DMH 19 Memorandum from The British Psychological
Society
General comments
The British Psychological Society is the learned
and professional body, incorporated by Royal Charter, for psychologists
in the United Kingdom. The Society has a total membership of over
40,000 and is a registered charity.
The key Charter object of the Society is "to
promote the advancement and diffusion of the knowledge of psychology
pure and applied and especially to promote the efficiency and
usefulness of members by setting up a high standard of professional
education and knowledge".
The Society is authorised under its Royal Charter
to maintain the Register of Chartered Psychologists. It has a
code of conduct and investigatory and disciplinary systems in
place to consider complaints of professional misconduct relating
to its members. The Society is an examining body granting certificates
and diplomas in specialist areas of professional applied psychology.
It also has in place quality assurance programmes for accrediting
both undergraduate and postgraduate university degree courses.
The Mental Health Act 1983 is clearly in need of
amendment. European Legislation, changes in the structure of the
National Health Service, changes in the roles of mental health
professionals, evolving professional opinions regarding mental
health care and improvements in therapeutic practice and theoretical
understanding all necessitate changes in legislation underpinning
mental health care.
The British Psychological Society welcomes, therefore,
the draft Bill. We also note the real changes made in the present
draft Bill in response to consultation, and welcome the consequent
improvements. The British Psychological Society considers that
progress has been made, but we also strongly believe that the
changes do not go far enough in reconciling the needs and rights
of service users in a Mental Health Bill for the 21st century.
The British Psychological Society, therefore, retains concerns
over many details of the present draft Bill, including key issues
regarding the definition of 'mental disorder' and the conditions
for compulsory treatment. These are detailed below.
Responses to points for consultation
1. Is the Draft Mental Health Bill rooted in a
set of unambiguous basic principles? Are these principles appropriate
and desirable?
The 'principles' referred to in Clause 1of the Draft
Bill are welcome. They are appropriate and desirable. They are
not, however, complete or unambiguous. The British Psychological
Society recommends that the principles are listed on the face
of the Bill (as with the Mental Capacity Bill, and in contrast
to being included in a Code of Practice) and strengthened - from
an aspirational statement for 'regard' to certain issues to a
requirement for all parties acting under the aegis of the legislation
to adhere to these principles. The British Psychological Society
also recommends, for reasons that will be made clear in further
comments below, that a further principle is included: that a person's
own choices about treatment (or lack of treatment) for mental
disorder should be honoured unless, because of a mental disorder,
the person's ability to make decisions about the provision of
health care is significantly impaired. We strongly believe that
such a principled amendment would improve the Bill. It would ensure
that the Bill is fully compatible with the Human Rights Act, the
Mental Capacity Bill and consonant with recent judicial rulings
in respect to capacity and medical treatment. We also believe
that such an amendment would make the Bill's provisions more (rather
than less) workable. Such an amendment could both reflect and
also help to clarify the main reason for the necessity for a Mental
Health Bill - because mental disorder can result in impaired judgement,
it is not always possible merely to leave treatment choices to
the individual. Finally, we believe that the Bill should also
be based on the principle of reciprocity - that any treatments
permitted by the legislation should be of genuine net therapeutic
benefit to the individual.
2. Is the definition of Mental Disorder appropriate
and unambiguous? Are the conditions for treatment and care under
compulsion sufficiently stringent? Are the provisions for assessment
and treatment in the Community adequate and sufficient?
The British Psychological Society appreciates the
benefits outlined in the Richardson Report of a broad definition
of mental disorder coupled with supplementary criteria for compulsion.
We welcome the revision to the definition of 'mental disorder'
in the present draft Bill, and in particular the implied reference
to impairment of psychological functioning. We believe this is
an improvement upon the (currently applicable) 1983 Mental Health
Act. Nevertheless, we believe that this definition remains too
broad in its scope. The definition of 'mental disorder' and its
appropriateness cannot be separated from the proposed conditions
for compulsion. It is necessary, therefore, that strict conditions
also apply.
The British Psychological Society very strongly recommends
that the conditions for compulsion are amended further to reflect
the principle that persons whose capacity to make decisions about
their health care is unimpaired should retain their right to decide
their own treatment. We recommend, therefore, that a further condition
be added - "that because of the mental disorder the patient's
ability to make decisions about the provision of such medical
treatment is significantly impaired". This wording appears
in the Mental Health (Care and Treatment) (Scotland) Act 2003.
