mental health (care and treatment) (scotland) act 2003 code of practice volume 2 ?civil compulsory powers (parts 5, 6, 7 and 20)
Volume 2 of the Code of Practice for the Mental Health (Care andTreatment) (Scotland) Act 2003 (“the Act”) deals with a range of issuesrelating to what can be termed “civil compulsory powers”.
chapter 3 applying for a compulsory treatment order (part 7 chapter 1)
Introduction
This chapter looks at the process involved in preparing an application for a compulsory treatment order ( CTO) and in the determination of that application the Mental Health Tribunal for Scotland. The flowchart on page 59 provides an overview of this process.
The first section of this chapter describes the overall framework for the preparation of an application for a CTO while the second provides details about the medical recommendations which initiate the application.
The third section turns to the MHO's report and the proposed care plan which accompany the application.
Finally, the chapter discusses the various possible outcomes with respect to a CTO application.
Note that at the end of this chapter a table is included which aims to summarise the statutory duties to be carried out during the application process.
FLOWCHART OF STATUTORY DUTIES TO BE CARRIED OUT DURING THE CTO APPLICATION PROCESS (PART 7, CHAPTER 1)
Overview of the application process
Who must make the application? (section 57(1))
01 The application for a CTO can only be made by an MHO in the circumstances set out in section 57(1) to (5) (see paragraph 25 below).
In those circumstances, the MHO must make the application even where he/she disagrees with the need for the CTO. It would be expected that the patient's designated MHO would make the application where this is practicable and where the patient already has a designated MHO as a result of being subject to, for example, a short-term detention certificate.
When must the application be made? (section 57(7))
02 An application for a CTO must be made within 14 days (that is, 14 calendar days and not 14 working days). This 14 day period begins with the date on which the medical practitioners examined the patient for the purpose of preparing their mental health reports. Where the medical practitioners examine the patient separately and on different days, the later of these dates marks the beginning of the 14 day period (see section 57(7) of the Act). The medical practitioners providing the mental health reports should bear in mind that the clock starts ticking on this 14 day period on the latest date of the medical examinations and not when the MHO receives the two medical reports. It is therefore imperative that the practitioners complete their mental health reports and transmit them to the MHO making the application as swiftly as possible after the medical examinations have taken place.
03 It should be stressed that an application for a CTO can be made even if the patient is not currently detained under the Act (for example, subject to a short-term detention certificate). Where a patient is in the community (that is, he/she is not detained under the Act), the timescales for the completion of the CTO application are the same as where the patient is detained under the Act.
Identifying the need for an application
04 It is essential that the decision to proceed with a CTO application is only taken after all the relevant members of the patient's multi-disciplinary team have engaged in as much prior discussion as is practicable of the need for the application. It will also be essential to have regard to the views of the patient and the patient's carers and named person. Best practice is that the decision to proceed with an application should be taken after a multi-disciplinary case conference involving all relevant parties. Such parties could include CPNs, clinical psychologists, occupational therapists, the patient's advocate, relatives and/or carers, etc.
05 It would be expected that the medical practitioners providing the mental health reports contact and consult the relevant MHO service well in advance of a decision to initiate an application. This is important because the patient may have a designated MHO if he/she is already subject to, for example, a short-term detention certificate. That MHO may well be in the process of preparing a social circumstances report with respect to the patient. It would be best practice to ensure that the MHO only receives the two mental health reports after as much prior discussion of the need for the application as is practicable. Where possible, such discussions should take place face-to-face. Exclusion of the MHO from the assessment process may adversely affect the quality of the assessment as well as that of the resulting proposed care plan. Early involvement of the MHO also gives time for the RMO and MHO to discuss and seek to resolve any differences of opinion prior to the application being made.
06 As a rule, the CTO application process should be characterised from beginning to end by co-operation and multi-disciplinary working between the medical practitioners providing the mental health reports, the MHO making the application and the other parties relevant to the application process, such as the patient's relatives and carers.
Which documents must be submitted as part of the application? What must the application contain? (section 63)
07 An application for a CTO consists of:
two mental health reports prepared by the medical practitioners under section 57 of the Act and examined in paragraphs 9 to 37 of this chapter;
the mental health officer's report prepared under section 61 of the Act and examined in paragraphs 38 - 63 of this chapter; and
the proposed care plan produced by the MHO under section 62 of the Act and examined in paragraphs 64 - 73 of this chapter.
08 The application must also specify the matters listed at section 63(2)(a) of the Act, namely:
the compulsory measures that are being sought in relation to the patient ( i.e. which of the compulsory measures listed at section 66(1) of the Act are being sought);
the medical treatment, community care services, relevant services and any other forms of treatment, care or service which it is proposed will be provided to the patient; and
the name of the hospital whose managers will appoint the patient's RMO. (This is only required where the proposed CTO seeks to impose community-based requirements.)
Preparing a Mental Health Report (Section 57-58)
09 Paragraphs 10 to 33 of this chapter describe what is required of a medical practitioner when preparing a mental health report as part of a CTO application.
Who can carry out the medical examination which precedes the preparation of the mental health report?
10 Section 58 of the Act provides that the two medical examinations can be carried out by either:
two approved medical practitioners; or
one approved medical practitioner and the patient's general practitioner.
11 Where the patient already has an RMO, it would be expected that that RMO would carry out one of the examinations. With respect to the second examination, it would be best practice for this to be carried out, wherever possible, by the patient's general practitioner as he/she can draw on knowledge and experience of the patient and their family, and often bring the benefit of an established, pre-existing relationship with the patient. The general practitioner can therefore provide an assessment of the patient's mental state which incorporates other dimensions of the patient's medical history which may not be available to an approved medical practitioner, including physical illnesses and treatments, and can offer a valuable insight into how these may interact with whatever mental health difficulties are at issue. The general practitioner is also best placed to express the potential contribution of primary care services to care and treatment plans in anticipation of playing an important longer term role in contributing to the patient's rehabilitation and recovery.
12 When it is not possible or practicable for the patient's general practitioner to carry out one of the medical examinations, an approved medical practitioner will undertake the examination. In such an event, the approved medical practitioner must not work directly with the other practitioner to ensure the independence of the opinion given. Wherever possible, however, it is important that the second examination be carried out by a practitioner who has previous knowledge of the patient. For details on the avoidance of conflicts of interest with respect to the medical examinations, see paragraphs 14 to 16 of this chapter.
13 Any practitioner who provides a mental health report may be required
by the Tribunal to attend any subsequent hearing. The Tribunal's
Rules of Procedure outlines the procedures relating to a citation to
attend to payments which may be made to any person attending a Tribunal hearing.
