The detaining Trust must refer the patient to the Mental Health Review Tribunal if the patient has not appealed during the previous 2 year period
Patients and nearest relatives have a right to appeal against the detention during both the detention for assessment and treatment periods. Further information regarding when and how this may be done is contained in the Mental Health Review Tribunal section of this Guidance.
The patient must be advised on a regular basis throughout the period of detention for assessment and for treatment of his right to apply to the Mental Health Review Tribunal (once within the first 6 months, once during the second 6 months and once during each subsequent 1 year period of detention) and a record kept of this. Staff advising him must ensure that repeated offers are made to explain this, especially when the patient's illness affects his understanding. Most mental health and learning disability services have advocates who will also do this informally.
The detaining Health and Social Care Trust also has a statutory responsibility to refer the case of a patient who has not appealed during the previous 2 year period.
May patients be granted leave from hospital during the period of detention for treatment?
Leave of absence may be given either for specified occasions or a specified period, often to help prepare the patient for discharge. Article 15 It should be considered part of the patient's treatment plan. Leave cannot be granted for more than 27 days at a time without informing RQIA of the patient's address.
The Responsible Medical Officer is responsible for the care and treatment of the detained patient and must ensure that appropriate arrangements are in place for the patient's supervision whilst absent on leave.
The Responsible Medical Officer can impose any conditions on the leave he thinks necessary in the interests of the patient or for the protection of other people and may recall a patient before the end of the period for which he was originally granted leave, if he believes it to be in the interests of the patient or for the protection of other persons. If the patient refuses to return at the appointed time he may be taken into custody and returned to hospital. These processes are set out in Article 29 and paragraphs 107 and 108 of the Guide. In a situation where the patient is in a private place and access is denied or prevented a Warrant can be sought to gain entry and remove the patient. LINK TO WARRANTS APPENDIX
What should happen if a detained patient leaves hospital without permission?
While a patient is subject to detention in hospital that patient is in the legal custody of the detaining Health and Social Care Trust. Article 29 provides powers to return a patient who is absent without leave to the hospital where he is required to stay. He may be returned by any officer on the staff of the hospital, any police officer, an approved social worker or any person authorised in writing to do so by the Trust. If necessary a warrant can be sought under Article 129 (2) of the Order to gain access to and remove the patient. Any person who assists a patient to leave hospital or obstructs those involved in gaining access to or returning the patient to hospital may be considered to have committed an offence under the Order. LINK TO OFFENCES SECTION.
When must the patient be discharged?
The Responsible Medical Officer has a duty to discharge the patient from detention if he is satisfied that the criteria are no longer met. This will follow consultation with the patient, the multidisciplinary team and the patient's family, including the nearest relative. In this instance, 'discharge' means discharge from detention. It does not mean that a person must leave hospital.
Article 14 of the Order directs that "a patient who is for the time being liable to be detained under this Part shall cease to be so liable if an order in writing discharging him from detention is made in respect of him by the Responsible Medical Officer (RMO), the responsible authority or his nearest relative".
The RMO should complete INTERNAL FORM 4 "Order of Discharge of Patient liable to be detained in hospital by RMO".
The patient may also be discharged following an application by the nearest relative or, following a decision by the Mental Health Review Tribunal or in some circumstances by the Trust.
An order to discharge cannot be made before the nearest relative gives notice in writing to the detaining Health and Social Care Trust. INTERNAL FORM 5. If the RMO then provides a written report to the Trust within 72 hours of this order in which he objects to the discharge, such a discharge cannot proceed. INTERNAL FORM 6
How should risks be managed on discharge from detention in hospital?
Assessment and management of risk begins at first presentation of the person/patient and is an integral part of a person's mental health assessment, treatment and discharge. The same principles apply whether a person is detained under the Order or not. Particular factors must be considered at discharge and local protocols and procedures have been developed in all Health and Social Care Trusts.
What should be done with all the Prescribed Forms/Reports used in the detention for assessment and treatment in hospital process?
All forms should be carefully completed. These are legal documents and
should be treated as such. Forms 7, 8, 9, 10, 11 and 12, also referred to
as "reports", must be furnished to and accepted by the detaining Health
and Social Care Trusts.
All Forms must also be copied and immediately forwarded to RQIA. LINK
TO Scrutiny and Rectification of Documents Appendix