Procedure for Section 5(2) of Mental Health Act 1983 ...

1 Policy No: MHS/MH0001/v001 Page 1 of 18 Procedure for Section 5(2) of Mental Health Act 1983 (Doctor s Holding Power) LEAD DIRECTOR: Steven Feast, Executive Medical Director POLICY APPROVED BY: Executive Management Team DATE POLICY APPROVED: 20 December 2012 IMPLEMENTATION DATE: December 2012 REVIEW DATE: December 2014 Date Equality Impact Assessment carried out: 21 June 2012 Health and Safety Assessment completed on: 21 June 2012 Policy No: MHS/MH0001/v001 Page 2 of 18 Document Control Sheet Policy Title Procedure for Section of Mental Health Act (Doctor s Holding Power) Purpose of Policy/Assurance Statement The purpose of this Procedure is to ensure that the use of Section 5(2) of Mental Health Act 1983 (MHA) within the North East London NHS Foundation Trust (NELFT) is applied within a legal and best practice framework.

2 It outlines the powers provided by the MHA as amended by the Mental Health Act 2007 and gives guidance on the powers and provisions of Section 5(2). This Procedure aims to give assurance to patients that Section 5(2) will be used correctly in accordance with the law and in response to patient user needs. Lead Director Steven Feast, Executive Medical Director Lead Robert Keys, Mental Health Law Manager Version (state if final or draft) Final Version Date August 2012 Circulated for Consultation to: MHA/MCA Governance Group, Executive Management Committee, Document Approval Group, Quality and Patient Team If draft [only complete remaining boxes] Draft Number Comments to Policy No: MHS/MH0001/v001 Page 3 of 18 CONTENTS Page No.

3 1. Introduction 4 2. Aims & Objectives 4 3. Duties & Responsibilities 4 4. Criteria & Definition 5 5. Purpose of Section 5(2) 5 6. Use of Section 5(2) 6 7 Use of Section 5(2) Power within NELFT 6 8. Powers of Delegation to a Nominated Deputy 6 9. Action Required to instigate Section 5(2) 7 10. Application of Section 5(2) 7 11. Assessment for Section 2 or 3 8 12. Ending Section 5(2) 8 13. Nurses use of Section 5(4) Holding Power 9 14. Medical Treatment 9 15. Information to the patient 9 16. Section 17 Leave 10 17. Section 17 (A) Supervised Community Treatment In-Patient 10 18. Section 18 Absent Without Leave 10 19. Section 19 Transfer to another hospital 10 20. Inappropriate/Unlawful Use of Section 5(2) 11 21. Standards/Key Performance Indicators 11 22. Process of Implementation 11 23.

4 Equality Statement 11 24. Training 12 25. Links to Other Policies 12 26. References 12 Appendix 1 Monitoring Form for Section 5/2 13 Appendix 2 Flowchart on Procedure for use of Section 5(2) 14 Appendix 3 Section 5(2) Checklist 15 Equality Impact Assessment Screening Tool 16 Health & Safety impact Assessment 17 EMT/LT Approval Sheet 18 Policy No: MHS/MH0001/v001 Page 4 of 18 Assurance Statement The purpose of this Procedure is to ensure that the use of Section 5(2) of Mental Health Act 1983 (MHA) within the North East London NHS Foundation Trust (NELFT) is used lawfully and within a best practice framework. It outlines the powers provided by the Mental Health Act (MHA) 1983 as amended by the Mental Health Act 20071 and gives guidance on the powers and provisions of Section 5(2).

5 This Procedure aims to give assurance to patients that Section 5(2) will be used correctly in accordance with the law and in response to patients needs. 1. Introduction Section 5(2) is the power under the MHA that allows the responsible consultant or their nominated deputy to detain an existing informal in-patient for a maximum period of up to 72 hours in order to make arrangements for their assessment for detention under Section 2 or Section 3 of the MHA 1983 . The legal definition of Section 5(2) is given at as is the definition of who can use the power of Section 5(2). Its use is not confined to Mental Health Services, though it is always likely to be more common there. 2. Aims and Objectives To outline the scope of the power to hold patients and any limitations, as defined in the MHA.

6 To define best practice and provide guidance to staff including Social Services Staff To clarify the changes in use of the powers introduced by the MHA 2007. 3. Duties and Responsibilities Medical Director: To oversee the working of this policy in cooperation with the Mental Health Law Manager. To address any concerns about medical assessment issues. Consultant Doctors2: To personally assess in-patients for (2). When contactable but not able to attend the ward to nominate a deputy to implement Middle Grade Doctors: To carry out assessments under (2) where specifically nominated to do so by the responsible consultant. Junior Doctors Out of hours to act as the nominated deputy for (2) assessments. Within hours to act as the nominated doctor for (2) when nominated by the responsible consultant or automatically when the consultant is not available.

7 Approved Mental Health Professionals3 (AMHP): to coordinate an assessment for patient s possible detention under or 1 Section 9 of Mental Health Act 2007 amended Section 5(2) and (3) of the 1983 Act so that an Approved Clinician who is not a registered medical practitioner may hold a patient under (2) An approved clinician (AC) is a person approved by the Secretary of State to act as an approved clinician for the purposes of the MHA . Currently and for the foreseeable future NELFT does not have ACs who are not doctors. Consultant Psychiatrists are almost always ACs. The actual wording of the MHA refers to the registered medical practitioner in charge of the treatment of the patient , which in practice is almost always a consultant level doctor 3 A social worker or other professional approved by a local social services authority (LSSA) to carry out a variety of functions under the MHA 1983 .

8 S13 (1) of MHA 1983 outlines the duty of the Local Social Services Authority (LSSA) to Policy No: MHS/MH0001/v001 Page 5 of 18 Locality Mental Health Act Managers: To arrange for the medical/administrative scrutiny of (2) statutory forms. To provide advice to staff and others about the power. Mental Health Law Manager: To monitor the use of (2), preparing reports and statistics and raising concerns as necessary. To provide advice to staff and others on correct use of the power. Nursing staff: To contact the responsible consultant or( if they are not available) the duty doctor when (2) appears to be indicated. To arrange for an AMHP to attend to assess for Section 2 or 3. To ensure that patients are given information and informed of their rights4. 4.

9 Criteria and Definition This Section is defined in MHA 1983 as follows: 5 (2) If, in the case of a patient who is an in-patient in a hospital, it appear appears to the registered medical practitioner or approved clinician in charge of the treatment of the patient that an application ought to be made under this Part of this Act for the admission of the patient to hospital, he may furnish to the managers a report in writing to that effect; and in any such case the patient may be detained in the hospital for a period of 72 hour from the time when the report is so furnished. 5 (3) The registered medical practitioner or approved clinician in charge of the treatment of a patient in a hospital may nominate one (but not more person) to act for him under subsection (2) above in his absence5.

10 An in-patient is any person who is receiving in-patient treatment. Informal admission occurs when the following criteria are met. The person has: been assessed by a healthcare professional complied with the arrangements for arrival at the hospital understood and accepted the offer of a bed and cooperated with the admission Procedure was not at the time of admission, either verbally or physically being resistant to staying at the hospital premises. 5. Purpose of Section 5(2) An informal patient6 has the right to discharge themselves from hospital at any time they wish. The (2) power allows an informal patient to be detained for up to 72 hours to allow an assessment under the MHA with a view to an application under or 3. arrange of an Approved Mental Health Professional (AMHP) to carry out an assessment for an application for sections 2 or 3.