Conflicts of interest in relation to the medical examination
14 The Mental Health (Conflict of Interest) (Scotland) (No 2) Regulations 2005 specifies the circumstances where there is or there is not to be considered a conflict of interest in relation to compulsory treatment orders. Considered a conflict when:
either medical practitioner is related to the patient in any degree specified (see list of prohibited degrees of relationship below);
the two medical practitioners are related to each other in any degree specify (see list of prohibited degrees of relationship below);
where the CTO proposes the detention in an independent health care service and either medical practitioner is employed by or contracted to provide services in or to that health care service;
where the CTO authorises detention in an NHS hospital and both medical practitioners are employed or contracted to provide services in or to that hospital;
prohibited degrees of relationship are - child, grandchild, parent, grandparent, wife, husband, sister, brother, daughter-in-law, son-in-law, mother-in-law, father-in-law, sister-in-law, brother-in-law, cohabitee and any child, grandchild, parent, grandparent, sister or brother of a cohabitee.
15 An examination is permitted to be carried out even where there is a conflict of interest if:
the conflict of interest is in terms of regulations 4(1)(c) or (d) (see third and fourth bullet points of paragraph 14 above);
failure to carry out a medical examination would result in delay which would involve serious risk to the health, safety and welfare of the patient or to the safety of other persons; and
if one of the medical practitioners is a consultant and the other practitioners does not work directly with or under the supervision of that consultant.
16 Although the Act makes no reference to conflicts of interest which may arise in relation to the MHO's involvement in the detention process, an MHO should nonetheless bear in mind that it would be best practice to avoid becoming involved in the detention of a colleague, relative or friend. An MHO who believes that a conflict of interest might arise should request local authority employers to designate another MHO to deal with the case. Where no other MHO can be designated, the MHO should declare this possible conflict of interest in the MHO's report prepared under section 61 of the Act.
When must the two medical examinations be carried out? Should the examinations be carried out separately?
17 Section 58 of the Act states that the two medical examinations should be carried out separately. In such circumstances, the second medical examination must be completed no later than 5 days after the first (that is, 5 calendar days, not working days).
18 However, if the patient gives consent, the examinations may take place at the same time. If the patient is incapable of granting consent, then the examinations may take place at the same time if the patient's named person, guardian or welfare attorney ( i.e. a welfare guardian or welfare attorney holding the relevant powers under the Adults with Incapacity (Scotland) Act 2000) has granted his/her consent. It would be best practice for the medical practitioners to advise the patient of his/her right to separate examinations. It would also be best practice to ensure that where the examinations are carried out at the same time, they record in the mental health reports their reasons for not carrying out the examinations separately.
What form of medical examination should be carried out?
19 Medical practitioners should ensure that they not only examine the current medical state of the patient, they should also weigh up that current medical state with the practitioner's experience of the past episodes of the patient's illness and crucially, previous adherence to treatment. Medical examinations as part of an application for long-term compulsion should be based not only on a 'moment-in-time' mental state examination but also on a consideration of the patient's past psychiatric history and a prediction of the success of longer-term care and treatment. In the course of these considerations, practitioners would be expected to seek input from the patient's MHO to inform their assessment of the patient's condition. Similarly, the views of other relevant parties who currently provide or are likely to provide care and treatment to the patient in the future should be sought while all the time respecting issues of patient confidentiality.
20 Medical practitioners should always ensure that the examination takes place at a time and place which is convenient and safe for the patient as well as the practitioners. They should be sensitive to the wishes of the patient to have their independent advocate, named person, etc present at the medical examination. It would be good practice for the practitioners to discuss with the patient whom they would wish to be present at any interviews which are for assessment purposes. While the patient's choice should be accepted to the greatest extent possible, it will be a matter of judgement for the practitioner to establish a balance between the patient's need for support and the circumstances in which a full assessment can take place. In that context, given that the independent advocate's role includes helping the patient articulate his/her views, that advocate may be extremely helpful in both supporting the patient and helping the practitioners achieve a greater understanding of the patient's perspective which will in turn assist in their assessment. This may also be the case with a relative, carer or named person.
21 In all cases where the patient is being examined, sensitivity should be shown to ensure that the patient is supported but not overwhelmed by too many people in the room where the examination is taking place.
It will be important to try to ensure that the patient does not feel as if he/she is on trial where an assessment in being made.
22 Where a patient is in the community (and therefore not subject to compulsory measures) when the medical examination takes place but refuses to consent to the examination, the medical practitioners and the MHO will need to decide whether they have each been able to carry out a good enough assessment. If they cannot, and if sufficient concern exists about the patient's need for treatment and the potential risk to the patient or others, then consideration should be given to whether the patient meets the criteria for the granting of a short-term detention certificate. This would allow for a period of hospital detention during which a fuller and more satisfactory examination of the patient can take place. (For further information on the process of granting a short-term detention certificate, see Part 6 of the Act or Chapter 2 of this Volume of the Code of Practice.)
What are the criteria for long-term compulsion which must be met and which must be referred to in the mental health report?
23 Before an application for a CTO is made, certain requirements need to be met. These are set down in section 57(2) to (5) of the Act. One of these is that each of the medical practitioners who examines the patient must be satisfied that the criteria listed at section 57(3) of the Act have been met. Quoting from section 57(3) of the Act, these criteria are:
(a) that the patient has a mental disorder;
(b) that medical treatment which would be likely to-
(i) prevent the mental disorder worsening; or
(ii) alleviate any of the symptoms, or effects, of the disorder;
is available for the patient;
(c) that if the patient were not provided with such medical treatment there would be a significant risk-
(i) to the health, safety or welfare of the patient; or
(ii) to the safety of any other person;
(d) that because of the mental disorder the patient's ability to make decisions about the provision of such medical treatment is significantly impaired; and
(e) that the making of a compulsory treatment order is necessary.
24 It is important to remember that the final criterion in the box above will be satisfied only if the patient will not accept treatment voluntarily and that treatment cannot be provided without recourse to compulsory measures.
What must the mental health report contain?
