Hospital Managers’ Hearings - bcpft.nhs.uk

MHA SOP 4 Hospital Managers’ Hearings Page 1 of 14 Version 2.2 Oct 2019

Standard Operating Procedure (SOP 4)

Hospital Managers’ Hearings

Why we have a procedure?

The powers to review detention are conferred by the Mental Health Act upon ‘Hospital Managers’. They have the key responsibility for ensuring the requirements of the Act are followed. In particular, they must ensure that patients are detained only as the Act allows, that their treatment and care fully accord with its provisions, and patients are fully informed of, and supported in, exercising their statutory rights. In England, NHS hospitals are managed by NHS trusts and NHS foundation trusts. For these hospitals, the trusts themselves are defined as the ‘hospital managers’ for the purposes of the Act. They can arrange for their functions to be carried out, day-to-day, by particular people on their behalf, except for discharging patients from detention or community treatment orders (CTOs). The power to discharge patients from detention or CTOs is delegated to managers’ panels made up of ‘associate hospital managers’ appointed specifically for this purpose, who are not officers or employees of the Trust. The Trust appoints an adequate number of associate hospital managers to provide a balance of experience, gender and ethnicity to undertake this role. People who are subject to detention under the Mental Health Act can ask for their case to be reviewed by associate hospital managers for possible discharge. Similarly, where a clinician with overall responsibility for the care and treatment of a patient under the Mental Health Act, seeks to renew their detention or extend a CTO, associate hospital managers will assess and decide if this application is justified.

What overarching policy the procedure links to? Mental Health Act Policy

Which services of the trust does this apply to? Where is it in operation?

Group Inpatients Community Locations

Mental Health Services all

Learning Disabilities Services all

Children and Young People Services all

Corporate Services all

Who does the procedure apply to?

All staff providing care under The Mental Health Act, who will support and attend Hospital Managers’ Hearings in the course of their duties.


When should the procedure be applied?

Patients detained in a hospital under Sections 2, 3, 4 and 37of the Mental Health

Act for assessment and/or treatment for mental disorder. Patients who receive compulsory treatment outside hospital under section 17(A)

through CTOs.

How to carry out this procedure

Hospital Managers’ Hearing Associate hospital managers are independent of the hospital, the Trust and local clinical commissioning groups. They safeguard people’s rights under the Act as well as provide support and the opportunity to talk to an independent person about any issues they may have. The Trust employs a dedicated Mental Health Act administration team with specialist knowledge of the Mental Health Act and Code of Practice, who provide support to associate hospital managers. They will convene a hospital managers’ panel for a review to take place so that associate hospital managers can decide whether a patient should either continue to be detained or be discharged from hospital. A Hospital Managers’ Hearing may take place at any time at an associate hospital manager’s discretion but they must hold a review: a) When the Responsible Clinician submits a report renewing the patient’s detention.

(Section 20) or extending a Community Treatment Order (Section 20A) The Managers must consider holding a review: b) When the patient requests one (unless a hearing has recently taken place and the

Manager’s view is that the circumstances have not altered materially) c) When the Responsible Clinician makes a report to the Managers barring a

discharge made by a Nearest Relative However, patients on short-term sections, Section 5(4), Section 5(2) or Section 135/ 136 do not have the right to appeal. Patients detained under Section 4 can appeal, but this will be heard under either Section 2 or Section 3. A Hospital Managers’ Hearing should not be confused with a Mental Health Review Tribunal. If someone feels the decision to treat them against their will is unfair or unnecessary they can challenge the decision to stay in hospital and a mental health review tribunal will be held. This is an independent panel of three people, a judge who is in charge of the tribunal, a tribunal doctor and a specialist lay member who has detailed knowledge of the Mental Health Act. The tribunal can order a patient’s release, recommend their transfer to a different hospital, ask that their doctor considers treatment in the community, or that they are allowed to leave the hospital for periods of time to see if they are ready for life in the community. The Mental Health Act administration team supports this process. Prior to the Hearing

The Mental Health Act Office will:

Identify panel members, paying due attention to the gender, ethnicity and other needs of the patient

Agree a date and time for the hearing with the Responsible Clinician and panel Organise legal representation on behalf of the patient, if so requested


Ascertain whether the patient wishes a relative or friend to attend Inform the patient, legal representative and nearest relative (if appropriate) of the

date, time and venue of the hearing Inform relevant professional staff of the date, time and venue of the hearing Ensure that medical, nursing, social circumstances reports and those from

professional staff (if required) are circulated to associate hospital managers 5 days in advance for Section 3, 17(a) and 37 and no less than 30 minutes prior to the hearing for Section 2

