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 4 — Supervised community treatment
26

(9)
Where a report is duly furnished under subsection (4) above, the
community treatment period shall be thereby extended for the period
prescribed in that case by subsection (3) above.
20B
Effect of expiry of community treatment order
(1)
A community patient shall be deemed to be discharged absolutely from
5
liability to recall under this Part of this Act, and the application for
admission for treatment cease to have effect, on expiry of the
community treatment order, if the order has not previously ceased to
be in force.
(2)
For the purposes of subsection (1) above, a community treatment order
10
expires on expiry of the community treatment period as extended
under this Part of this Act, but this is subject to sections 21 and 22
below.”
(4)
Schedules 3 and 4 (which contain further amendments) have effect.
33
Relationship with leave of absence
15
(1)
The 1983 Act is amended as follows.
(2)
In section 17 (leave of absence from hospital), after subsection (2) insert—
“(2A)
But longer-term leave may not be granted to a patient unless the
responsible clinician first considers whether the patient should be dealt
with under section 17A instead.
20
(2B)
For these purposes, longer-term leave is granted to a patient if—
(a)
leave of absence is granted to him under this section either
indefinitely or for a specified period of more than seven
consecutive days; or
(b)
a specified period is extended under this section such that the
25
total period for which leave of absence will have been granted
to him under this section exceeds seven consecutive days.”
(3)
In Part 2 of Schedule 1 (patients subject to special restrictions), in paragraph 3
after paragraph (a) insert—
“(aa)
subsections (2A) and (2B) shall be omitted;”.
30
34
Consent to treatment
(1)
Part 4 of the 1983 Act (consent to treatment) is amended as follows.
(2)
For section 56 substitute—
“56
Patients to whom Part 4 applies
(1)
Section 57 and, so far as relevant to that section, sections 59 to 62 below
35
apply to any patient.
(2)
Subject to that, this Part of this Act applies to a patient only if he falls
within subsection (3) or (4) below.
(3)
A patient falls within this subsection if he is liable to be detained under
this Act but not if—
40

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
27

(a)
he is so liable by virtue of an emergency application and the
second medical recommendation referred to in section 4(4)(a)
above has not been given and received;
(b)
he is so liable by virtue of section 5(2) or (4) or 35 above or
section 135 or 136 below or by virtue of a direction under section
5
37(4) above; or
(c)
he has been conditionally discharged under section 42(2) above
or section 73 or 74 below and he is not recalled to hospital.
(4)
A patient falls within this subsection if—
(a)
he is a community patient; and
10
(b)
he is recalled to hospital under section 17E above.”
(3)
In section 61 (review of treatment), in subsection (1)—
(a)
before “a report on” insert “, or by virtue of section 62A below in
accordance with a Part 4A certificate (within the meaning of that
section),”, and
15
(b)
in paragraph (a) for “or 21B(2) above renewing the authority for the
detention” substitute “, 20A(4) or 21B(2) above in respect”.
(4)
After section 62 insert—
“62A
Treatment on recall of community patient or revocation of order
(1)
This section applies where—
20
(a)
a community patient is recalled to hospital under section 17E
above; or
(b)
a patient is liable to be detained under this Act following the
revocation of a community treatment order under section 17F
above in respect of him.
25
(2)
For the purposes of section 58(1)(b) above, the patient is to be treated as
if he had remained liable to be detained since the making of the
community treatment order.
(3)
But section 58 above does not apply to treatment given to the patient
if—
30
(a)
the certificate requirement is met (within the meaning of section
64C below); or
(b)
as a result of section 64B(4) or 64E(4) below, the certificate
requirement would not apply (were the patient a community
patient not recalled to hospital under section 17E above).
35
(4)
In a case where this section applies, the certificate requirement is met
only in so far as—
(a)
the Part 4A certificate expressly provides that it is appropriate
for one or more specified forms of treatment to be given to the
patient in that case (subject to such conditions as may be
40
specified); or
(b)
a notice having been given under subsection (4) of section 64H
below, treatment is authorised by virtue of subsection (7) of that
section.
(5)
Subsection (4)(a) above shall not preclude the continuation of any
45
treatment, or of treatment under any plan, pending compliance with
section 58 above if the approved clinician in charge of the treatment