25 If the medical practitioner is satisfied that these criteria have been met, he/she must complete a 'mental health report'. It is recommended that pro forma CTO1, part 3 be used for this purpose. This report should refer to the points listed at section 57(4) of the Act. (There is no form prescribed in regulations for these treatments but a pro-forma, CTO1, may be found on the Scottish Executive's website at www.scotland.gov.uk/health/mentalhealthlaw.) Quoting from that section of the Act, the RMO must:
(a) state that the medical practitioner submitting the report is satisfied that the conditions mentioned in paragraphs (a) to (e) of subsection (3) above are met in respect of the patient;
(b) state, in relation to each of the conditions mentioned in paragraphs (b) to (e) of subsection (3) above, the medical practitioner's reasons for believing the condition to be met in respect of the patient;
(c) specify (by reference to the appropriate paragraph (or paragraphs) of the definition of "mental disorder" in section 328(1) of this Act) the type (or types) of mental disorder that the patient has;
(d) set out a description of-
(i) the symptoms that the patient has of the mental disorder; and
(ii) the ways in which the patient is affected by the mental disorder;
(e) specify the measures that should, in the medical practitioner's opinion, be authorised by the compulsory treatment order;
(f) specify the date or dates on which the medical practitioner carried out the medical examination mentioned in subsection (2) above; and
(g) set out any other information that the medical practitioner considers to be relevant.
26 As much information as possible regarding the points listed at section 57(4) ( i.e. those quoted immediately above) should be included in the mental health report. Discussion of these points should cover, where appropriate and relevant:
a description of the alternatives to compulsory powers which are considered to be unworkable or unlikely to succeed; and
why the care and treatment options proposed and the compulsory measures recommended involve the minimum restriction on the freedom of the patient that is necessary in the circumstances.
27 The purpose of such discussions is to provide the patient's MHO with the widest scope possible within which to prepare the application. Similarly, it allows the Tribunal to make as informed a decision as possible with respect to the application. In this regard, it will be important for the medical practitioners to ensure that the mental health reports are drafted in language which is largely understandable to a non-medical reader.
28 The MHO should not have to rely solely on the evidence provided in the mental health report when it comes to his/her knowledge of the patient's medical/mental state. The function of a mental health report provided by a medical practitioner is to reflect the communication between the medical practitioner and the MHO which has already taken place prior to the report being prepared, not serve as the communication between them.
What are the compulsory measures which a medical practitioner can recommend in a mental health report?
29 The measures which the medical practitioner may recommend in line with paragraph (e) of section 57(4) (quoted in the box above) are those listed at section 66(1) of the Act. Quoting from that sub-section of the Act, these are:
(a) the detention of the patient in the specified hospital;
(b) the giving to the patient, in accordance with Part 16 of this Act, of medical treatment;
(c) the imposition of a requirement on the patient to attend-
(i) on specified or directed dates; or
(ii) at specified or directed intervals;
specified or directed places with a view to receiving medical treatment;
(d) the imposition of a requirement on the patient to attend-
(i) on specified or directed dates; or
(ii) at specified or directed intervals;
specified or directed places with a view to receiving community care services, relevant services or any treatment, care or service;
(e) the imposition of a requirement on the patient to reside at a specified place;
(f) the imposition of a requirement on the patient to allow-
(i) the mental health officer;
(ii) the patient's responsible medical officer; or
(iii) any person responsible for providing medical treatment, community care services, relevant services or any treatment, care or service to the patient who is authorised for the purposes of this paragraph by the patient's responsible medical officer;
to visit the patient in the place where the patient resides;
(g) the imposition of a requirement on the patient to obtain the approval of the mental health officer to any proposed change of address; and
(h) the imposition of a requirement on the patient to inform the mental health officer of any change of address before the change takes effect.
30 It would be expected that a medical practitioner would only recommend imposing community-based compulsory powers in a limited range of circumstances. For example, a requirement to reside at a particular place should only be recommended in exceptional circumstances. Much will depend upon the individual circumstances of the patient who is subject to the application, but circumstances in which a medical practitioner might recommend recourse to community-based compulsory measures might include where:
community-based powers would provide a safe and viable alternative to compulsory hospitalisation;
a patient has previously relapsed whilst off medication in the community, and as a result, has presented a risk to themselves and/or others;
all other means of trying to negotiate with the patient and maintain them in the community without compulsion have been tried and have failed; and
alternatively, less restrictive approaches to secure and adequate adherence with necessary treatments have been shown to be impracticable.
31 Before recommending that community-based compulsory measures be applied for, the medical practitioner would be expected to demonstrate in the mental health report that issues such as those listed above, in addition to any others relevant to the patient's case, have been fully taken into consideration. In doing so, it will be important to demonstrate that consideration has been given to the potential impact of these community-based compulsory measures on any carers or other persons who live with and/or care for the patient.
32 If it is expected that community-based compulsory measures would only be recommended under certain circumstances, as described above, consideration should similarly be given to whether community-based measures are being recommended as an alternative to hospital-based compulsory measures for the appropriate reasons. For example, community-based measures should not be recommended only because a hospital bed is not available or only because the carers or person(s) that the patient currently lives alongside do(es) not wish them to reside at that address. Best practice suggests that a medical practitioner would only recommend that the patient be treated in hospital where that patient requires the care, treatment and services which only a hospital in-patient service can provide.
33 The medical practitioner should, where relevant and practicable, seek input into the mental health report from appropriately qualified professionals, such as speech and language therapists, occupational therapists and clinical psychologists, where they would be able to contribute to the assessment process from their own areas of expertise. For example, it would be important for a medical practitioner to seek input from an appropriately qualified psychologist in relation to a complex assessment of impaired decision-making ability or a case involving a significant learning disability or personality disorder. Similarly, where psychological interventions are being recommended, input should be sought from the appropriately qualified party likely to be providing that intervention.
Further points to be covered in a mental health report: withholding notice
34 There are two further points which the approved medical practitioner must cover in the mental health reports in terms of section 57(5)(c). Note that these points are to be covered only by the approved medical practitioner, not by any non-approved medical practitioner who examines the patient. If two approved medical practitioners examine the patient, it would be best practice for the patient's RMO to deal with these two points. The points are:
a statement as to whether or not written notice should be given to the patient of the fact that an application for a CTO is to be made; and
a statement as to whether or not the practitioner considers the patient to be capable of arranging for a person to represent him/her at any future Tribunal hearing.
35 It would be best practice to only take decisions on these matters after engaging in as full prior consultation as possible with the patient's MHO and other members of the patient's multi-disciplinary team. The expectation is that notice of the application would always be given to the patient, and therefore, that it would only be withheld under exceptional circumstances. However, subject to any prior consultation with the patient's MHO and other relevant parties, it is acceptable to recommend withholding notice where such notice would be likely to cause significant harm to the patient or to another person (see section 57(6)). This could happen in a case where the patient is highly unsettled or likely to abscond and therefore become a risk to themselves through, for example, not taking medication.
36 The approved medical practitioner should be mindful of the fact that the MHO is under a duty to inform the patient of their rights in relation to the application later in the application process. Recommending that notice be withheld from the patient may cause the MHO serious difficulties in carrying out his/her duty to inform the patient of his/her rights with respect to the application under section 61. In such circumstances, it would be best practice for the RMO to discuss with the MHO the best and most sensitive way in which this duty can be carried out.
