Decoding? What’s new in the Mental Health Act 1983 Code of Practice (2015)
Last week, the revised Mental Health Act 1983 Code of Practice (the Code) was published, providing updated guidance to mental health professionals. The Code provides guidance on how professionals can ensure that their roles and responsibilities under the Mental Health Act 1983 (the 1983 Act) are carried out in a manner that ensures the delivery of safe and high quality care to patients.
The Government consulted widely on the Code, receiving approximately 350 responses, which have informed the latest version of the Code. A key aim of the code is to ensure that patients (and, where appropriate, their carers and families) are involved in discussions about their care, and are provided with personalised care. The Code has also be updated to reflect a number of significant legislative, common law, and policy changes since the previous version was published in 2008.
The Code has wide-ranging application; it applies to the care and treatment of all patients in England who are subject to the exercise of powers and duties under the Act. The Code notes that the 1983 Act “affects the lives and liberty of many people, impacting upon them, their families and community. In 2013-14 there were more than 53,000 detentions in England under the Act.” (1)
While the Act also applies to Wales, Wales has its own Code of Practice that applies in Wales only. The Welsh Government is currently reviewing the Welsh code of practice, and a revised version is due to be published later this year.
Subject to parliamentary approval, the Code will come into force on 1 April 2015. The Code provides statutory guidance for registered medical practitioners and other professionals in relation to the medical treatment of patients suffering from mental disorders.
- The introduction of five new overarching principles (see further below), which should always be considered when taking decisions on matters covered by the Act. Although each of the principles is of equal importance the weight given to each principle in reaching a particular decision will vary depending on the context and nature of the decision being made
- Additional chapters on equality and health inequalities, care planning, and human rights
- New guidance on when to use the 1983 Act and when to use the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).
Patient objects to:
Patient does not object to:
|Patient has capacity to consent||Only the 1983 Act is available||
The 1983 Act is available.
Informal admission is also available.
Neither DoLs authorisation nor a Court of Protection order is available.
|Patient lacks capacity to consent||Only the 1983 Act is available||
The 1983 Act is available.
DoLs authorisation and a Court of Protection order are available.
- Additional guidance on blanket restrictions; immigration detainees; supporting patients (including young people) with autism and learning disabilities; supporting patients with dementia; and physical health care
- Revisions to the chapters on restrictive interventions (including seclusion and long-term segregation) – see also the first of the overarching principles below.
The overarching principles
- Least restrictive option and maximising independence
Where a patient can be treated safely and lawfully without detention under the 1983 Act, the Code is clear: the patient should not be detained. Wherever possible, the focus should be on promoting the patient’s recovery and independence.
- Empowerment and involvement
Patients should be fully involved in decisions about their treatment, care and support, and able to participate in decision-making as far as they can. Where appropriate, the views of the patient’s family and carers should also be considered.
A patient’s views, wishes and feelings (including present, past and those expressed in advance) should be considered so far as they can be ascertained. With this in mind, the Code encourages professionals to support patients to develop advance statements of their feelings and wishes so that, during periods of wellness, they may express views about their future treatment and care.
- Respect and dignity
Not only should patients be treated with respect and dignity but these principles should also apply to the treatment of their families and carers.
- Purpose and effectiveness
Decisions about a patient’s care should:
- have clear therapeutic aim;
- promote recovery;
- be performed to current national and/or best practice guidelines.
- Efficiency and equity
The organisations involved in providing care and treatment to patients should work together to ensure that mental healthcare services are of high quality and are given equal priority to both physical health and social care services.
1. While the Act also applies to Wales, Wales has its own Code of Practice that applies in Wales only. The Welsh Government is currently reviewing the Welsh code of practice, and a revised version is due to be published later this year.