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
28

considers that the discontinuance of the treatment, or of the treatment
under the plan, would cause serious suffering to the patient.
(6)
In a case where subsection (1)(b) above applies, subsection (3) above
only applies pending compliance with section 58 above.
(7)
In subsection (4) above—
5
“Part 4A certificate” has the meaning given in section 64H below;
and
“specified”, in relation to a Part 4A certificate, means specified in
the certificate.”
35
Authority to treat
10
(1)
After Part 4 of the 1983 Act, insert the following Part—
“Part 4A
Treatment of community patients not recalled to hospital
64A
Meaning of “relevant treatment”
In this Part of this Act “relevant treatment”, in relation to a patient,
15
means medical treatment which—
(a)
is for the mental disorder from which the patient is suffering;
and
(b)
is not a form of treatment to which section 57 or 58A above
applies.
20
64B
Adult community patients
(1)
This section applies to the giving of relevant treatment to a community
patient who—
(a)
is not recalled to hospital under section 17E above; and
(b)
has attained the age of 16 years.
25
(2)
The treatment may not be given to the patient unless—
(a)
there is authority to give it to him; and
(b)
if it is section 58 type treatment, the certificate requirement is
met.
(3)
But the certificate requirement does not apply if—
30
(a)
giving the treatment to the patient is authorised in accordance
with section 64G below; or
(b)
the treatment is immediately necessary and—
(i)
the patient has capacity to consent to it and does consent
to it; or
35
(ii)
a donee or deputy or the Court of Protection consents to
the treatment on the patient’s behalf.
(4)
Nor does the certificate requirement apply in so far as the
administration of medicine to the patient at any time during the period
of one month beginning with the day on which the community
40
treatment order is made is section 58 type treatment.

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
29

(5)
The reference in subsection (4) above to the administration of medicine
does not include any form of treatment specified under section 58(1)(a)
above.
64C
Section 64B: supplemental
(1)
This section has effect for the purposes of section 64B above.
5
(2)
There is authority to give treatment to a patient if—
(a)
he has capacity to consent to it and does consent to it;
(b)
a donee or deputy or the Court of Protection consents to it on his
behalf; or
(c)
giving it to him is authorised in accordance with section 64D or
10
64G below.
(3)
Relevant treatment is section 58 type treatment if, at the time when it is
given to the patient, section 58 above would have applied to it, had the
patient remained liable to be detained at that time (rather than being a
community patient).
15
(4)
The certificate requirement is met in respect of treatment to be given to
a patient if—
(a)
a registered medical practitioner appointed for the purposes of
Part 4 of this Act (not being the approved clinician in charge of
the treatment) has certified in writing that it is appropriate for
20
the treatment to be given or for the treatment to be given subject
to such conditions as may be specified in the certificate; and
(b)
if conditions are so specified, the conditions are satisfied.
(5)
Treatment is immediately necessary if—
(a)
it is immediately necessary to save the patient’s life; or
25
(b)
it is immediately necessary to prevent a serious deterioration of
the patient’s condition and is not irreversible; or
(c)
it is immediately necessary to alleviate serious suffering by the
patient and is not irreversible or hazardous; or
(d)
it is immediately necessary, represents the minimum
30
interference necessary to prevent the patient from behaving
violently or being a danger to himself or others and is not
irreversible or hazardous.
(6)
Subsection (3) of section 62 above applies for the purposes of this
section as it applies for the purposes of that section.
35
64D
Adult community patients lacking capacity
(1)
A person is authorised to give relevant treatment to a patient as
mentioned in section 64C(2)(c) above if the conditions in subsections (2)
to (6) below are met.
(2)
The first condition is that, before giving the treatment, the person takes
40
reasonable steps to establish whether the patient lacks capacity to
consent to the treatment.
(3)
The second condition is that, when giving the treatment, he reasonably
believes that the patient lacks capacity to consent to it.
(4)
The third condition is that—
45

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
30

(a)
he has no reason to believe that the patient objects to being
given the treatment; or
(b)
he does have reason to believe that the patient so objects, but it
is not necessary to use force against the patient in order to give
the treatment.
5
(5)
The fourth condition is that—
(a)
he is the approved clinician in charge of the treatment; or
(b)
the treatment is given under the direction of that clinician.
(6)
The fifth condition is that giving the treatment does not conflict with—
(a)
an advance decision which he is satisfied is valid and
10
applicable; or
(b)
a decision made by a donee or deputy or the Court of
Protection.
(7)
In this section—
(a)
reference to an advance decision is to an advance decision
15
(within the meaning of the Mental Capacity Act 2005) made by
the patient; and
(b)
“valid and applicable”, in relation to such a decision, means
valid and applicable to the treatment in question in accordance
with section 25 of that Act.
20
64E
Child community patients
(1)
This section applies to the giving of relevant treatment to a community
patient who—
(a)
is not recalled to hospital under section 17E above; and
(b)
has not attained the age of 16 years.
25
(2)
The treatment may not be given to the patient unless—
(a)
there is authority to give it to him; and
(b)
if it is section 58 type treatment, the certificate requirement is
met.
(3)
But the certificate requirement does not apply if—
30
(a)
giving the treatment to the patient is authorised in accordance
with section 64G below; or
(b)
in a case where the patient is competent to consent to the
treatment and does consent to it, the treatment is immediately
necessary.
35
(4)
Nor does the certificate requirement apply in so far as the
administration of medicine to the patient at any time during the period
of one month beginning with the day on which the community
treatment order is made is section 58 type treatment.
(5)
The reference in subsection (4) above to the administration of medicine
40
does not include any form of treatment specified under section 58(1)(a)
above.
(6)
For the purposes of subsection (2)(a) above, there is authority to give
treatment to a patient if—
(a)
he is competent to consent to it and he does consent to it; or
45