We believe that this amendment is vital for two reasons.
First, while we welcome the Government's intention to reduce the
number of people subject to compulsion, and note that the definitions
and conditions in the present draft Bill are stricter than those
in the 1983 Mental Health Act, we remain concerned at their breadth.
With the removal of the exclusions (see below), the removal of
the 'treatability loophole', and the potential for compulsion
in the community, there still remains great potential for greatly
increased compulsion. This danger may be potentiated if, as many
believe, there is a developing culture of 'defensive practice'
where (for instance) practitioners may feel obliged to treat a
person under compulsion rather than run the risk of being blamed
for any future adverse incidents. Strict conditions must guard
against this eventuality. Secondly, we believe it is the impairment
of judgement that provides the ethical, professional and legal
basis for compulsion. We will expand on this point below, when
discussing the Human Rights Act.
We very strongly welcome the fact that the Bill is
based on a care plan (as opposed to the 1983 Act, which provides
for admission and then treatment in a very general sense). We
recognise that this fact, coupled with the specific provisions
of the draft Bill, allow for compulsory treatment in the community.
However, we also share the great concerns expressed by colleagues
in respect to this issue; that without robust controls this provision
could lead to excessive use of compulsory powers. We believe that
this excess could also fall disproportionately on people from
Black and ethnic minorities and other socially excluded groups
such as people in inner-city and socially deprived areas. On the
other hand, we also recognise that the present draft Bill reflects
substantial changes in this issue. The British Psychological Society
also notes that the possibility for care plans to be implemented
under compulsion in the community may offer a better 'least restrictive
alternative' than the present Act, which permits only admission.
We also note that such powers of compulsion in the community are
only lawful if the person involved continues to meet the conditions
for compulsion.
The British Psychological Society notes, however,
that care plans are most likely to be effective if they are based
on true collaboration between the patient and the care team. We
also note that appropriate alternative services must exist 'on
the ground' for the concept of a least restrictive alternative
to be a genuine one.
We therefore recommend that, in addition to the necessary
amendment to the conditions outlined above, further amendments
be made to limit the possibility of compulsion in the community
to people who more closely fit the 'revolving door' profile for
which the provisions are drafted. These amendments might follow
the approach taken in the Canadian Province of Saskatchewan. This
limits compulsion in the community to people who meet certain
specific clinical history profiles. It should be noted that such
a clinical history criterion would not only address the 'revolving
door' issue, but would also ensure that such community powers
could not be used in the case of people perceived to be dangerous
(but who are not classic 'revolving door' patients). This model
is compatible with the views of the British Psychological Society
in respect to public safety outlined below.
The British Psychological Society also has concerns
regarding the wording of the fifth condition - 'the fifth condition
is that medical treatment is available which is appropriate in
the patient's case, taking into account the nature or degree of
his mental disorder and all other circumstances in his case'.
We understand this to be a welcome recognition of the need for
reciprocity - ensuring that the proposed care plan is of therapeutic
benefit. We consider, however, this clause to be clumsy and difficult
to understand. As such, it may have the opposite effect to that
intended. That is, the complex and ambiguous wording may leave
clinicians believing that any and all treatments are appropriate,
rather than ensuring that they take care to plan only treatments
of therapeutic benefit. We have concerns that a 'bare minimum'
service will be the only one on offer, meaning that patients treated
under compulsion will be provided with services that may permit
lawful compulsion, but are of an objectively unacceptable standard.
Finally, the British Psychological Society strongly
regrets the decision not to retain the provisions that people
whose mental disorder is solely characterised by the drug or alcohol
use or by sexual deviance should be excluded from the provisions
of the Bill. We believe that allowing the mental health legislation
to be used in such cases, in the absence of other consequences
or concomitants of mental disorder, may permit disproportionate
and inappropriate compulsion. Moreover, we note that both in terms
of the provisions of the Human Rights Act, and in terms of existing
UK legislation, powers to deal with alcohol and drug abuse and
to deal with sexual crimes already exist. If it were felt that
additional powers are required, either for the protection or care
of individuals, or to protect society, there are routes other
than the distortion of the mental health legislation by which
these ends could be met.
3. Does the draft bill achieve the right balance
between protecting the personal and human rights of the mentally
ill on one hand, and concerns for public and personal safety on
the other?
