Memorandum submitted by the College of Occupational Therapists (MH 60)

The College of Occupational Therapists (COT) is the professional body for occupational therapists in the UK. The organisation has more than 28,000 members, including students and support staff. COTSS-MH (the College's Specialist Section for mental health) represents the mental health membership of COT and here expresses the views of that membership.

Whilst we accept and applaud the majority of the amendments recently made by the Lords to the Mental Health Bill we hold significant concerns relating specifically to the amendment relating to the role of Responsible Clinician.


In maintaining that the Responsible Clinician must be a Psychiatrist this legislation continues to support archaic practice. It does not reflect the level of skill in the existing and future workforce or even current multidisciplinary working practice with shared decision-making, risk assessing and positive risk management as underpinned by New Ways of Working (DoH, 2007; DoH 2004). It is understood that any legislation that deprives an individual of his liberty should be ECHR compliant and that this is the primary rationale for the amendment, however we believe that has been insufficient consideration to alternative means of ensuring that the Mental Health Bill is ECHR compliant and reflective of the workforce, competencies and skills that underpin the option of opening the role of the Responsible Clinician to the five core mental health professions.


It is our understanding that the concern of the Lords is that to have a mental health professional other than a Psychiatrist to make the decisions relating to renewal and discharge will not be compliant with ECHR as demonstrated by the Winterwerp ruling (Winterwerp V. the Netherlands 1979).


There are robust governance safeguards in place at the point of initial detention. They exist at the point of conversion from assessment to treatment, and transfer between treatment orders. However, these appear to be lacking at the point of renewal and, equally, they are lacking at the point of discharging an individual from detention from assessment or treatment.


It is the lack of safeguards at these points that appear to prevent mental health professionals other than Psychiatrists from being Responsible Clinicians. We would therefore respectfully request that the safeguards at these points of significant decision making are reviewed, in-order to enable Occupational Therapists and other mental health professionals with the requisite competencies and training to take up the role of the Responsible Clinician.


We would instead propose that an assessment which is equitable to that of the initial detention should occur as a part of the renewal process, so allowing a medical opinion to be expressed, and that as an integral part of the discharge process there should be a requirement for a recorded multidisciplinary discussion, which must include a Psychiatrist who is qualified to act as a Responsible Clinician.


The current and predicted workforce is insufficient to meet the current and projected needs of service users. To extend the Responsible Clinician role to Occupational Therapists and other mental health professional goes some way to addressing this workforce issue.


In the recent National Strategy for Occupational Therapy in Mental Health Services document, (Recovering Ordinary Lives, The Strategy for Occupational Therapy in Mental Health Services 2007-2017, College of Occupational Therapists 2006) users of mental health services and their families called for a greater role for occupational therapists in providing the care they receive, as Occupational Therapists are perceived by service users as being more abreast of the issues affecting them than other practitioners.


To summarise, the inherent risk of allowing one professional to make such onerous decisions which could deprive an individual of his liberty or discharge him from care without regard to other professionals' opinions, as supported by the Lords amendment, has been clearly demonstrated in numerous enquires.

The option proposed by COT assists in both managing risk for the individual, the public and the professional in a safe, but not risk-averse manner. It has the additional benefit of accessing skills that are most appropriate to meet the services users' needs for care and treatment from a workforce that is drawn on the basis of competency, not professional elitism, and is delivered by a workforce that has a critical mass large enough to meet demand appropriately.


April 2007