How similar must the two reports be to one another for the application process to proceed?
37 The CTO application cannot proceed if the two mental health reports do not come to similar conclusions about the patient's condition. For the application to proceed, the two reports must:
agree on the category of primary mental disorder: that is, a report must specify at least one type of mental disorder that is also specified in the other report. (These types of mental disorder are defined in section 328(1) of the Act: i.e. mental illness; personality disorder; and learning disability.); and
specify the same compulsory measures that should be authorised by the CTO. (These are the compulsory measures listed at section 66(1) of the Act.)
Duties of the MHO once in receipt of two mental health reports
38 The MHO making the CTO application must comply with a range of duties before he/she submits the application to the Tribunal. These duties are set out in sections 59 to 63 of the Act and in paragraphs 38 to 73 of this Chapter of the Code of Practice. Paragraphs 40 to 57 of this chapter provide details of the duties which an MHO must carry out with respect to the patient. Paragraphs 58 to 73 then describe the process of completing a mental health officer's report and the proposed care plan.
39 Throughout the CTO application process, the MHO should have regard to the principles of the legislation and the other matters set out in sections 1 to 3 of the Act. In this context, it will be particularly important to have regard to the principles of ensuring that the patient can participate as fully as possible in the processes involved in applying for and determining the CTO and of providing such information and support to the patient as is necessary to facilitate that participation.
The MHO must identify the patient's named person
40 Section 59 of the Act states that the MHO must take all the steps that are practicable to ascertain the name and address of the patient's named person. The MHO should do this as soon as is practicable after the duty to make the application arises. Identifying the patient's named person may necessitate discussion with the RMO and/or other relevant professionals as to whether the patient has the capacity to nominate a named person.
41 It would be best practice for the MHO to first explain to the patient verbally and with a follow-up leaflet the status and rights of the named person as well as the role they can play in the CTO application process and beyond. The MHO will consequently also need to explain the difference between the roles of the named person and the independent advocate.
42 An MHO will need to be very familiar with the procedures outlined in Part 17 Chapter 1 of the Act regarding the nomination process of the named person. This is because under section 255 of the Act the MHO has a duty in certain circumstances and a power at other times to apply to the Tribunal for an order under section 257 to remove and replace an "apparent named person" ( i.e. a person whom the MHO considers to be inappropriate to act in that role). The decision as to whether the apparent named person is inappropriate to act should not be made by the MHO alone but in consultation with other relevant members of the patient's multi-disciplinary team. The expectation is that the patient's right to choose whom he/she wishes to have as a named person would be respected. The MHO has no power to veto the patient's choice at the time of nomination, nor should they apply undue influence on the patient. The MHO should intervene using the powers given at section 255 only where there are clear and significant reasons for doing so. (For further details regarding the nomination process of a named person, see Part 17 Chapter 1 of the Act or Chapter 6 Volume 1 of the Code of Practice.)
43 The MHO should explain to the patient that in the absence of them nominating a named person, their primary carer shall (where they are aged 16 or over) become their named person. When ascertaining the identity of the named person and the primary carer, the MHO should be careful to respect the patient's rights with respect to confidentiality and to only disclose a minimal level of information about the patient's detention. The patient may after all wish a relative with whom they have a poor relationship to know little about their detention. The MHO should also explain the process whereby the patient can make a declaration under section 253 of the Act or an application under section 256 of the Act to prevent a particular individual being their named person.
44 As with all occasions where a named person is being nominated, the MHO should consider the impact on the nearest relative/primary carer where they are not nominated as the named person. This could be done through explaining to them the role of the named person and the rights of relatives/carers who are not the patient's named person.
45 The MHO should also ascertain whether the named person is fully aware of the fact that they have been nominated as the named person and that they are in fact willing to take on that role. If they are, the MHO should explain to them what the role of named person entails; and the rights and responsibilities it confers on them (for example, with respect to making applications to the Tribunal).
46 It would also be best practice for the MHO to find out at this stage whether the patient has an advance statement and where it is located.
The MHO must notify certain parties that the application is being made
47 Section 60 of the Act states that before submitting the application to the Tribunal, the MHO must notify the following parties in writing that the application is being made. The parties are:
the patient;
the patient's named person; and
the Commission.
48 The MHO must do this as soon as is practicable after the duty to prepare the application arises. Providing notice as early in the application process as possible enables the patient and the named person to take legal advice and prepare fully for the hearing.
49 Where the approved medical practitioner has recommended in his/her mental health report that notice of the application being made should be withheld from the patient, the MHO may override this recommendation. Section 60(2) of the Act states that the MHO may notify the patient of the application where he/she considers it appropriate to do so. Where the MHO does decide to override the approved medical practitioner's recommendation, he/she should have discussed in some detail with the medical practitioner the reasons for this decision. Moreover, in such cases, the MHO should record in writing his/her reasons for overriding the medical practitioner's original recommendation. This is particularly important in cases where the mental health report includes an assessment of high risk.
50 Although section 60 of the Act imposes a duty on the MHO to give notice to the patient (that is, give notice in writing), the MHO should always consider informing the patient and the named person orally in addition to the written notification. This will give the patient and the named person as much time as possible to prepare for the Tribunal hearing. Moreover, it would be best practice for an MHO, where practicable, to ensure that any written notification is hand-delivered (or sent by recorded delivery) to the patient so that the details, implications and importance of the notification and the application can be explained to the patient. There may be circumstances in which the MHO would want to seek the assistance of other members of the multi-disciplinary team to carry this out or to assist in carrying this out. It would also be best practice for the MHO to discuss with the patient whether they wish anyone else to be informed of the application, such as the primary carer, if they are not the named person, or their independent advocate, if the patient already has one.
The MHO must inform the patient of his/her rights
51 Section 61(2)(b) to (d) of the Act imposes on the MHO a range of further duties which must be carried out in advance of submitting the CTO application to the Tribunal. These include:
a duty to inform the patient that the application is to be made;
a duty to inform the patient of the availability of independent advocacy services; and
a duty to take appropriate steps to ensure that the patient has the opportunity to make use of these advocacy services.
52 The MHO should not look at the process of complying with these duties as a simple 'tick-box exercise' as the manner of carrying out these duties will need to vary considerably from one patient to another. The onus is on the MHO to engage in a dynamic process which will allow him/her to demonstrate that the patient has been made aware of his/her rights in a manner which aims to ensure that he/she can gain the best possible understanding of these rights. The MHO may need to involve other members of the multi-disciplinary care team in this process, such as a clinical psychologist, ward nursing staff or CPN.