The British Psychological Society remains concerned
that the draft Bill places undue emphasis on a misguided attempt
to assuage perceived (but largely illusory) public fears and thereby
threatens to undermine the human rights of people with mental
health problems. We recognise the need for Mental Health legislation
to protect the public from the very small number of people whose
mental disorder renders them dangerous. However, in our opinion,
such protection can be maintained with provisions similar to those
proposed, with the important inclusion of the 'Scottish clause'
('that because of the mental disorder the patient's ability to
make decisions about the provision of such medical treatment is
significantly impaired') referred to above.
This, we believe, is feasible and justified because
a) dangerous individuals are very rare, b) it is, in practice,
statistically impracticable validly to identify such people before
they have committed offences if they are not experiencing mental
disorders of a nature or kind as to render their decision-making
capacity impaired, c) there exist present and planned provisions
under criminal justice legislation that serve the same purpose
under judicial rather than medical process, d) such provisions
are presently under-utilised and e) we believe attempts to protect
society from such perceived threats in such a manner are incompatible
with the Human Rights Act. In particular, in this context, we
note the provisions of the Powers of Criminal Courts Act (1973),
which permit a Court to impose Community Rehabilitation Orders
including specified conditions of treatment under the supervision
of a chartered psychologist, but which are relatively seldom used.
We also note with concern a major assumption that
pervades the Bill, one that has potentially grave implications.
The Bill could be read as an enabling provision - permitting doctors
to care for people in the way they, the doctors, think best. The
conditions do not allow the competent patient to choose to reject
the doctor's advice, and they permit the development of a care
plan in worryingly broad terms. The British Psychological Society
does not believe that all judgements by all doctors are necessarily
correct or benevolent. We similarly, of course, believe that not
all judgements by all psychologists are necessarily correct or
benevolent. We recognise that decisions must be made on behalf
of people who cannot make valid decisions for themselves, but
the Bill should not presume that any powers devolved to professionals
would necessarily be of benefit to patients.
4. Are the proposals contained in the Draft Mental
Health Bill necessary, workable, efficient, and clear? Are there
any important omissions in the Bill?
The British Psychological Society recognises that
the Mental Health Bill itself is necessary. The British Psychological
Society very strongly welcomes the central premise of the Bill
- the implementation of care plans under compulsion. We believe
that this properly reflects the nature of modern mental health
care.
We also note that whether the Bill's provisions are
workable depends, in great part, on workforce considerations.
The present draft Bill contains new and welcome safeguards
(such as rights to advocacy and the substantially increased provisions
for Tribunals) that depend on proper staffing and training. The
draft Bill also states that compulsion is lawful only if there
is appropriate treatment available. In the short term, this may
lead to great pressure on clinicians - caught between the evident
needs of the patient, an unavailability of resources, legal, societal
or familial pressure for action, the rights of the individual
and the unlawfulness of inappropriate treatment. It
may be necessary to review the provisions in the draft Bill that
apply if compulsory treatment is indicated, but no appropriate
care is available. There are also potential large financial and
resource implications. We believe that the Scrutiny Committee
should consider in some detail the plans for implementing the
provisions of the Bill.
One important omission from the Bill is the provision
for patients to make binding statements of preference in respect
to future treatment. Such statements of informed choice by sound-minded
persons are clinically important and are part of the provisions
of the Mental Capacity Bill. The British Psychological Society
believes that there should a) be an obligation on clinicians to
draw up statements outlining the patients desires in relation
to future treatment and b) a duty on clinicians implementing the
Bill to adhere to them, or to derogate from them only under specified
circumstances which should be clearly recorded. This may best
be incorporated in respect to the duty to develop a 'clinically
appropriate' care plan incorporating 'all relevant factors'. These
relevant factors should also include other care plans developed
during consensual care. Although the Care Programme Approach care
plans are not legally binding, they should be relevant in order
to ensure good continuity of care.
5. Is the proposed institutional framework appropriate
and sufficient for the enforcement of measures contained in the
draft bill?
On balance, the British Psychological Society believes
that the abolition of the Mental Health Act Commission, and for
the transfer of responsibilities to CHAI, the Healthcare Commission,
is appropriate. On balance, we believe that the proposed responsibilities,
and the power of CHAI and the other authorities, are appropriate.
We welcome the increased functions, powers and remit of CHAI compared
to those of the present Mental Health Act Commission.
