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The Mental Health Acts 1983 and 2007 (England and Wales)

Scope of the guidance

This EGP Update item is only relevant to GPs practising in England and Wales; as there is new changing information in relation to the Mental Health Act legislation.

The item is based on two Department of Health (England) publications ‘The Mental Health Act 1983: Guidance for general practitioners - medical examinations and medical recommendations under the Act’ and ‘Mental Health Act 2007 – overview’ (see Original source material). These Acts cover England and Wales, but not Scotland and Northern Ireland. (The current mental health legislation in Scotland is: The Mental Health (Care and Treatment) (Scotland) Act 2003 which is still current, although some amendments have been made.  The Mental Health (Northern Ireland) Order 1986 governs the treatment of people with mental health problems in Northern Ireland.)

The basis of the 1983 Mental Health Act (MHA) is to allow the compulsory detention of a patient with a mental health disorder and their subsequent treatment in hospital for the disorder without their consent. The 2007 MHA makes various amendments to the 1983 Act. 

Source

Department of Health, The Mental Health Act 1983: Guidance for general practitioners - medical examinations and medical recommendations under the Act. London: DH; 2007.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008834 

This EGP Update item aims to clarify the GP’s role in undertaking mental health assessments under the 1983 and 2007 MHAs. Amendments made by the 2007 Act are in bold below.

Key points

1.     Definitions

• The 2007 MHA revises the definition of mental illness as ‘any disorder or disability of the mind’ so that a single definition applies throughout.

2.     Role of the GP

• A GP has detailed knowledge of the patient, especially their medical history and personal situation, that aids the decision as to whether compulsory powers should be used. A GP’s role could also include arranging or carrying out assessments for possible compulsory admission to hospital for assessment and/or treatment. 

3.     Initiating the process

• This usually starts with the GP being approached by a worried relative or carer.  However, sometimes a patient may be detained by the police to enable him / her to be examined by a medical practitioner (often the GP) and interviewed by an Approved Social Worker (ASW).
• After making an assessment, the next step is to discuss the case with a psychiatrist and if necessary request a domiciliary visit by an approved psychiatrist, if it is required.
• If the psychiatrist feels that a patient needs admission to hospital but informal admission is not appropriate, an ASW or nearest relative (NR) should be contacted to make arrangements for a formal ‘application’ to be made.

• In situations where the process needs to take place rapidly and it is not practical for a psychiatrist to come to examine the patient before compulsory admission, then the GP can approach the ASW or NR directly.

• Informal admission should always be considered as first option.

4.      Role of the ASW: The 2007 MHA, changes the definition of ASW to any person approved by Social Services.

• Detention of a patient for treatment of a mental health disorder requires a formal ‘application’ by either the NR or preferably the ASW.  The 2007 MHA gives patients or courts the right to displace their NR (where there are reasonable grounds to do so) and adds civil partners to the list of relatives. 
• The ‘approved mental health professional’ is the new name for the former approved social worker.   

5.       Medical recommendations for the application to compulsorily admit:

• Before an application can be made for admission to hospital, two doctors (who have both examined the patient) both need to give a ‘medical recommendation’. One doctor must be approved under the MHA, usually a consultant psychiatrist (but a GP can apply to become approved under Section 12(2) of the MHA).  If possible, one doctor (e.g. the GP) should have met the patient before.
• However an application for an emergency admission requires only one medical recommendation. This can be provided by a GP.
• Occasionally, GPs are asked to examine a patient in hospital and provide a second medical recommendation to detain a patient who is already voluntarily admitted, or is already detained under another Section (e.g. Section 4, emergency admission).
• A medical recommendation should not be given if there are any conflicts of interest.
• The ‘responsible clinician’ replaces the role of ‘responsible medical officer’ being in overall charge of the care of the sectioned patient. This person has powers to grant leave and discharge.

6.      Sections of the MHA

• Section 2: admission to hospital for up to 28 days for assessment
• Section 3: admission to hospital for up to 6 months for treatment

• There is a three part treatment test:

  • the patient must be suffering from a mental disorder
  • it must be necessary for the health or safety of the patient or for the protection of other persons that s/he should receive such treatment and it cannot be provided unless they are detained under this section
  • appropriate medical treatment is available to the patient.
• Section 4: admission on an emergency basis for up to 72 hours; only one medical practitioner required.
• Section 136: detention by the police to enable examination by a medical practitioner and interview by an ASW

7.     After detention in hospital

The 2007 MHA introduces supervised community treatment (SCT) for patients following a period of detention in hospital. This allows a small number of patients with a mental disorder to live in the community, whilst ensuring that they continue to take medication for their mental disorder – so long as their compulsory supervision is in line with the treatment test.

Practical tips for the busy GP >>

EGP 1. May 2008