Ensure that a copy of the reports are handed to the patient, his legal representative and his/her relative, as appropriate (other than in exceptional circumstances where ‘Non-disclosure to Patient’ is requested)

Immediately prior to the hearing, the patient and his/her legal representative will be given the opportunity to speak to the panel alone

The Named Nurse will:

encourage the patient to seek a friend, relative or advocate to attend with them and help them to represent themselves

go through the reports with the patient if necessary Medical Staff involved in the case will:

Produce independent written, signed and dated reports for the Mental Health Act Office

Notify the Mental Health Act Office in exceptional circumstances of any sections of the report which should not be disclosed to the patient, on the following grounds: - the information is likely to cause serious harm to the physical or mental health of

the patient or any person, or - the information relates to or has been provided by another person who could be

identified by that information and that other person does not consent Attend the hearing in person to present their report, or where that is not possible

ensure that an appropriate representative who knows the patient presents and is able to speak to the report

Statutory reports for a hospital managers’ hearing usually include a medical report, a nursing report and a social circumstances report. - The medical report will state the grounds for further detention and provide an

opinion of the patient’s current mental state, response to treatment and prognosis. It should also attempt to forecast the effect on the patient of the discontinuance of treatment under section

- The primary nurse’s report will give details of the patient’s care plan, and behaviour on the ward and other relevant information, including their response and compliance with treatment. It should also include the level of observation, any history of seclusion and any self-harm behaviour

- The social circumstances report will be prepared by the patient’s care coordinator and provide information about the patient’s family background and relationships within and outside the family. It will also give an opinion on the patient’s capacity to live outside the hospital, with or without support and information regarding community support available. It should also detail the patient’s financial position and any strengths, which would allow the panel to form a balanced view on discharge. Where possible a post-discharge care plan should be attached but If this is not possible, then the report should describe details of the aftercare support that would be available in the community in the event of a discharge


- In addition, reports may be obtained from other professionals as considered appropriate e.g. psychology. The patient is also entitled to submit an independent medical or social worker’s report.

Associate Hospital Managers will: Ensure they have reports from the patient’s responsible clinician and other relevant

disciplines That, if the patient consents, his/her nearest relative is informed of the review and

asked to attend That, if the patient withholds consent for his/her nearest relative to attend, the

appropriate professional concerned should obtain the views of his/her nearest relative and include these in his/her report

That, where appropriate professional staff are not present and/or up-to date reports are missing, consider whether or not they have sufficient available information in order to make an informed decision. In such circumstances, it may be necessary, in consultation with the patient and/or their legal representative and/or advocate, to postpone the hearing due to insufficient information being available.

The Hearing The review will be conducted by a panel of three associate hospital managers selected to provide a balance of experience, gender and ethnicity for each patient attending the hearing. Every effort will be made to achieve a relaxed and informal atmosphere in which the patient can feel at ease. At the start of the hearing, the Chair should ensure that everyone introduces themselves and explain clearly to the patient the purpose of the hearing and how it will proceed. During the hearing, the Chair’s role is to encourage comprehensive questioning and thorough consideration of issues, and to ensure that each panel member has fully participated in the decision-making process All parties will normally be present throughout the hearing. However, the Chair will ask the patient if they wish to speak to the panel alone, with or without the patient’s advocate. At times, doctors or social workers may need to leave before the conclusion of the hearing but this may only take place with the permission of the Chair and with the agreement of the patient’s solicitor. The Named Nurse must remain throughout the hearing to escort the patient back to the ward. Only a doctor with the power to discharge the patient should attend hearings. Ideally the Responsible Clinician will be present but if their absence is unavoidable, a senior member of the medical team will attend for them. If neither are available, the hearing must be adjourned. A member of staff from the Mental Health Act Office will attend the hearings to assist in taking supporting notes, and be available should advice on operational procedures be required. More complex legal advice should be obtained from the Trust’s solicitors. Order of Proceedings At the start of the hearing, the Chair will set out clearly the order of proceedings, which will normally be as follows: Introduce all those in attendance State clearly the purpose of the hearing and the order of proceedings (to help focus

the discussion and set the agenda) Invite the patient and/or their legal representative or advocate to state the case for

the patient’s discharge


Ask the Responsible Clinician and other professionals to give their views on whether the patient’s continued detention is justified and the factors on which those views are based

Give the patient the opportunity to comment on the views expressed through his/her legal representative or advocate