53 Where the patient is hostile, indifferent or too ill to comprehend, the MHO should also consider making contact with the patient's relatives, carers, named person or independent advocate, as appropriate. The MHO should also always be willing to visit the patient more than once in an attempt to fulfil these duties. Merely putting a leaflet through the patient's letter-box without making further attempts to inform the patient of his/her rights would not be sufficient.
The MHO must interview the patient
54 Section 61(2)(a) of the Act imposes a duty on the MHO to interview the patient. The function of this interview is to permit the MHO to assess the impact of the suspected mental disorder on the individual's social functioning and to determine whether recourse to compulsory powers under the Act, as recommended in the mental health reports, is warranted. The interview could focus, on the one hand, on the points of contention between what the two medical practitioners have proposed in their mental health reports and, on the other, the views of the patient. Views on this subject should also be elicited from a range of sources beyond the interview with the patient, such as from any advance statement made by the patient; and, within the bounds of patient confidentiality, discussions with the patient's independent advocate, named person, carers, relatives or key worker.
55 As much prior notice of the interview as possible should be given to the patient to enable the patient's independent advocate, named person, etc to attend. However, the failure of any party to attend the interview should not be allowed to paralyse the application process. The interview should also be held in as private a space as possible and in a location that is as convenient and safe as possible for the patient as well as the MHO.
56 It is unlikely to ever be completely impracticable for an MHO to comply with the duty to interview the patient. Indeed, it may be necessary for an MHO to attempt on more than one occasion to interview the patient. Only in exceptional circumstances would an MHO not be able to comply with this duty: for example, where the patient is acutely psychotic and/or there is an immediate risk to the MHO's personal safety. In such circumstances, it would be best practice to meet the patient's named person, nearest relative, key worker, carers, etc instead. Where the MHO has been unable to comply with the interview requirement, he/she should make a record of the actions taken, why these actions failed, and what alternatives were considered and followed up. By way of section 61(4)(d) of the Act, this record must be included in the mental health officer's report which accompanies the CTO application.
57 The following statements represent a non-exhaustive list of some best practice points which an MHO should comply with when carrying out these duties with respect to the patient. The MHO should:
explain the CTO application process to the patient, including how the Tribunal hearing will operate, where it will take place, who will be in attendance etc…;
advise the patient of his/her rights with respect to legal representation at the hearing. It would be good practice for an MHO to have knowledge of the solicitors in the local area willing to take on such work (although the MHO should be careful not to promote any one practice);
inform the patient of the rights and responsibilities of the named person and then, if necessary and if this has not been done already, explain the process of nominating a named person;
ask the key worker and/or RMO to impart any necessary information to the patient if the patient is hostile to interventions by the MHO;
back up any information given to the patient orally with a leaflet setting out similar information so that the patient (and/or family members, carers, etc) can have the opportunity to assimilate the information at a later date. The MHO should ensure that a contact address/number is included in any such written information;
contribute to making sure that any communication barriers are addressed by, for example, ensuring that a translator/interpreter is provided if necessary; ensuring that relevant documents are made available in Braille, audio-cassette format, etc…; and
ascertain whether the patient wants or already has an independent advocate. This could include giving the patient oral and written information about local advocacy services as well as helping the patient make use of those services. One important task will be for the MHO to explain to the patient the difference between the functions of the named person, a legal advocate and an independent advocate.
Preparing a mental health officer's report
58 Section 61(4) of the Act sets out the items that must be included in the MHO's report which accompanies the CTO application. These are:
the name and address of the patient;
the name and address of the patient's named person and the patient's primary carer, if they are known by the MHO;
the steps which the MHO has taken to comply with the duties imposed on him/her by section 61(2) of the Act (these duties are described in paragraphs 38 to 46 above);
the reason it was impracticable to interview the patient, if this proved to be the case;
details of the personal circumstances of the patient in so far as they are relevant for the purposes of the application;
the MHO's views on the 2 mental health reports relating to the patient;
details of any advance statement which the patient has made (and not withdrawn), where known by the MHO; and
any other information that the MHO considers relevant to the Tribunal's determination of the application.
59 In essence, the purpose of this report is to provide the Tribunal with:
relevant background information relating to the patient;
information on any previous periods of hospitalisation because of mental disorder (whether formal or informal) and their effect on the patient;
confirmation that the patient has been made aware of his/her rights and the steps which the MHO has taken in this process;
details of whether the patient has an advance statement and the extent to which the wishes set out in the advance statement have been taken into account in the proposals for the patient's care and treatment;
the views of the MHO on the mental health reports and on the extent to which he/she supports the application, including the MHO's views on whether the criteria for compulsory powers are satisfied and on whether there are viable courses of action which could be taken other than those recommended in the mental health reports, particularly those which could avoid recourse to compulsory powers. To come to a view on these issues, the MHO may need on occasion to request a report from, for example, a clinical psychologist, an occupational therapist or a nurse therapist among others to complement the information provided by the medical practitioners in their mental health reports;
an assessment of whether it is necessary to compel the patient to accept treatment and of how likely it is that the treatment could be provided informally. This is essential as the fundamental decision which the Tribunal hearing is making is whether the patient's autonomy should be overridden when it comes to making decisions about treatment. It is therefore crucial that the MHO address the appropriateness of each of the compulsory measures which the medical practitioners recommended in their mental health reports;
the possible impact of the proposed compulsory measures on the patient's personal finances, particularly welfare benefits (for example, Income Support or Disability Living Allowance), housing costs, etc; and
an indication as to the views of the patient's informal support networks, including the named person and carers. For example, if the MHO supports the medical recommendations and the CTO application but the carer does not, the report should contain information on the carer's suggested alternatives to compulsion and an account of why the MHO (and RMO etc) believe these alternatives are not viable.
60 It would be best practice for the MHO to include in the report the contact details of not just the named person and the primary carer, as is required by section 61(4)(b), but also the contact details of the wider care network, including the patient's advocate, where known, and any other relevant individuals who provide care and treatment.
61 An MHO is free to, and indeed expected to, express views on the mental health reports prepared by the medical practitioners, and in particular, views on the range of compulsory measures being recommended in the mental health reports. If the MHO disagrees with the reports, he/she should identify any deficiencies in the reports with regard to the explanation of whether the criteria for compulsory powers are met. However, there should be prior discussion with the medical practitioners in which these views or concerns are raised. The MHO should also consider whether the care and treatment proposed by the medical practitioners as well as the compulsory measures they recommended represent, in all the circumstances, the least restrictive environment in which the patient can be cared for and treated. This process will require the MHO to have a knowledge of the availability of alternative supports and services as well as an assessment of whether these would be appropriate and viable in the circumstances.
