Roles and Responsibilities of Relatives and Professionals

Question 1

What should the Nearest Relative be consulted about?

Answer 1

All application for admission.

Under Section 3, NR can veto the application being made.

Question 2

What positive obligation does the AMHP have in respect to the NR?

Answer 2

To take ‘practicable steps’ to consult with RR of patient whom it is desired to admit for treatment - unless this would cause unreasonable delay (section 11).

Question 3

What is the importance of TW v LB Enfield?

Answer 3

The applicant argued that her NR ought to have been consulted (s11) before Section 3 detention.
BUT it was found that it was not ‘reasonably practicable’ to have consulted the NR.

Question 4

What was the CoA decision in TW v Enfield?

Answer 4

It was found that social workers should consider whether it is reasonably practicable to consult the NR before making an application to admit a P, pursuant to sections 3(10 and 13(1) of the MHA.

Question 5

What did TW v Enfield state about section 11(4)?

Answer 5

It imposes an obligation on social workers to strike a balance between the patients right under article 5 of the ECHR not be detained unless it was done by a procedure that was in accordance with the law and the P’s right to private life under article 8.

Question 6

What happens if the NR objects to the application for admission for treatment?

Answer 6

The application cannot be made and if an application is made in the face f an objection, the detention will be unlawful (TTM v Hackney)

Question 7

What case illustrates when it is not practicable to consult NR?

Answer 7

DP v South Tyneside

The P was perceived to be potentially at risk from the NR (forced marriage), and consultation was not possible without disclosing the P’s location.

Question 8

When else can admission lawfully occur without consultation?

Answer 8

If in the case to consult would lead to unreasonable delay in the admission of the P to hospital.

Question 9

What can a NR once P is admitted under s.2 or s.3?

Answer 9

The NR can apply to have the P released from detention unless the RC vetoes the P’s discharge as dangerous on the grounds that if discharged, the P would be likely to act in a manner that is dangerous to other persons or himself (s.25).

Question 10

What if RC vetoes NR’s application for discharge?

Answer 10

The NR has a right to petition the MHRT for dischrage of the P.

Question 11

What if there is concerns that NR is taking decisions that are detrimental to the welfare of P or unreasonably objects to the making of applications under the Act?

Answer 11

The AHMP can apply to the County Court to have the NR removed.

Question 12

What case illustrated the AMHP removing NR?

Answer 12

Kay v Gueli - the NR vetoed the P’s admission to hospital under section 3 of the MHA, partly because she did not accept that P had a mental illness and also because she believed that P would co-operate with professionals if treatment was agreed informally.

Question 13

What is a difficulty of removing NR?

Answer 13

It can be long process. R (M) Homerton University Hospital, an interim application was granted removing the P’s mother as NR in July 2007. At the time of the judgement, the hearing to displace the mother had still not taken place.

Question 14

P’s lacking capacity to instruct solicitor have no readily available advocate who can petition to hospital managers or MHRT for discharge. What did CoA suggest about this in R (MH) Sec of State for Health?

Answer 14

That this is in breach of article 5(4) - the P was detained in ecess of seven months under section 2 pending determination of the application to displace NR.

Held that the absence of such NE was not in breach of Article 5(4).

Question 15

Can P choose NR?

Answer 15

No - it is within hierarchy of relationship where priority is given. A relative who ordinarily resides with or cares for P will be placed at the top.

Question 16

What was an important amendment of the 2007 Act?

Answer 16

The power of the P to be able to apply to the court to have the NR displaced under the grounds outlined above or on the additional ground that it is unsuitable for the person on the list to act as NR.

Question 17

What impact did M v Sec of State have?

Answer 17

It ignited the amendment of P being able to displace NR. High Court ruled that the acts provision concerning the P’s NR breached Article 8 ECHR.

The fact that P has no means of challenging appointment of a person as NR was in violation of a P’s right to respect for private life.

Question 18

How did the court ‘novelly interpret’ the 1983 Act to avoid breaches of article 8?

Answer 18

Courts sought to give effect to P’s wishes concerning NR, by declining the involve ‘NR’ in consultations about the P’s proposed admission. It was justified with power of section 11, that requires consultation UNLESS it appears to the social worker, that in the circumstances, ‘such consultation is not reasonably practicable or would involve unreasonable delay’.

