Parts of the new Mental Health Act 2007 are already with us but most of it comes in to force this October. It's a smaller bit of legislation than the original Act, so it will still be known as the Mental Health Act 1983 (MHA 1983) but this new bit of law ammends some key areas.
Some are widely known. No longer will doctors have to look after detained patients, the Responsible Medical Officer (RMO) role ceases to exist and instead we have Approved Clinicians (who could be nurses, psychologists, occupation therapists etc) who can then act as the Responsible Clinician instead of a psychiatrist. So when detained under section 3, it could be almost anyone looking after you and deciding when you are allowed out, with psychiatrists nowhere to be seen.
Interesting times, eh?
The implications of some changes are less well known. It was, oddly, a carers forum that developed this scenario at me. I then spoke with a lawyer :
A patient, Alex, becomes unwell after drinking alcohol and using cannabis and becomes psychotic. He stops work and is admitted under the MHA 1983 for 6 weeks, having a period of time being detained in hospital for treatment under section 3.
After 6 weeks in hospital he's back home again with his family.
2 weeks after this he's back at work.
Alex then drinks alcohol and use cannabis.
He become psychotic and is admitted, again.
His family are cross that he's psychotic again, why did we let this happen?
This pattern repeats itself over time.
Summary : A patient has serious psychotic episodes as a result of lifestyle choices they elect to make.
Implications : We've detained him under section 3 of the MHA 1983 and have a duty of care. Her Majesty's Government has given us an instrument to provide care for him, in the form of the MHA 1983. From October this year, this extends to Supervised Community Treatment (SCT) that has to be considered for all patients detained under section 3 (and other treatment sections). We have to consider this (as in, the law says so, and when we have to, e.g. when you have more than 7 days leave, so it can't be ignored).
If Alex uses alcohol and cannabis, he becomes psychotic. If Alex doesn't, he doesn't. When we look after him, we are attempting to get him well and keep him well (with advice, psychological therapy, medication, support, whatever). We have to, it's our duty of care for a detained patient (and continues to be our duty through section 117, SCT and under the Care Programme Approach). Some sections (7, 25) specifically require more.
How do we exercise our duty to look after Alex and avert psychosis (with the loss of income, distress to him and his family, time out in hospital and so on) when he's discharged from hospital?
We use a SCT that requires he abstains. We say he has to abstain, since to do otherwise is to cause a relapse. Just the way he could be told he has to take his tablets, family/carers were adamant that mental health services should be directing patients who become psychotic on drugs not to take drugs. Under a SCT what happens if they fail to take their tablets or fail to abstain from cannabis? They're recalled back to hospital by their Responsible Clinician, RC (who could be a CPN, ward nurse, psychologist, OT, whoever). After a couple days and an AMHP (from October what an approved social worker will be) a section 3 starts again (note, no medical recommendation has been made for this and they're there for up to 6 months, now).
The stick : abstain from alcohol and drugs, take your tablets, or you're locked up. Again.
The pressure from carers and family : how can the Responsible Clinician not do this? The RC has a duty of care to Alex. The RC knows if Alex uses alcohol/drugs he becomes psychotic so to support community placement Alex must avoid them. The government's given us a tool to effect this care plan and ensure Alex remains well. To not use a SCT, thus allowing him to become psychotic (which is a forseeable event we can reasonably predict) can be seen as a failure of the RC in their duty of care to Alex and as medical negligence. The family can complain that the RC was able to avert this psychotic episode through use of the SCT but didn't, thus a letter from Bastard, Bugger and Brown Solicitors is on it's way to the Trust to sue their asses for an episode of psychosis that was forseeable and could have been prevented if the RC had used an SCT appropriately.
Mental health services enforcing such things, and there are oh so many things that impact 'pon mental wellbeing that we could enforce . . .
. . . may we live in interesting times.