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
31

(b)
giving it to him is authorised in accordance with section 64F or
64G below.
(7)
Subsections (3) to (6) of section 64C above have effect for the purposes
of this section as they have effect for the purposes of section 64B above.
(8)
Regulations made by virtue of section 32(2)(d) above apply for the
5
purposes of this section as they apply for the purposes of Part 2 of this
Act.
64F
Child community patients lacking competence
(1)
A person is authorised to give relevant treatment to a patient as
mentioned in section 64E(6)(b) above if the conditions in subsections (2)
10
to (5) below are met.
(2)
The first condition is that, before giving the treatment, the person takes
reasonable steps to establish whether the patient is competent to
consent to the treatment.
(3)
The second condition is that, when giving the treatment, he reasonably
15
believes that the patient is not competent to consent to it.
(4)
The third condition is that—
(a)
he has no reason to believe that the patient objects to being
given the treatment; or
(b)
he does have reason to believe that the patient so objects, but it
20
is not necessary to use force against the patient in order to give
the treatment.
(5)
The fourth condition is that—
(a)
he is the approved clinician in charge of the treatment; or
(b)
the treatment is given under the direction of that clinician.
25
64G
Emergency treatment for patients lacking capacity or competence
(1)
A person is also authorised to give relevant treatment to a patient as
mentioned in section 64C(2)(c) or 64E(6)(b) above if the conditions in
subsections (2) to (4) below are met.
(2)
The first condition is that, when giving the treatment, the person
30
reasonably believes that the patient lacks capacity to consent to it or, as
the case may be, is not competent to consent to it.
(3)
The second condition is that the treatment—
(a)
is immediately necessary to save the patient’s life; or
(b)
is immediately necessary to prevent a serious deterioration of
35
the patient’s condition and is not irreversible; or
(c)
is immediately necessary to alleviate serious suffering by the
patient and is not irreversible or hazardous; or
(d)
is immediately necessary, represents the minimum interference
necessary to prevent the patient from behaving violently or
40
being a danger to himself or others and is not irreversible or
hazardous.
(4)
The third condition is that if it is necessary to use force against the
patient in order to give the treatment—

Mental Health Bill [HL]
Part 1 — Amendments to Mental Health Act 1983
Chapter 4 — Supervised community treatment
32

(a)
the treatment needs to be given in order to prevent harm to the
patient; and
(b)
the use of such force is a proportionate response to the
likelihood of the patient’s suffering harm, and to the
seriousness of that harm.
5
(5)
Subsection (3) of section 62 above applies for the purposes of this
section as it applies for the purposes of that section.
64H
Certificates: supplementary provisions
(1)
A certificate under section 64B(2)(b) or 64E(2)(b) above (a “Part 4A
certificate”) may relate to a plan of treatment under which the patient
10
is to be given (whether within a specified period or otherwise) one or
more forms of section 58 type treatment.
(2)
A Part 4A certificate shall be in such form as may be prescribed by
regulations made by the appropriate national authority.
(3)
Before giving a Part 4A certificate, the registered medical practitioner
15
concerned shall consult two other persons who have been
professionally concerned with the patient’s medical treatment but, of
those persons—
(a)
at least one shall be a person who is not a registered medical
practitioner; and
20
(b)
neither shall be the patient’s responsible clinician.
(4)
The appropriate national authority may at any time give notice
directing that a Part 4A certificate shall not apply to treatment given to
a patient after a date specified in the notice, and the relevant section
shall then apply to any such treatment as if that certificate had not been
25
given.
(5)
The relevant section is—
(a)
if the patient is not recalled to hospital in accordance with
section 17E above, section 64B or 64E above;
(b)
if the patient is so recalled or is liable to be detained under this
30
Act following revocation of the community treatment order
under section 17F above, section 58 above (subject to section
62A(2) above).
(6)
The notice under subsection (4) above shall be given to the approved
clinician in charge of the treatment in question.
35
(7)
Subsection (4) above shall not preclude the continuation of any
treatment or of treatment under any plan pending compliance with the
relevant section if the approved clinician in charge of the treatment
considers that the discontinuance of the treatment or of treatment
under the plan would cause serious suffering to the patient.
40
(8)
In this section, “the appropriate national authority” means—
(a)
in relation to community patients in respect of whom the
responsible hospital is in England, the Secretary of State;
(b)
in relation to community patients in respect of whom the
responsible hospital is in Wales, the Welsh Ministers.
45