Question 19

What did R (E) v Bristol CC decide?

Answer 19

Consulting a NR in the face of a P opposition, has been considered to be unreasonably practicable.

Question 20

What is an AMHP?

Answer 20

AMHP Regulations 2008 indicate that this person may be a nurse, an occupational therapist or a psychologist. Role is to give a social perspective.

Question 21

What happens when an application is made by an AMHP?

Answer 21

They are under a legal obligation to take all reasonable steps to inform NR of the admission for assessment and to advise that relative that they are permitted by law to request the discharge of the P from hospital (s.11). Also have a duty to consult NR when proposing to make app for treatment.

Question 22

What does an AMHP need to do before making an application for admission?

Answer 22

Interview the P in a suitable manner; and satisfy himself that detention in hospital is in all circumstances of the case the most appropriate way of providing care and medical treatment of which the P stands in need (s.13(2).

Question 23

What was the decision in The Queen (V) v South London & Maudsley?

Answer 23

Where no consultation takes place and there is no evidence of unreasonable delay being occasioned, the application under section 3 will be invalid and a writ of habeas corpus will be granted.

Question 24

When can’t an AMHP make an application for admission for treatment be made according to the Act?

Answer 24

If the NR has notified the social worker or social services that they object to the application being made. The NR can veto the application.

Question 25

What is a concern regarding compulsory admission for assessments?

Answer 25

That it impacts negatively on the therapeutic relationship between doctors and patient.

Question 26

What is a way to prevent this that is under Review?

Answer 26

The formulation of a ‘joint crisis plans’, where the P, health and social care professionals agree a course of action in advance of P’s illness entering an acute phase.

Question 27

What is an implication of ‘joint crisis plan’?

Answer 27

It has reduced the use of MHA to compel treatment, though has not resulted in an overall reduction in hospital admissions.

Question 28

Applications for admission or treatment must be supported by recommendations of?

Answer 28

Two Registered Medical Practitioners

Question 29

What is the requirements of these two medical practitioners?

Answer 29

One must be approved by the secretary of state as having special expertise in the diagnosis and treatment of mental disorder. One of the doctors must have previous acquaintance with the P.

Furthermore, medical examinations must take place within not more than 5 clear days of each other if done separately.

Question 30

Under the amended Act, what roles were replaced?

Answer 30

Responsible Clinician - The RC need not be a psychiatrist, but could be another professional discipline such as nursing, OT or psychology.

Question 31

What does the RC do?

Answer 31

Makes decision concerning the treatment of P and also renews P’s detention.

Question 32

What did Moncrieff and Crawford reveal?

Answer 32

Within psychiatry, tension exists between dominant biomedical model and competing models derived from psychoanalysis and social psychiatry.

Question 33

What did Rogers and Pilgrim say?

Answer 33

“The weakening of the territorial base of the hospital and reorientation towards primary care and community settings have, shifted mental health care away from detention and treatment in hospital”.

Question 34

Section 5 holding power may be exercised by an approved clinician but who else?

Answer 34

Also a Registered medical practitioner. Meaning detention may be authorised by someone who is not a doctor.

Question 35

What did section 130 MHA 2007 introduce?

Answer 35

ROLE OF IMHA - An statutory obligation on the government to provide advocacy services for detained patients held under longer-term sections.

Question 36

Who can NR petition for discharge of P under section 23?

Answer 36

Hospital Managers.

Question 37

What does section 25 state?

Answer 37

“An order for the discharge of P who is liable to be detained in hospital shall be not made by his NR except after giving not less than 72 hours after such notice has been given, the RC furnishes to the managers a report certifying that in the opinion of that clinician the P, if discharged, would be likely to act in a manner dangerous to other persons or himself”.

Question 38

What was the decision in South Staffs and Shropshire v Hospital Managers?

Answer 38

The hospital managers ordered the discharge of a P who had bipolar and PD, despite issuing of a barring certificate and a recent refusal of a tribunal or discharge the P.

Concerns about risk of P to his elderly parents.

High Court concluded that there was no obligation on the managers to take into account the decision by the tribunal not to discharge P.

Reasoning adopted by managers, though differing in its conclusions that of the tribunal could not be said t be irrational.