Mental Health Bill [HL]

House of Commons

Session 2006 - 07
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Other Bills before Parliament

Mental Health Bill [HL]

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 3 — Safeguards for patients
19

(5)
Before giving a certificate under subsection (4) above the registered
medical practitioner concerned shall consult two other persons who
have been professionally concerned with the patient’s medical
treatment, and of those persons one shall be a nurse and the other shall
be neither a nurse nor a registered medical practitioner nor the
5
responsible clinician.
(6)
Before making any regulations for the purposes of this section, the
appropriate national authority shall consult such bodies as appear to it
to be concerned.
(7)
In this section—
10
(a)
a reference to an advance decision is to an advance decision
(within the meaning of the Mental Capacity Act 2005) made by
the patient;
(b)
“valid and applicable”, in relation to such a decision, means
valid and applicable to the treatment in question in accordance
15
with section 25 of that Act;
(c)
a reference to a donee is to a donee of a lasting power of attorney
(within the meaning of section 9 of that Act) created by the
patient, where the donee is acting within the scope of his
authority and in accordance with that Act; and
20
(d)
a reference to a deputy is to a deputy appointed for the patient
by the Court of Protection under section 16 of that Act, where
the deputy is acting within the scope of his authority and in
accordance with that Act.
(8)
In this section, “the appropriate national authority” means—
25
(a)
in a case where the treatment in question would, if given, be
given in England, the Secretary of State;
(b)
in a case where the treatment in question would, if given, be
given in Wales, the Welsh Ministers.”
31
Section 30: supplemental
30
(1)
Part 4 of the 1983 Act (consent to treatment) is amended as follows.
(2)
In section 58 (treatment requiring consent or a second opinion)—
(a)
in subsection (1)(b), after “section 57 above” insert “or section 58A(1)(b)
below”, and
(b)
in subsection (3)(b), before “has not consented to it” insert “being so
35
capable”.
(3)
In section 59 (plans of treatment), for “or 58” substitute “, 58 or 58A”.
(4)
In section 60 (withdrawal of consent), for “or 58”, substitute “, 58 or 58A”.
(5)
In section 61 (review of treatment)—
(a)
in subsection (1), for “or 58(3)(b)” substitute “, 58(3)(b) or 58A(4)”, and
40
(b)
in subsection (3)—
(i)
for “or 58(3)(b)” substitute “, 58(3)(b) or 58A(4)”, and
(ii)
for “and 58” substitute “, 58 and 58A”.
(6)
In section 62 (urgent treatment)—
(a)
in subsection (1), for “and 58” substitute “, 58 and 58A”, and
45

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
20

(b)
in subsection (2), for “or 58” substitute “, 58 or 58A”.
(7)
In section 63 (treatment not requiring consent), for “, not being treatment
falling within section 57 or 58 above,” substitute “, not being a form of
treatment to which section 57, 58 or 58A above applies,”.
Chapter 4
5
Supervised community treatment
32
Community treatment orders, etc
(1)
The 1983 Act is amended as follows.
(2)
After section 17 insert—
“17A
Community treatment orders
10
(1)
The responsible clinician may by order in writing discharge a detained
patient from hospital subject to his being liable to recall in accordance
with section 17E below.
(2)
A detained patient is a patient who is liable to be detained in a hospital
in pursuance of an application for admission for treatment.
15
(3)
An order under subsection (1) above is referred to in this Act as a
“community treatment order”.
(4)
The responsible clinician may not make a community treatment order
unless—
(a)
in his opinion, the relevant criteria are met;
20
(b)
if the responsible clinician is not a medical practitioner, the
responsible clinician has arranged for the patient to be
examined by—
(i)
the registered medical practitioner who has been
professionally concerned with the medical treatment of
25
the patient; or
(ii)
if no such practitioner is available, a registered medical
practitioner who is an approved clinician;

and the medical practitioner has made a written
recommendation in the prescribed form including a statement
30
that in the opinion of the practitioner the relevant criteria set out
in subsection (5) below are met; and
(c)
an approved mental health professional states in writing—
(i)
that he agrees with that opinion; and
(ii)
that it is appropriate to make the order.
35
(5)
The relevant criteria are—
(a)
the patient is suffering from mental disorder of a nature or
degree which makes it appropriate for him to receive medical
treatment;
(b)
except where a patient is detained under Part 3 of this Act (a
40
patient concerned in criminal proceedings or under sentence),
the patient’s ability to make decisions about the provision of