62 Where the practitioners have recommended community-based compulsory measures in the mental health reports, it would be good practice for the MHO to consider the extent to which the issues described at paragraphs 29 to 33 above have been taken into account before including these compulsory measures in the final CTO application.
63 While it may be that the MHO legitimately reaches the conclusion that, in his/her view, the criteria for compulsory measures are not in fact satisfied, the assessment should include an analysis of the likely impact on the patient's health, safety and welfare if the care and treatment does not proceed on a compulsory basis. The decision to formally dissent from the opinions offered in mental health reports should only be taken following detailed discussion with the medical practitioners, wherever this is practicable. Where such legitimate professional differences still exist, it is for the Tribunal to make a judgement on whether or not to grant the application.
Preparing a "proposed care plan"
64 In terms of section 62(2) of the Act, the MHO must prepare a "proposed care plan" as part of the application for a CTO. Section 62(3) to (8) of the Act sets out the content of the proposed care plan. In essence, the proposed care plan revolves around four factors:
the patient's needs;
the actions proposed to meet those needs;
the objectives of those actions; and
the parties who are carrying out those actions.
65 Information on these four factors is then broken down into three further categories. These are:
the patient's needs, etc with respect to medical treatment for mental disorder;
the patient's needs, etc with respect to community care or other relevant services;
the patient's needs, etc with respect to other forms of care and treatment.
66 It is imperative to remember in the preparation of the proposed care plan that the Act provides a precise definition of what constitutes medical treatment: that is, medical treatment under the Act means medical treatment for the patient's mental disorder. Section 329 of the Act states that within this definition of medical treatment is included: nursing; care; psychological intervention; habilitation and rehabilitation (including education and training in work, social and independent living skills).
67 The proposed care plan should also make clear which elements of the care package are being provided with the patient's agreement and which it is proposed will be provided on a compulsory basis. However, in order to maintain a holistic approach to the patient's care and treatment, it is important that compulsory and non-compulsory elements are expressed in a way which underlines that the efficacy of the overall plan depends on the delivery of all the elements as a unified whole, wherever this is the case. Moreover, the proposed care plan should spell out which of each of the compulsory and non-compulsory powers are essential to the overall efficacy of the plan. This then helps the Tribunal decide what might be specified in the CTO as a recorded matter. (For further information on "recorded matters", see section 64(4)(a)(ii) of the Act.)
68 The information with respect to needs, actions, objectives and parties carrying out those actions should be set out in the table on pro forma CTO1, part 4 which is recommended to be used for this purpose. The MHO will also have to explain reasons for coming to the conclusions laid out in that table. (There is no form prescribed in regulations for these treatments but a pro-forma, CTO1, may be found on the Scottish Executive's website at www.scotland.gov.uk/health/mentalhealthlaw.) The questions to which the MHO will be expected to respond include:
how do the elements of the proposed care plan above comply with the principles of the Act and other matters at sections 1 to 3 of the Act ( e.g. the principle of least restrictive alternative)?
what alternatives were considered to the options proposed? Why were these alternatives deemed to be not workable or practicable?
what contingency plans are in place if the options proposed do not work, including crisis management contingency plans?
to what extent does this care plan reflect the wishes of the patient as expressed in any advance statement or elsewhere? If any of these wishes have not been respected, why not?
who was consulted in the process of drawing up this proposed care plan? To what extent are the views of those consulted reflected in the plan?
how have issues of risk (either to the patient or others) been taken into consideration in the drawing up of the plan? What form of risk assessment has been carried out?
69 The proposed care plan should also describe the patient's un-met needs, where these exist, and why these needs are not being met or cannot be met. Providing this information affords the Tribunal a fuller view of the patient's case and of the care package.
70 The MHO should prepare the proposed care plan in close consultation with the practitioners who produced the mental health reports and with all other persons/agencies who will be providing services, treatment or care to the patient. All these parties would be expected to contribute willingly and fully to its preparation. In effect, the MHO should be producing a plan proposed by the whole multi-disciplinary team. As such, the burden of its preparation should not be shouldered by the MHO alone. It will also be important for the MHO to recognise the potentially vital contributions which the patient (as well as the patient's relatives, carers, independent advocate, as appropriate) can make to the process of preparing the proposed care plan.
71 Occasions may arise where the MHO disagrees with key elements of what is being proposed both in the mental health reports and the proposed care plan. The MHO should, however, highlight such differences of opinion and propose alternative courses of action where these are thought to be available, viable and appropriate. It would then be for the Tribunal to grant or refuse the application in light of all the information presented to it.
72 The process of developing a proposed care plan will be informed by local procedures and protocols relating to assessment and care management and/or the Care Programme Approach. The crucial difference is that the preparation of a proposed care plan is a specialist task for the purposes of the CTO application. Well developed systems for assessment and care management, care programming and Single Shared Assessment should greatly enhance and facilitate the development of a proposed care plan.
73 It would be expected that where a proposed care plan is proposing, for example, a psychological intervention, a psychologist or other appropriately qualified person making that intervention would have been consulted and involved in the assessment process. Such involvement may be particularly important where the patient's diagnosis of primary mental disorder is learning disability or personality disorder or where the plan includes psychological interventions which are intended to be implemented without the patient's consent such as behaviour modification programmes.
Submitting the application to the Tribunal and the Tribunal's determination of the application
74 For information on the process of submitting the application to the Tribunal, see the Tribunal's Rules of Procedure.
75 The flowchart on page 88 explains the options which are open to the Tribunal when determining a CTO application as well as the statutory duties which must be complied with subsequent to a CTO being made.
76 Once the application has been submitted to the Tribunal, the patient's RMO should give the patient a copy of the application papers and, more importantly, be available to discuss the application, explain the process and answer any questions which the patient may have. This applies whether the patient is in hospital or in the community at the time of the application. It would also be expected that the RMO ensures that the patient's independent advocate is informed of the time and date of the hearing so that he/she can support the patient throughout the Tribunal process.
When must the Tribunal determine the application? (sections 68 and 69)
77 Where a patient is subject to a short-term detention certificate or an extension certificate, that patient may be detained in hospital and treated under Part 16 of the Act under the authority of section 68 of the Act for a further 5 working days once the CTO application has been submitted. This 5 working day extension period begins at the point when the short-term detention certificate or the extension certificate expires. Note that it does not begin when the application is submitted to the Tribunal.
