carry out monitoring of implementation and compliance as required. They must ensure that all employees in posts in the Trust clinical services are aware of their responsibilities in relation to the MHA and attend appropriate training commensurate with their role.
3.3.2 Medical Staff / Approved Clinicians
hold a key role in the processes and actions that are required to be taken in relation to detention and treatment of patients. They must be aware of this procedure and ensure implementation of the processes and actions that are required to be taken in relation to patients for whom they are responsible.
3.3.3 Trust employees working in roles to provide healthcare in direct clinical contact with patients
are responsible for carrying out procedures in line with the standards detailed in this and other related Trust’s SOPs and maintaining their individual competence in the practice of the Acts and attending training as required by their roles.
3.3.4 Approved Mental Health Professionals
are accountable for their own practice and must be aware of legal and professional responsibilities relating to their competence, observe this procedure, legislation and guidance as detailed above, and work within the Code of Practice of their professional body.
3.3.5 The Mental Health Legislation Manager
is responsible for the development, monitoring and review of this procedure and practice standards, disseminating new guidance as it arises and giving advice to all staff on MHA issues. This manager is also responsible for highlighting practice issues arising within the Trust, provision of appropriate administration support in relation to the MHA, education to support the policy standards, advising the Mental Health Legislation Committee that monitors the use of the MHA and reports to the Quality Governance Committee of any issues relating to the implementation of the MHA and this SOP.
3.3.6 Mental Health Legislation Department staff
are responsible for carrying out key roles in the provision of information to detained patients and their nearest relatives as detailed in this SOP, ensuring compliance with this SOP within their area of responsibility.
4. Information for patients
4.1 Section 132 of the MHA requires detained patients, including those on community treatment orders (CTO), to be provided with the information about how the MHA applies to them and their rights of appeal as soon as practicable after the commencement of their detention. Information must also be provided to CTO patients being recalled to hospital at the time they are being recalled.
4.2 Information must be provided both orally and in writing, in accessible formats as appropriate (e.g. Braille, Easy Read), and in a language the patient understands (see 6 below).
4.3 In providing information it is not sufficient to repeat what is written on the relevant information leaflet. All those involved in provision of information to patients must ensure they are familiar with the specific requirements of Chapters 4 and 6, and paragraphs 29.34, 29.35 and 29.68 of the MHA Code of Practice.
4.4 Information on consent to treatment, advocacy, right of appeal, legal advice, complaints, safeguarding, and the role of the Care Quality Commission (CQC) must also be made available to the patient throughout their detention or period under CTO.
5. Explanation and Understanding
5.1 Effective communication is essential in ensuring appropriate care and respect for patients’ rights. It is important that the language used is clear and unambiguous and that people giving information check that the information that has been communicated has been understood.
5.2 Everything possible should be done to overcome barriers to effective communication, which may be caused by any of a number of reasons – for example, if the patient’s first language is not English. Patients may have difficulty in understanding technical terms and jargon or in maintaining attention for extended periods. They may have a hearing or visual impairment or have difficulty in reading or writing. A patient’s cultural background may also be very different from that of the person speaking to them.
5.3 Those with responsibility for the care of patients need to identify how communication difficulties affect each patient individually, so that they can assess the needs of each patient and address them in the most appropriate way.
5.4 In carrying out its statutory responsibilities to provide information, the Trust will take into account the communication and language needs of those involved and utilise interpreting services in line with the Trust procedure on Interpreters. Where an interpreter is needed, every effort should be made to identify who is appropriate to the patient, given the patient’s gender, religion, language, dialect, cultural background and age. The patient’s relatives and friends should only exceptionally be used as intermediaries or interpreters. Interpreters (both professional and non- professional) must respect the confidentiality of any personal information they learn about the patient through their involvement.
5.5 Independent Mental Health Advocates (IMHAs) engaged by patients can be invaluable in helping patients to understand the questions and information being presented to them and in helping them to communicate their views to staff. Where a patient lacks capacity to decide whether to obtain assistance from an IMHA, or if a patient lacks capacity to decide whether to seek a review of detention or a CTO, the nurse in charge of the ward (RC if a community patient) is responsible for ensuring a referral is made to the IMHA service on behalf of the patient. Further information on IMHAs can be found in the Trust IMHA standard operating procedure.
6. Written Information – detained patients in hospital
6.1 The MHA Administrators are responsible for ensuring that the relevant standard leaflet (see Appendix 1), together with, where applicable, information on the IMHA service and the Care Quality Commission (CQC), is completed and delivered to the ward the patient is detained on as soon as possible and at most within one working day of their detention. Production of this information must be recorded within the RiO section record.
6.2 The nurse in charge of the patients ward is then responsible for ensuring that the patient receives the information at the earliest appropriate and practicable time, having regard for the patient’s state of mind and ability to understand the information. Once the initial written and verbal information has been provided, the nurse in charge must ensure that this is documented on Form 1A within the RiO Electronic Patient Record (Mental Health Act folder – MHAct Forms / Assessments).
6.3 If a patient is too unwell to be given the required information, or to understand and retain it, further attempts must be made at regular intervals.
6.4 All written information to patients must be in typed format. Where it is necessary to add handwritten information, this must be clear and concise.
6.5 A supply of blank standard leaflets are available for use on wards where information is required prior to being received from the MHA Administrators.
6.6 It is important to ensure that all patients are given information in a language or format they are able to understand. Written information is available in the foreign languages listed at Appendix 2 and the MHA Administrators will take steps to have standard information translated into other languages or media if required. Where a patient requires information in a format other than English, the nurse in charge of the patient’s ward is responsible for requesting this from the MHA Administrators.
6.7 In addition to the initial information provided to the patient, the MHA Administrators will forward a copy of the patient’s detention or CTO documentation to the ward. Where personal information about third parties is contained in the documentation, the MHA Administrators will remove this prior to forwarding to the ward. The nurse in charge of the patient’s ward is then responsible for ensuring the patient receives this copy as soon as practicable and as a priority, unless they are of the opinion (based on the advice of the authors of the documents or the RC) that the information disclosed would adversely affect the health or wellbeing of the patient or others. It may be necessary to remove any personal information about third parties.
7. Verbal Explanation – detained patients in hospital
7
7.1 The nurse in charge of the patients ward is responsible for ensuring that the patient receives a verbal explanation of the information relating to their detention as soon as practicable following their detention and at the time the written information is handed to the patient, from a member of staff who has received sufficient training and guidance to do so. They must ensure they are familiar with the specific requirements of Chapters 4 and 6, and paragraph 29.68 of the MHA Code of Practice.
7.2 Patients should also be told the essential legal and factual grounds for their detention. For the patient to be able to adequately and effectively challenge the grounds for their detention or CTO, should they wish, they should be given the full facts rather than simply the broad reasons. This should be done promptly and clearly. They should be told they may seek legal advice, and assisted to do so if required.
7.3 The person giving the verbal information must do so in a suitable manner appropriate to the level of understanding of the patient and try to explain any points the patient appears not to understand. The provision of initial verbal information must be documented on Form 1A within the RiO Electronic Patient Record (Mental Health Act folder – MHAct Forms / Assessments).
7.4 Ward staff must make regular reminders and checks on the patients understanding of their legal status and rights. Information given to a patient who is unwell may need to be repeated as their condition improves. Further explanation of patient’s rights should be considered where the patient is considering appealing against their detention or becomes eligible again to apply to the Tribunal or where there are any changes in their status or their rights, including discharge (see paragraphs 4.29 – 4.30 of the MHA Code of Practice).