6. Are the safeguards against abuse adequate?
Are the safeguards in respect of particularly vulnerable groups,
for example children, sufficient? Are there enough safeguards
against misuse of aggressive procedures such as ECT and psychosurgery?
Although the British Psychological Society welcomes
the greater focus on safeguarding the well-being of children in
the present draft, and the amendments made to the provisions for
the compulsory treatment of prisoners, we believe that much greater
safeguards are necessary throughout. In particular, we believe
that the Bill should include a clear statement of the principles
upon which care plans should be based - for the proposed treatments
to be of proven efficacy, to be based on currently accepted professional
practice guidelines (eg the British National Formulary in respect
to drug regimes and guidelines from the National Institute for
Clinical Excellence) and for the therapeutic benefits to outweigh
the likely cost to the individual.
The British Psychological Society strongly believes
that a major safeguard against abuse, generally, would be the
adoption of an 'impaired judgement' condition as exists in Scotland
and as outlined above (point 2 above). More particularly, we view
the provisions against the misuse of what we think are correctly
termed 'aggressive procedures such as ECT and psychosurgery as
weak. The British Psychological Society believes that it is inappropriate,
unethical and indeed illegal (in terms of the Human Rights Act)
to provide for the compulsory treatment of people who are able
to make valid decisions about their health care. In physical care,
such decisions are not legal, and we believe the principle of
non-discrimination means that such decisions should not be taken
in the case of people with mental disorders.
This position becomes even more relevant where the
proposed treatment has the potential to harm or damage the individual's
brain. The draft Bill states that people who retain capacity should
not normally be given treatments such as ECT and psychosurgery.
But such treatments may still be given to capable persons 'in
emergencies'. The British Psychological Society questions the
notion of ECT being an immediately lifesaving treatment, when
compared with 24-hour one-to-one intensive care for instance.
The British Psychological Society believes that none of the provisions
of the draft Bill should apply to people who are not significantly
impaired in their ability to make decisions about their health
care. It follows that, for the aggressive procedures, the safeguards
should be even stronger. We believe that ECT, psychosurgery and
other such procedures should be prohibited for persons not able
to give informed consent. Given the nature of these procedures,
the British Psychological Society also recommends that such treatments
should be subject to the ratification of a Tribunal even if the
patients are able to give informed consent.
As mentioned below, the British Psychological Society
believes that there should be greater clarity regarding the nature
of the care plan. In particular, we believe that the Bill should
specify that clinicians are not permitted to draw up care plans
that deviate from accepted professional standards - ie that adhere
for instance to BNF guidelines for prescribing and the relevant
professional codes of professional behaviour.
We note that the Bill contains no offence related
to inappropriately using these provisions in respect to a person
who does not meet the relevant conditions, nor of negligently
investigating the relevant circumstances in this regard. We recommend
that consideration be given to this issue.
7. Is the balance struck between what has been
included on the face of the draft bill, and what goes into Regulations
and the Code of Practices right?
Although the British Psychological Society recognises
that not all matters should be in the text of the Bill, we believe
that the present draft omits important matters. Because the emphasis
on a care plan is central to the Bill, and is welcome, the British
Psychological Society believes that the Bill should clarify the
essential nature, scope and content of this care plan more closely.
The Bill, in essence, will render the care plan legally enforceable.
The British Psychological Society recognises the fact that the
present provisions for a care plan are more rigorously specified
than the current 1983 Mental Health Act. Nevertheless, we recommend
that the Bill be amended further to clarify the procedures that
the Clinical Supervisor must follow when drawing up a care plan,
which professionals must be consulted and be involved, what therapeutic
elements must be considered etc. We also believe that the Bill
should require clinicians to provide written reasons for their
actions (including their decisions not to do certain things).
We believe that there are some important details
of the process that are not yet clarified. In particular we believe
that greater clarity over the procedural duties of the Clinical
Supervisor in developing a care plan is required. We note that
it is possible for a Tribunal to impose changes to a care plan
after this has been prepared. We believe that this offers protection
to patients. Nevertheless, we are concerned that it may leave
Clinical Supervisors in the position of implementing care plans
that they believe are inappropriate. In such circumstances, we
recommend that the Bill (rather than the Code of Practice) should
specify that Clinical Supervisors could refuse to oversee care
plans that they consider inappropriate and that the Bill therefore
should contain provisions for the appointment of alternative Clinical
Supervisors.
