Newly revised Mental Health Act 1983 Code of Practice
On 3 October 2016, a newly revised Mental Health Act 1983 Code of Practice (the Code) will come into force in Wales, providing updated guidance to mental health professionals. This follows the introduction of a similar updated code for England in January. Like its predecessor, the Code will provide statutory 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.
In addition, the code will also provide non-statutory guidance to the police, ambulance service and others in the health and social services involved in the commissioning or providing services to people who are, or may become, subject to compulsory measures under the Act.
The new Code takes account of the changes to relevant legislation since the previous Code was written. In particular, the requirements in the Mental Health (Wales) Measure 2010, with regards to care and treatment planning, and also, the relationship between the 1983 Act, the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
The Code was prepared in collaboration with members of the Welsh Government’s Mental Health Act 1983 Code of Practice steering group. The group represented mental health stakeholders in Wales, and included service users, carers, third sector organisations and mental health professionals. A relatively modest 51 responses were received to the consultation which informed the latest version of the Code.
Within the Code there is strengthened emphasis on:
- the involvement of patients and, where appropriate, their families and carers in all aspects of assessment and treatment
- understanding the principles of the Mental Capacity Act 2005 and how these should apply to all care and treatment
- the involvement of Independent Mental Health Advocates
- the use of appropriate transport for patient subject to the 1983 Act to ensure their dignity and safety as far as is practicable.
The code also reiterates that the 1983 Act provides a limit of 72 hours for detention under section 136 and that assessments should only take place in a police station in exceptional circumstances. In addition, the code proposes that, in any case, assessments should be undertaken within 3 hours and that detention in a police station should not exceed a maximum of 12 hours.
In addition to this, in much the same way as the English code introduced a set of 5 overarching guiding principles, the Welsh Code used this as a blueprint to establish the following principles which should always be considered when making decisions about a course of action under the 1983 Act:
- Dignity and respect
- Emphasising that practitioners performing functions under the Act should respect the rights and dignity of patients and their families and carers, while also ensuring their safety and that of others.
- Least restrictive option and maximising independence
- This ensures that services should be provided in line with the presumption of capacity, be the least restrictive option, serve a person’s best interests and maximise independence.
- Fairness, equality and equity
- There must be no unlawful discrimination and reasonable adjustments must be made. Individuals’ protected characteristics should be taken into account and good practice followed in all aspects of care and treatment planning and implementation.
- Empowerment and involvement
- Where assessment under the Act is required, patients should be empowered to be as fully involved in the assessment process as possible.
- Keeping people safe
- Patient well-being and safety should be at the heart of all decision-making under the Act.
- Effectiveness and efficiency
- Anyone made subject to compulsion under the Act must be provided with appropriate assessment and/or treatment and care, the purpose of which should be: to establish the presence of; to alleviate; to minimise the harm caused by; or prevent a worsening of, their mental disorder, or any of its symptoms or manifestations.
The Code makes it clear that all guiding principles are of equal importance, and should inform any decision made under the Act. The weight given to each principle in reaching a particular decision will need to be balanced in different ways according to the circumstances and nature of each particular decision.
To ensure a seamless transition to the new Code for users, here is a useful table cross-referencing the chapters in the previous code to the corresponding updated chapters. Most chapters are replicated in substance, however, some previous substantive chapters have been subsumed as segments of new chapter headings and some have no discernible specific destination in the new code:
|Previous Code||New Code|
|No.||Previous Chapter Title||New Chapter
|1.||Guiding Principles||Guiding Principles||1|
|2.||Considering admission to hospital or guardianship||Leave of absence, a community treatment order or guardianship?||31|
|3.||Conflicts of Interest||Conflicts of Interest||39|
|4.||Appropriate Medical treatment||Appropriate Medical treatment||23|
|5.||Admissions to hospital under Part 2||No dedicated chapter – various references throughout|
|7.||Places of safety and police powers||Police powers and places of safety||16|
|9.||Conveyance of Patients||Transport of Patients||17|
|10.||Receipt and Scrutiny of prescribed forms||Receipt and scrutiny of documents||35|
|11.||Duties of hospital managers||Duties of hospital managers||37|
|12.||Function of responsible clinician and approved clinicians||Allocation or changing a responsible clinician||36|
|13.||Interface between the Mental Health Act and the Mental Capacity Act 2005||Relationship between the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards||13|
|14.||Care and treatment Planning||Care and treatment Planning||34|
|15.||Advance statements of wishes and feelings||Views expressed in advance||9|
|16.||Capacity, competence and consent||No dedicated chapter – various references throughout|
|17.||Medical treatment under the Act||Medical treatment||24|
|Second opinions||No dedicated chapter – appears under 'Treatments subject to special rules and procedures||25.6 – 25.18|
|19.||Managing behaviours that challenge||Safe and therapeutic responses to challenging behaviour||26|
|20.||Visiting patients in hospital||Visiting patients in hospital||11|
|Personal Searches||No dedicated chapter – appears under 'Privacy, dignity and safety'||8.35 – 8.47|
|22||Information for patients and nearest relatives||Information for patients, nearest relatives, families, carers and others||4|
|23||The nearest relative||Nearest Relative||5|
|24.||Involvement of carers||No dedicated chapter – appears under 'Information for patients, nearest relatives, families, carers and others'|
|25.||Independent mental health advocacy||Independent mental health advocacy||6|
|26.||The mental health tribunal for Wales||The mental health tribunal for Wales||12|
|27.||The hospital managers' power of discharge (section 23)||Hospital managers' discharge power||38|
|28.||Leave of absence from hospital||Leave of absence||27|
|29.||Absence Without Leave||Absence Without Leave||28|
|30.||Supervised Community-treatment||Community Treatment Orders||29|
|32.||Assessment, admission and discharge||No dedicated chapter|
|33.||Children and young people under||Children and young people under||19|
|the age of 18||the age of 18|
|34.||People with learning disabilities and||People with learning disabilities and||20|
|autistic spectrum disorder||autistic spectrum disorder|
For further information or advice on mental health issues, please contact Eve Piffaretti.