After each presentation, seek clarification or any further information Provide the patient and/or his or her legal representative, advocate or nearest

relative, the opportunity to ask questions The Panel should bear in mind the hearing likely to be stressful for the patient. The Panel should therefore balance the formality necessary to carry out their tasks with informality in the interest of supporting the patient and assist the patient in making his or her case for discharge as effectively as possible. There is no set time for the length of a hearing. However, the Panel should consider the effect of a lengthy review on the patient’s wellbeing so if the patient becomes distressed a short break may be directed by the Chair. If the patient chooses to absent himself/herself from the hearing, the Panel should decide whether to continue with the appeal. The procedures for the hearing should be informal. Although all parties should be actively and positively questioned, formal cross examination should be avoided. The questions should be asked of all parties in a manner, which is thorough, fair and courteous and care should be taken not to undermine the patient’s relationship with his/her family and professional staff. Reaching a Decision In arriving at a decision, the Panel should in particular: be cautious of and test ‘hearsay’ evidence that is second or third hand, carefully examine opinions about risk both to the patient and others, consider the patient’s state of mind and insight into his/her illness and assess the credibility of the patient and weigh his/her views against professional opinion. The Panel should be clear about the criteria for discharge and on the basis of the agreed or preferred statements of facts and opinions, determine whether the criteria for continued detention are satisfied. The Panel’s Decision The decision of the Panel should be either to continue to detain the patient, adjourn the hearing, or to discharge the patient. The power to discharge a detained patient can only be exercised when all three members of the panel are in favour of discharge otherwise the decision will be unlawful. In exercising the powers of discharge, the Panel must act in a way that is fair, reasonable and lawful, giving due consideration to the various reports and recommendations made, but not necessarily being bound by such reports and recommendations. In cases where Managers uphold a patient’s continued detention they must ensure that the patient and the patient’s nearest relative are fully informed of the reasons for this decision in line with guidance given in the Code of Practice and Article 5(2) of the Human Rights Act 1998.


Where the Panel is of the opinion that discharge arrangements are not sufficiently advanced and, on the basis of the criteria set out above, are concerned for the welfare of the patient, they may decide either to continue to detain the patient and to hold a further review after a specified period. The Panel should take into account the potential to violate Article 5 of the Human Rights Act 1998 if the length of delay in discharge could be construed as being unreasonable. Communicating the Panel’s Decision In communicating their decision, the Panel should ensure that their decision and the reasons for it are communicated immediately to the patient, to any relative who has been involved and to the relevant professionals. Wherever possible, at least one member of the Panel explains to the patient in person the reason for the decision. If the patient is unavailable or unwilling to meet with a panel member, the reason for the decision should be communicated by their advocate or a member of the professional staff. Recording the Decision The Panel’s decision and the rationale for it should be recorded by the Chair on the Managers’ Review of Detention Meeting Control Form (Appendix 1) and copies circulated to the professionals involved. In the event that a legal challenge to a decision to continue detention arises, the information will facilitate a response. Copies of the reports prepared for the review, together with the Panel’s decision are to be filed in the patient’s records. Where the patient is capable of understanding the nature and consequences of giving or withholding consent, his/her wishes should be ascertained before confidential information is disclosed to any third party not actively concerned with his/her treatment or care. Legal Challenge to the Panel’s Decision If the Panel’s decision to continue detention is legally challenged, the Mental Health Act Office will write on behalf of the Chair to the patient’s solicitor, giving a clear account of the reasons for the continued detention including copies of the relevant supporting documentation. In the event that the patient’s solicitor continues to challenge the decision, further legal advice must be obtained from the Trust’s solicitors Recommendations/ Evaluations Any evaluations or recommendations made at hearings will be entered onto the Evaluation Form (Appendix 2) and discussed at Hospital Managers meeting, which take place quarterly. Any urgent recommendation requiring a response will be forwarded to the Service Director of the relevant Directorate, with an indication of when a reply is expected.

Where do I go for further advice or information?

Mental Health Act Office - 0121 612 8035

Training Training in the understanding and implementation of the Mental Health Act and the associated Code of Practice is included in mandatory training for those staff where it has been identified by the Trust as essential to their role and responsibilities.


Monitoring / Review of this Procedure In the event of planned change in the processes described within this document or an incident involving the described processes within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness.

Equality Impact Assessment Please refer to overarching policy

Data Protection Act and Freedom of Information Act Please refer to overarching policy


Managers’ Review of Detention Meeting Control Form

Venue……………………………………………Date…………………Time……….