78 For example, if an application is submitted to the Tribunal in respect of a patient on day 13 of the short-term detention certificate, the time period within which the Tribunal must determine the application is the 15 days of the short-term detention certificate which are left to run plus the 5 working days added by way of section 68(2)(a) of the Act. If the application is submitted on day 2 of the extension certificate, the time period within which the application must be determined is the 1 remaining working day of the extension certificate plus the additional 5 working days added by section 68(2)(a). In terms of section 69 of the Act, the Tribunal is required to determine before the expiry of that period of 5 working days whether or not to make an interim CTO. (For further information on an interim CTO, see section 65 of the Act and Chapter 4 of this Volume of the Code of Practice.) If the Tribunal does not make an interim CTO, then it is obliged to determine the application for the CTO within that period of
5 working days.
Who must be allowed to give evidence to the Tribunal? (section 64(2) and (3))
79 In terms of section 64(2) of the Act, a wide range of parties must be allowed to make either oral or written representation and to lead or produce evidence to the Tribunal. These parties are:
the patient;
the patient's named person;
any guardian of the patient;
any welfare attorney of the patient who has the relevant powers;
the patient's mental health officer;
the medical practitioners who submitted the mental health reports which accompany the application;
if the patient has a responsible medical officer, that officer;
the patient's primary carer;
any curator ad litem appointed in respect of the patient by the Tribunal; and
any other person appearing to the Tribunal to have an interest in the application (for example, the patient's nearest relative if they are not the primary carer; the patient's or the medical practitioner's lawyer; other medical practitioner or clinical psychologist called to give evidence; key worker or named nurse; the Commission, etc).
Can someone be compelled to attend a Tribunal hearing?
80 Yes. Any person can be compelled to attend a Tribunal hearing (see Schedule 2, Part 3, paragraph 12). Similarly, the Tribunal has the power to require any person to produce evidence for any hearing. Sanctions can be imposed for non-compliance, without reasonable excuse, with a request to attend or produce evidence for any hearing. Further details on this issue can be found in the Tribunal's Rules of Procedure. The Tribunal also has the power to pay allowances and expenses to persons attending a Tribunal hearing.
81 A Tribunal hearing could still go ahead in the absence of any individual.
It is up to the individual Tribunal panel, however, to decide whether to proceed with or postpone the hearing in the event of one or more of the attendees not turning up.
Which criteria does the Tribunal use in determining whether to make a CTO?
82 The criteria which the Tribunal uses in determining whether or not to make a CTO are set out in section 64(5) of the Act. Quoting from that sub-section of the Act, these are:
(a) that the patient has a mental disorder;
(b) that medical treatment which would be likely to-
(i) prevent the mental disorder worsening; or
(ii) alleviate any of the symptoms, or effects, of the disorder;
is available for the patient;
(c) that if the patient were not provided with such medical treatment there would be a significant risk-
(i) to the health, safety or welfare of the patient; or
(ii) to the safety of any other person;
(d) that because of the mental disorder the patient's ability to make decisions about the provision of such medical treatment is significantly impaired;
(e) that the making of a compulsory treatment order in respect of the patient is necessary; and
(f) where the Tribunal does not consider it necessary for the patient to be detained in hospital, such other conditions as may be specified in regulations.
83 The above criteria are cumulative: that is, all of them must be met before the order can be made.
84 With respect to criterion (f) in the list above, there are currently no plans to exercise this regulation-making power. This situation will, however, be kept under review.
CONSIDERATION OF A COMPULSORY TREATMENT ORDER APPLICATION - FLOWCHART
What can the Tribunal authorise with respect to the CTO application?
85 The Tribunal has three options. It can refuse the application (this outcome is dealt with in paragraph 86 of this chapter); it can grant the CTO (see paragraphs 87 to 93); or it can grant an interim compulsory treatment order (see paragraphs 94 to 97).
The Tribunal can refuse the application (section 64(4)(b))
86 Where the Tribunal is satisfied that the relevant detention criteria are not met in respect of the patient, it must refuse to grant the application. In such cases, it would be expected that, where the patient was subject to a short-term detention certificate or an extension certificate immediately before the hearing, the RMO would revoke that detention certificate. If the patient is ultimately to be discharged from hospital as a result of the application being refused, it would be best practice for the RMO, in consultation with the other members of the patient's multi-disciplinary team, to oversee the drawing up and implementing of a discharge plan of care. This will enable the RMO and the multi-disciplinary team to comply with the duty placed on them by way of section 1(6) of the Act to have regard to the importance of the provision of appropriate services to the person who is, or has been, subject to compulsory powers.
The Tribunal can grant the application for a CTO (section 64(4)(a))
87 If all the conditions set out in section 64(5) of the Act are met, then the Tribunal may make an order containing the elements outlined at sections 64(4)(a), 64(6) to (8) and 66(1) of the Act. These elements are described in the following paragraphs. In summary, they are:
a series of compulsory measures;
recorded matters;
the type of mental disorder which the patient has; and
the name of the hospital the managers of which are responsible for appointing the patient's RMO (where community-based measures have been authorised).
88 An order will authorise a series of compulsory measures for a period of 6 months beginning with the day on which the CTO is made. This will be a combination of the compulsory measures listed at section 66(1) of the Act. Note that if the order authorises community-based compulsory measures, it must include a record of the name of the hospital whose managers will be responsible for appointing an approved medical practitioner to act as the patient's RMO. The compulsory measures which can be granted are:
the detention of the patient in hospital;
the giving of medical treatment to the patient in accordance with
Part 16 of the Act;imposing on the patient a requirement to attend certain places at certain times for the purpose of receiving medical treatment (this is sometimes called "an attendance requirement");
imposing on the patient a requirement to attend certain places at certain times for the purpose of receiving community care services, or other relevant services or treatment (this is similarly sometimes called "an attendance requirement");
imposing on the patient a requirement to reside at a specified place (this is sometimes called "a residency requirement");
imposing on the patient a requirement to allow certain parties to visit the patient in the place where he/she lives (these parties could be, for example, the patient's MHO or RMO);
imposing on the patient a requirement to obtain the approval of his/her MHO to any proposed change of address; and
imposing on the patient a requirement to inform his/her MHO of any change of address before that change of address takes effect.
89 The Act states at section 66(1)(c) and (d) that an attendance requirement may require a patient to attend "on specified or directed dates; or at specified or directed intervals" for medical treatment, community care services or other services. Section 66(3) defines "directed" as meaning "in accordance with directions given by the patient's RMO" and "specified" as meaning "specified in the compulsory treatment order". Where the Tribunal grants a compulsory treatment order which includes an attendance requirement, it has therefore two options. The first option is to specify in that order the times or dates on which the patient must attend for treatment. This could mean that the order would explicitly state that the patient must attend for treatment, for example, every second Tuesday or twice a week. The second option is to allow such detail to be left to the discretion of the patient's RMO. It is important to bear in mind that where the first option is chosen, an application would have to be made to the Tribunal under section 95 of the Act to vary the compulsory treatment order if the patient's RMO wishes to vary the times or dates on which the patient must attend for treatment. However, no such application would have to be made if the dates on which or the intervals at which the patient must attend for treatment are not specified in the order but are instead left to directions to be given by the RMO.
