Approved Medical Practitioners - Mental Health (Care and Treatment) (Scotland) Act, 2003 Training Manual

Section 3. Short-term Detention Certificate ( STDC) - Section 44

The short-term detention certificate ( STDC) lasts for 28 days. Transfer to hospital must occur within three days of the certificate being granted. Detention is only authorised once the receiving hospital managers have been given the certificate.

Criteria for issuing an STDC

The AMPmust consider it likely that the following criteria are met:

• The patient has a mental disorder.

• The patient has significantly impaired decision-making ability (see Appendix 2) with respect to medical treatment for mental disorder, as a result of his or her mental disorder.

• Detention in hospital is necessary to determine what medical treatment is required and to provide that treatment.

• Significant risk exists to the health, safety and welfare of the patient or to the safety of others if the patient is not detained.

• There are sufficient grounds for believing that granting of an STDC is necessary for a patient who is refusing to accept treatment on a voluntary basis.

The word 'likely' that the criteria are met means that the AMP needs to be satisfied only on the balance of probabilities. The meaning of the new criterion of 'significantly impaired decision making ability' is explored in Appendix 2. The AMP also now has to formally state that detention is necessary (i.e. that informal alternatives have been considered or attempted).

Granting an STDC

An STDC may only be granted by an AMP. Where the patient refuses to be examined by an AMP, an EDC (see later) may have to be issued.

The AMP must consult a MHO when considering issuing an STDC to gain his or her consent. Where practicable, the AMP should also consult the patient's named person, and must complete the STDC within three days of examining the patient.

Revoking and extending an STDC

The certificate must be revoked by an AMP prior to 28 days if detention criteria are no longer met.

It can be extended by:

Section 47

An AMP may extend an STDC by three working days using Section 47. This allows an application for a CTO to be made, which may be particularly important if the patient's mental state has changed in recent days. A MHO should be consulted, where possible, regarding an extension certificate.

Once an extension certificate is completed, the AMP must inform the patient, the named person, Tribunal, Mental Welfare Commission, MHO and any guardian or welfare attorney.

Section 68

Once a CTO application has been submitted, the patient can be detained for a further five working days from expiry of the STDC under Section 68 of the 2003 Act to allow the Tribunal to have a hearing.

Right of appeal about an STDC

The patient and named person have the right to apply to the Tribunal for revocation of the short-term detention order.

The Tribunal will consider at appeal whether the criteria for STDC are met. The Mental Welfare Commission has the power to revoke a certificate if the criteria are not met, but will principally be assisting the person make an application to the Tribunal although the Commission may refer direct to the Tribunal, if appropriate. This represents a change from the 1984 Act.

The responsible medical officer must review the need for continued detention, and revoke the certificate if criteria are no longer met.

If revocation of the certificate occurs, the responsible medical officer must write to notify the patient, named person, the consenting MHO, and any guardian or welfare attorney. Written notice of the revocation must go to the Tribunal and Mental Welfare Commission within seven days.

Comparison of the conditions and effects of short-term detention between the 1984 and 2003 Acts is shown in Tables 4 and 5.

Table 4. Short-term detention in hospital - conditions

2003 Act Part 6 (Section 44-56)	1984 Act (Section 26)
From hospital or community	From emergency detention in hospital
Approved medical practitioner (Section 22)	Approved medical practitioner (Section 20)
Mental disorder likely	Mental disorder
Likely that decision-making ability is significantly impaired
To determine medical treatment needed, or give medical treatment under Part 16	Appropriate to be detained
Significant risk to health, safety or welfare of patient, or safety of others	Interests of patient's health or safety or with a view to protection of others
Consent from MHO	Consent from MHO or nearest relative
Certificate issued within three days of examination	Examination within three days of Section 24 detention
Extension for up to three working days	Extension for up to three working days

Table 5. Short-term detention in hospital - effects

2003 Act	1984 Act (Section 26)
Removal to hospital within three days
Starts immediately and revokes any emergency detention certificate	Starts when emergency detention expires
Detention for up to 28 days (plus 3)	Detention for up to 28 days (plus 3)
Determine treatment
Compulsory treatment allowed	Compulsory treatment allowed
Duty to inform named person, guardian, welfare attorney, Tribunal, Mental Welfare Commission	Duty to inform Mental Welfare Commission, nearest relative, local authority
MHO interview prior to consent	MHO interview and social circumstance report to Mental Welfare Commission
Responsible medical officer continuing duty to review
Application by patient or named person to Tribunal for revocation	Appeal to Sheriff (the exception)
Appeal to Sheriff Principal (if appeal to the Tribunal fails)	No further appeal