8. Is the Draft Mental Health Bill adequately
integrated with the Mental Capacity Bill (as introduced in the
House of Commons on 17 July 2004)?
The present draft Mental Health Bill is not adequately
integrated with the Mental Capacity Bill. The legal aspects are
relatively clear - the Mental Capacity Bill excludes provisions
for treatment otherwise covered by the Mental Health Bill.
The British Psychological Society, however, believes
that - in contrast to the clear view of Government - both Bills
should address the needs of people whose ability to make decisions
for themselves is impaired by mental disorder. Thus the Mental
Capacity Bill effectively allows for proxy decision-making in
respect to decisions other than mental health care if the person
cannot make decisions for themselves. We believe that the Mental
Health Bill should allow for appropriate clinicians to provide
compulsory treatment if the person's mental disorder renders them
impaired in their ability to make valid decisions for themselves.
At present, the Mental Capacity Bill appears ethical,
lawful and necessary; the Mental Health Bill uses criteria that
leave the two Bills asymmetrical in their scope. This means that
the Mental Health Bill is discriminatory - people with physical
health problems are legally protected in their decision-making
autonomy (even if their decisions in this respect are bizarre
or life-threatening), people not subject to the Mental Capacity
Bill are similarly 'masters of their own fate'. The British Psychological
Society does not believe that people whose decision-making ability
is indeed impaired by mental disorder should be left to suffer
from the consequences of potentially irrational decisions. We
do believe that people who retain the ability to make un-impaired
decisions but who happen to have a mental disorder (that is, one
in four of the population) should have the same rights to decide
on the nature of their treatment as do people with physical illnesses.
We do not believe that the Mental Health Bill should
use the same definition of 'incapacity' as the Mental Capacity
Bill. This is because we recognise that people with mental disorder
can frequently make very clear and unambiguous decisions. We therefore
seek to distinguish an inability to make decisions from the impairment
in decision-making ensuing from mental disorder. But we do contend
that a condition such as that applicable in Scotland is necessary
for England and Wales. Because, in the case of mental disorder,
such impairment in decision-making is likely to be transient (reflecting
the natural course of mental disorders), continual reassessment
is necessary.
We note also, in this context, the issue of people
with learning disabilities who may also require psychiatric care.
We note that, because learning disability is a 'mental disorder'
in the terms of the Bill, people with such learning disabilities
already and always meet this first condition. This means that
there is potential for abuse in terms of becoming inappropriately
subject to the provisions of the Bill. The obvious vulnerability
of some people in this group in other respects should give cause
for additional concern. The British Psychological Society does
not believe that the Bill should exempt people with learning disabilities
from its provisions (for this would either exclude people from
the care they needed or involve inappropriate care with fewer
safeguards under the provisions of the Mental Capacity Bill).
But we do believe that the Bill should recognise the special needs
of people who meet the criteria for both Bills. The British Psychological
Society recommends that the Bill should include a provision to
invite a Special Visitor (in the terms of the Mental Capacity
Bill) to overview the applicability of the conditions and the
appropriateness of the care plan in the case of people who have
or are suspected to have a learning disability or who do or may
be deemed to lack capacity in the terms of the Mental Capacity
Bill. Again, it is worth noting that this exemplifies the distinction
between our recommended 'impaired judgement' condition for the
Mental Health Bill and the inability to make decisions referred
to in the Mental Capacity Bill. Nevertheless, we believe this
arrangement reflects the reality of the situation, is compatible
with the concept of 'unsound mind' (see below) and will ensure
proper compatibility between the two Bills.
9. Is the Draft Mental Health Bill in full compliance
with the Human Rights Act?
The present draft Mental Health Bill is not in full
compliance with the Human Rights Act.
Article 5 of the Human Rights Act states that "No
one shall be deprived of his liberty save in the following cases
and in accordance with a procedure prescribed by law". The
'following cases' include "persons of unsound mind".
While the British Psychological Society unreservedly welcomes
both the principles behind and the provisions of the Human Rights
Act, we believe that psychological science has a great deal to
offer in respect to the interpretation of the term 'unsound mind'.
We note that research and consequent understanding in this are
has advanced significantly in recent years
The British Psychological Society recognises that
the legal advice given to Government - and indeed the Scrutiny
Committee - may be that 'of unsound mind' can legitimately be
equated with meeting the conditions outlined in the Bill, and
specifically with meeting the definition of 'mental disorder'.