90 It should be noted that where the Tribunal authorises a "residency requirement" by way of section 66(1)(e), the address at which the patient must reside is specified in the order. This means therefore that if the RMO wishes a different address to be specified, he/she must make an application to the Tribunal under section 95 of the Act for an order which would vary the address specified in the compulsory treatment order.
91 In addition to the compulsory measures listed at section 66(1) of the Act, an order can specify "recorded matters". These are the particular types of medical treatment, community care services, relevant services or any other form of treatment, care or service which the Tribunal wishes to mark out as being essential to the care package. The Tribunal may wish to make something a recorded matter because where a recorded matter is not being provided to a patient over the course of the CTO, the patient's RMO is under a duty to bring this fact to the attention of the Tribunal in terms of section 96(3) of the Act. The Commission has the power to do likewise in terms of section 98 of the Act. On being informed of a failure to provide a recorded matter, the Tribunal will decide whether it wishes to vary the measures or recorded matters specified in the CTO or else revoke the CTO entirely. For more information on the procedures for varying and/or revoking a CTO, see Part 7 Chapter 4 of the Act or Chapter 5 of this Volume of the Code of Practice.
92 A CTO must also record the type(s) of mental disorder which the patient has. These types are listed in the Act at section 328(1): i.e. mental illness, personality disorder, or learning disability.
93 As a result of the various representations made to the Tribunal, it may decide to specify in the order different, additional or fewer compulsory measures from those included in the application in terms of section 64(6) of the Act. It should be noted once again that these compulsory measures are those listed at section 66(1) of the Act. However, the Tribunal may only specify different compulsory measures in the order where it has complied with the two following requirements:
it must give notice to all the parties listed at section 64(3) of the Act (see paragraph 79 of this Chapter above for further details) setting out that it is proposing to specify compulsory measures other than or additional to those contained in the CTO application. It must also set out what those compulsory measures are. However, the Tribunal need not provide written notification if the affected parties are present at the Tribunal hearing; and
it must allow these parties the chance to make representation to the Tribunal in relation to what is proposed or to lead or produce evidence.
The Tribunal can authorise an interim compulsory treatment order (section 65)
94 The Tribunal may decide that it does not wish to grant a full 6 month CTO. It may instead grant a shorter order: an interim CTO. This outcome could happen where, for example, the Tribunal does not feel it has enough information on which to base their decision about the full CTO; where it wishes to seek further evidence from another party such as a medical practitioner, psychologist, social care provider, carer or relative; or where the patient and his/her representatives require further time in which to prepare their evidence. An interim CTO may also be granted where any person who has an interest in the proceedings makes an application for one.
95 The criteria which must be met before an interim CTO can be made are very similar to the criteria to those for a CTO. As set out in section 65(6) of the Act, they are:
that the patient has a mental disorder;
that medical treatment which would be likely to prevent the mental disorder worsening or to alleviate any of the symptoms, or effects, of the disorder, is available for the patient;
that if the patient were not provided with such medical treatment there would be a significant risk to the health, safety or welfare of the patient, or to the safety of any other person;
that because of mental disorder the patient's ability to make decisions about the provision of such medical treatment is significantly impaired; and
that it is necessary to make an interim compulsory treatment order
( i.e. that the treatment cannot be provided without recourse to compulsory measures).
96 An interim CTO may last for any period of up to 28 days. The Tribunal may grant more than one interim CTO in respect of a patient. However, the total period for all the interim CTOs granted taken together may not exceed a period of 56 consecutive days.
97 An interim CTO can authorise the same compulsory measures as those authorised by a 'full' compulsory treatment order. These are the measures listed at section 66(1) of the Act (see paragraph 88 above). Like a CTO, an interim CTO must also include details of the hospital whose managers are responsible for appointing the patient's RMO if it specifies community-based requirements.
98 Before an interim CTO can be made, the parties referred to at section 65(5) must be given the opportunity to make representation to the Tribunal and to lead/produce evidence.
Interaction of CTO or interim CTO with other orders and certificates
99 Section 70 of the Act states that where a patient is detained in hospital on the authority of a short-term detention certificate, and where a CTO or an interim CTO is made in respect of him/her, then the short-term detention certificate is revoked on the making of the CTO or interim CTO.
100 Section 75 states that where a patient who is subject to an interim CTO and where a CTO is made in respect of that patient, then the interim CTO is revoked.
Statutory duties with respect to an application for a Compulsory Treatment Order
Which party must provide information or notification? |
Timescale |
Whom must they give this information or notification to? |
What specific information must they provide? |
|---|---|---|---|
Medical practitioner providing a mental health report |
No timescale is specified in the Act. Note, however, that the Code of Practice makes clear that the report should be transmitted to the MHO as quickly as is practicable as the MHO has only 14 days in which to make the application. The clock starts running on this 14 day period when the second of the 2 medical examinations has taken place. |
Mental Health Officer |
The mental health report must:
|
MHO (sections 57 & 63) |
Within 14 days beginning with the later, or latest, of the medical examinations |
They must prepare the CTO application and submit it to the Tribunal |
1. With respect to the mental health reports, the MHO should ensure that:
2. The MHO must submit to the Tribunal:
|
MHO (section 59; Part 17, Chapter 1) |
As soon as practicable after the duty to make the application arises |
The Tribunal or the Commission, where applicable. |
The MHO must take such steps as are reasonably practicable to ascertain the name and address of the patient's named person. He/she should comply with the provisions of Part 17 Chapter 1 of the Act with respect to the nomination of a named person. |
MHO (section 60) |
As soon as practicable after the duty to make the application arises |
|
The MHO must give notice to those parties that the application is to be made. If the view set out in one of the mental health reports (that is, the report by an AMP) is that notice should not be given to the patient, the MHO need not give that notice. However, if the MHO considers it appropriate to give that notice anyway, the MHO may do so. MHO (section 61) Before the application is made The patient The MHO must carry out a range of duties with respect to the patient:
|
MHO (section 61) |
As part of the CTO application |
To be submitted to the Tribunal |
The MHO must prepare a report under section 61(4) stating:
|
MHO (section 62) |
As part of the CTO application |
To be submitted to the Tribunal |
The MHO must prepare a proposed care plan stating:
|
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