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
21

medical treatment is significantly impaired because of his
mental disorder;
(c)
it is necessary for the protection of others from serious harm
that he should receive treatment;
(d)
subject to his being liable to be recalled to hospital for medical
5
treatment, such treatment can be provided without his
continuing to be detained in a hospital and it cannot be
provided unless he is liable to be recalled to hospital;
(e)
the patient has, on at least one occasion previous to the present
admission under section 3, refused to accept medical treatment
10
for a mental disorder, and—
(i)
when appropriate medical treatment has been refused
there has been a significant relapse in his mental or
physical condition justifying compulsory admission to
hospital; and
15
(ii)
medical treatment following compulsory admission
alleviated or prevented a deterioration in his condition;
and
(f)
appropriate medical treatment is available for him.
(6)
In this Act—
20
“community patient” means a patient in respect of whom a
community treatment order is in force;
“the community treatment order”, in relation to such a patient,
means the community treatment order in force in respect of
him; and
25
“the responsible hospital”, in relation to such a patient, means the
hospital in which he was liable to be detained immediately
before the community treatment order was made, subject to
section 19A below.
17B
Conditions
30
(1)
A community treatment order shall specify conditions to which the
patient is to be subject while the order remains in force.
(2)
But the order may only specify conditions which the approved mental
health professional mentioned in section 17A(4)(c) above agrees should
be specified.
35
(3)
The conditions which may be specified include—
(a)
a condition that the patient reside at a particular place;
(b)
a condition that the patient make himself available at particular
times and places for the purposes of medical treatment;
(c)
a condition that the patient receive medical treatment in
40
accordance with the responsible clinician’s directions;
(d)
a condition that the patient make himself available for
examination (for the purposes, in particular, of section 20A(4)
below or of enabling a Part 4A certificate (within the meaning of
section 64H below) to be given in his case);
45
(e)
a condition that the patient abstain from particular conduct.
(4)
The responsible clinician may from time to time by order in writing
vary the conditions specified in a community treatment order.

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
22

(5)
He may also suspend any conditions specified in a community
treatment order.
(6)
If a community patient fails to comply with a condition specified in the
community treatment order, that fact may be taken into account for the
purposes of exercising the power of recall under section 17E(1) below.
5
(7)
But nothing in this section restricts the exercise of that power to cases
where there is such a failure.
17C
Duration of community treatment order
A community treatment order shall remain in force until—
(a)
the period mentioned in section 20A(1) below (as extended
10
under any provision of this Act) expires, but this is subject to
sections 21 and 22 below;
(b)
the patient is discharged in pursuance of an order under section
23 below or a direction under section 72 below;
(c)
the application for admission for treatment in respect of the
15
patient otherwise ceases to have effect; or
(d)
the order is revoked under section 17F below,
whichever occurs first.
17D
Effect of community treatment order
(1)
The application for admission for treatment in respect of a patient shall
20
not cease to have effect by virtue of his becoming a community patient.
(2)
But while he remains a community patient—
(a)
the authority of the managers to detain him under section 6(2)
above in pursuance of that application shall be suspended; and
(b)
reference (however expressed) in this or any other Act, or in any
25
subordinate legislation (within the meaning of the
Interpretation Act 1978), to patients liable to be detained, or
detained, under this Act shall not include him.
(3)
And section 20 below shall not apply to him while he remains a
community patient.
30
(4)
Accordingly, authority for his detention shall not expire during any
period in which that authority is suspended by virtue of subsection
(2)(a) above.
17E
Power to recall to hospital
(1)
The responsible clinician may recall a community patient to hospital if
35
in his opinion—
(a)
the patient requires medical treatment in hospital for his mental
disorder; and
(b)
there would be a risk of harm to the health or safety of the
patient or to other persons if the patient were not recalled to
40
hospital for that purpose.
(2)
The responsible clinician may also recall a community patient to
hospital if the patient fails to comply with a condition imposed under
section 17B(3)(d) above.

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
23

(3)
The hospital to which a patient is recalled need not be the responsible
hospital.
(4)
Nothing in this section prevents a patient from being recalled to a
hospital even though he is already in the hospital at the time when the
power of recall is exercised; references to recalling him shall be
5
construed accordingly.
(5)
The power of recall under subsections (1) and (2) above shall be
exercisable by notice in writing to the patient.
(6)
A notice under this section recalling a patient to hospital shall be
sufficient authority for the managers of that hospital to detain the
10
patient there in accordance with the provisions of this Act.
17F
Powers in respect of recalled patients
(1)
This section applies to a community patient who is detained in a
hospital by virtue of a notice recalling him there under section 17E
above.
15
(2)
The patient may be transferred to another hospital in such
circumstances and subject to such conditions as may be prescribed in
regulations made by the Secretary of State (if the hospital in which the
patient is detained is in England) or the Welsh Ministers (if that hospital
is in Wales).
20
(3)
If he is so transferred to another hospital, he shall be treated for the
purposes of this section (and section 17E above) as if the notice under
that section were a notice recalling him to that other hospital and as if
he had been detained there from the time when his detention in
hospital by virtue of the notice first began.
25
(4)
The responsible clinician may by order in writing revoke the
community treatment order if—
(a)
he is satisfied, in accordance with subsection (5) below, that the
conditions mentioned in section 3(2) above are satisfied in
respect of the patient; and
30
(b)
an approved mental health professional states in writing—
(i)
that he agrees with that opinion; and
(ii)
that it is appropriate to revoke the order.
(5)
If the responsible clinician is not a medical practitioner he shall arrange
for the patient to be examined by—
35
(a)
the registered medical practitioner who has been professionally
concerned with the medical treatment of the patient; or
(b)
if no such practitioner is available, a registered medical
practitioner who is an approved clinician; and

the medical practitioner shall, if he believes the conditions are met,
40
make the written recommendation in the prescribed form including a
statement that in the opinion of the practitioner the conditions set out
in section 3(2) above are complied with.
(6)
The responsible clinician may at any time release the patient under this
section, but not after the community treatment order has been revoked.
45
(7)
If the patient has not been released, nor the community treatment order
revoked, by the end of the period of 72 hours, he shall then be released.