Indeed, we recognise that other European Governments have so interpreted
the phrase. Nevertheless, our submission, as the UK learned body
representing those scientists who study the functioning of the
human mind, is that one can only be considered 'of unsound mind',
in this context, if a person's mental disorder is of a 'nature
or kind' to make the person significantly impaired in their ability
to make valid decisions for themselves.
We note that many of the commonly-cited judgements
in the European Court of Human Rights date from some 30 years
ago, and are based on contemporaneous interpretations of Convention
Rights drafted in the 1940's. We also note that, in practice,
the opportunity to change mental health legislation comes once
in a generation. The British Psychological Society therefore believes
it is important to ensure that the present draft Mental Health
Bill reflects modern scientific knowledge of mental disorders,
and the implications of this understanding in Human Rights terms.
10. What are likely to be the human and financial
resource implications of the draft bill? What will be the effect
on the roles of professionals? Has the Government analysed the
effects of the Bill adequately, and will sufficient resources
be available to cover any costs arising from implementation of
the Bill?
We note the large human and financial resource implications
of the draft Bill. We recommend that the Scrutiny Committee seek
careful clarification that these issues will be properly addressed.
The Bill will have very major impacts on the roles
of many professionals. We welcome the emphasis on care planning,
and anticipate that the inclusion of care planning in the Bill
will lead to greater emphasis on this aspect of care in the wider
mental health service. We also note the fact that the Bill alters
the statutory duties of a number of professions. In particular
we note proposals to reform the role of the 'Responsible Medical
Officer'. The British Psychological Society welcomes the fact
that Chartered Psychologists might take Clinical Supervisor responsibilities.
We note, however, that this is a very significant change in the
responsibilities of psychologists. The British Psychological Society
recommends that the Government support both in principle and in
financial terms the training that will be required in enabling
psychologists to undertake such extended roles and responsibilities.
The British Psychological Society recommends that
the Scrutiny Committee consider ways in which the Bill, the Code
of Practice and the plans for implementation of the legislation
address the competencies required of Clinical Supervisors. The
possibility that psychologists may become Clinical Supervisors
has led to significant debate within the profession. Many psychologists
welcome the proposal, but others wish to play no role in compulsion
and are concerned about the impact of these changes on our therapeutic
relationships. Others feel that these proposals, in the context
of the present draft provisions, threaten the basic values underpinning
their practice. Many psychologists do not wish, personally, to
exercise these powers, but recognise that there are potential
benefits to these proposals so long as proper professional safeguards
are in place. Many senior and experienced psychologists see themselves
as having the high-level skills in assessment and treatment that
would equip them suitably for the Clinical Supervisor role, especially
when the principal mode of treatment will be a psychological intervention.
Psychologists eligible to be clinical supervisors
should be Chartered Psychologists (or psychologists eligible for
chartered status) with appropriate competencies, experience and
seniority. The British Psychological Society recommends that there
be a requirement for additional training to contextualise and
extend existing competencies. Appropriate competencies for such
individuals should include (but not be limited to): psychopathology,
mental health law, mental health services, forensic service, risk
assessment, care planning, clinical governance, supervision and
management, psychological formulations and psychopharmacology.
To reflect the concerns of many in our profession outlined above,
the threshold for registration or approval should be set high.
The British Psychological Society recommends that
the Scrutiny Committee consider ways in which the Bill, the Code
of Practice and the plans for implementation of the legislation
address the nature of training necessary in this regard. We would
welcome detailed plans for such training, and recommend that such
training be generic - ie that all Clinical Supervisors, whether
psychologists, psychiatrists or members of other professions,
should be subject to the same requirements for training and levels
of competency.
We note that, both in the choice of most appropriate
Clinical Supervisor and in the selection of an Expert Member of
a Tribunal, there is ambiguity. We would recommend that the Bill
better clarifies this issue. This may best be achieved through
an additional element in Section 24 of the draft stating that
the managers, when appointing a Clinical Supervisor, should have
regard to all relevant circumstances, including the nature of
the mental disorder, the likely nature of the care plan to be
developed, and the professional training and competencies of the
clinician, before appointing the Clinical Supervisor. It is also
important to note that, particularly for psychologists, adoption
of the Clinical Supervisor role may lead to conflicts between
the imposition of coercion and the therapeutic role.
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