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
24

(8)
But a patient who is released under this section remains subject to the
community treatment order.
(9)
In this section—
(a)
“the period of 72 hours” means the period of 72 hours beginning
with the time when the patient’s detention in hospital by virtue
5
of the notice under section 17E above begins; and
(b)
references to being released shall be construed as references to
being released from that detention (and accordingly from being
recalled to hospital).
17G
Effect of revoking community treatment order
10
(1)
This section applies if a community treatment order is revoked under
section 17F above in respect of a patient.
(2)
Section 6(2) above shall have effect as if the patient had never been
discharged from hospital by virtue of the community treatment order.
(3)
The provisions of this or any other Act relating to patients liable to be
15
detained (or detained) in pursuance of an application for admission for
treatment shall apply to the patient as they did before the community
treatment order was made, unless otherwise provided.
(4)
If, when the order is revoked, the patient is being detained in a hospital
other than the responsible hospital, the provisions of this Part of this
20
Act shall have effect as if—
(a)
the application for admission for treatment in respect of him
were an application for admission to that other hospital; and
(b)
he had been admitted to that other hospital at the time when he
was originally admitted in pursuance of the application.
25
(5)
But, in any case, section 20 below shall have effect as if the patient had
been admitted to hospital in pursuance of the application for admission
for treatment on the day on which the order is revoked.”
(3)
After section 20 (the cross-heading immediately above which becomes
“Duration of authority and discharge”) insert—
30
“20A
Community treatment period
(1)
Subject to the provisions of this Part of this Act, a community treatment
order shall cease to be in force on expiry of the period of six months
beginning with the day on which it was made.
(2)
That period is referred to in this Act as “the community treatment
35
period”.
(3)
The community treatment period may, unless the order has previously
ceased to be in force, be extended—
(a)
from its expiration for a period of six months;
(b)
from the expiration of any period of extension under paragraph
40
(a) above for a further period of one year,

and so on for periods of one year at a time.
(4)
Within the period of two months ending on the day on which the order
would cease to be in force in default of an extension under this section,
it shall be the duty of the responsible clinician—
45

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
25

(a)
to examine the patient; and
(b)
if it appears to him that the conditions set out in subsection (7)
below are satisfied, to furnish to the managers of the
responsible hospital a report, in the prescribed form, that in his
opinion the relevant conditions are met.
5
(5)
The responsible clinician may not furnish a report to the managers
unless—
(a)
an approved mental health professional states in writing—
(i)
that he agrees with the opinion of the responsible
clinician that the relevant conditions are met;
10
(ii)
that it is appropriate to make the order; and
(b)
if the responsible clinician is not a medical practitioner, a
medical practitioner, as provided in section 17F(5), has
examined the patient and as a result of the medical examination
it appears that the conditions mentioned in subsection (7) are
15
satisfied in respect of the patient.
(6)
Where such a report is furnished in respect of the patient, the managers
shall, unless they discharge him under section 23 below, cause him to
be informed.
(7)
The conditions referred to in subsection (4) above are that—
20
(a)
the patient is suffering from mental disorder of a nature or
degree which makes it appropriate for him to receive medical
treatment;
(b)
except where a patient is detained under Part 3 of this Act (a
patient concerned in criminal proceedings or under sentence),
25
the patient’s ability to make decisions about the provision of
medical treatment is significantly impaired because of his
mental disorder;
(c)
it is necessary for the protection of others from serious harm
that he should receive treatment;
30
(d)
subject to his being liable to be recalled to hospital for medical
treatment, such treatment can be provided without his
continuing to be detained in a hospital and it cannot be
provided unless he is liable to be recalled to hospital;
(e)
the patient has, on at least one occasion previous to the present
35
admission under section 3, refused to accept medical treatment
for a mental disorder, and—
(i)
when appropriate medical treatment has been refused
there has been a significant relapse in his mental or
physical condition justifying compulsory admission to
40
hospital; and
(ii)
medical treatment following compulsory admission
alleviated or prevented a deterioration in his condition;
and
(f)
appropriate medical treatment is available for him.
45
(8)
Before furnishing a report under subsection (4) above the responsible
clinician shall consult one or more other persons who have been
professionally concerned with the patient’s medical treatment.