PANEL DETAILS PATIENT DETAILS

Chair of panel

Name

2nd Member

RC

3rd Member

Current Section Date From: ……………….. To: …………………

Observing:

Reason for Meeting:- (please tick) Patient Request: S20 Renewal: Form H5 received. Date ………………. S25 Discharge by Nearest Relative: Form M2 received. Date ……………… S17A Community Treatment Order Form CTO7 received. Date ……………… Other:

Hearings Held or booked for current episode

MHRT/Hospital Managers

Date Outcome

Care Plan/Risk Assessment in place Yes/No Copy to Patient: Yes/No Interpreter: Yes/No

Reports Provided by: RC/Doctor: Social Worker: Primary Nurse: Psychologist: Other:

Appendix 1


Present at Hearing:- RC/Doctor: Social Worker: Nurse: Nearest Relative: Patient: Solicitor: Other:

CHECKLIST FOR CONDUCT OF HEARING

YES/NO COMMENT

1. Ensure MHA Clerk has ascertained from patient, and any relative present, their views on their involvement in the Hearing.

2. Check all mobile phones are switched off. 3. Chairman and Panel Members introduce themselves to

the Patient. 4. Everyone in room asked to introduce themselves –

including Mental Health Act team. 5. Explain the purpose of the meeting. 6. Ask patient, or their representative, what they are

seeking a) agree Review procedure b) Offer patient opportunity to meet managers on

their own 7. Report discussed with RC/Doctor 8. Invite Patient or advocate to express views 9. Discuss Social Circumstances Report with Social

Worker 10. Report discussed with Clinical Psychologist 11. Nursing Report discussed with Nurse 12. Other professions views heard 13. Check relatives views 14. Patient or representative to be given an opportunity to

sum up their case


15. Is there evidence of a Risk Assessment/CPA meeting? 16. Decision to be conveyed to patient

REASON FOR PATIENT REQUESTING A HEARING

DECISION OF THE PANEL OF HOSPITAL MANAGERS a) The patient SHALL be discharged from liability to be detained with effect

from ……………………………………………………………………………… b) The patient SHALL NOT be discharged c) The hearing SHALL be adjourned. d) The hearing WILL be reviewed in ……………………………………………. GROUNDS FOR PANEL’S DECISION The Panel is obliged to discharge the patient if the answer to any of the following questions is ‘NO’. SECTION 2

a) Is the patient suffering from a mental disorder of a nature or degree which warrants his/her detention in hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and

YES

NO

b) Is the detention justified in the interest of his/her own health or safety or with a view to the protection of other persons?

YES

NO


SECTION 3 OR 37

a) Is the patient suffering from a mental disorder of a nature or degree which warrants his/her detention in hospital for medical treatment; and

YES

NO

b) Is appropriate medical treatment available for the patient? And

YES

NO

c) Is it necessary for the health or safety of the patient or the protection of other persons that he/she should receive such treatment and that it cannot be provided unless he/she continues to be detained?

YES

NO

SECTION 17(A) - CTO

a) Is the patient still suffering from mental disorder?

YES

NO

b) If so, is the disorder of a nature or degree, which makes it appropriate for the patient to receive medical treatment?

YES

NO

c) If so, is it necessary in the interests of the patient’s health or safety or the protection of other people that the patient should receive such treatment?

YES

NO

d) Is it still necessary for the responsible clinician to be able to exercise the power to recall the patient to hospital, if that is needed?

YES

NO

e) Is appropriate medical treatment available for the patient?

YES

NO

SECTION 25

In addition to the above questions under Section 3, 37 and 17A:

a) If discharged, would the patient be likely to act in a manner dangerous to other persons or to him/herself

YES

NO


REASON FOR THE PANEL’S DECISION

SIGNED:………………………………………………………………………(Chair) ……………………………………………………………………………(2nd Member) ………………………………………………………………………………(3rd Member) DATED: ………………………………………….


Hospital Managers’ Hearing Evaluation Form

PATIENT: …………………………… SECTION: …………………………. HOSPITAL: …………………………… WARD: ……………………………… TYPE OF HEARING: ………………….. DATE: … …………………………… PANEL:………………………………………………………………………………... ……………………………………………………………………………………………… ……………………………………………………………………………………………… Evaluation of Hearing:- ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… Recommendations/Actions:- ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ………………………………………………………………………………………………

Appendix 2


Standard Operating Procedure Details

Review and Amendment History

Version Date Description of Change

2.2 Oct 2019 Minor changes to mirror update of main policy

2.1 Jun 2018 Full review – change Supervised Community Treatment to Community Treatment Order and SCT to CTO

2.0 Oct 2016 Full review and new SOP format

1.0 Jul 2013 New SOP for BCPFT

Unique Identifier for this SOP is BCPFT-MHA-SOP-02-10

State if SOP is New or Revised Revised

Policy Category Mental Health Act

Executive Director whose portfolio this SOP comes under

Medical Director

Policy Lead/Author Job titles only

Mental Health Act Admin Manager

Committee/Group Responsible for Approval of this SOP

Mental Health Act Legislation Forum

Month/year consultation process completed

n/a

Month/year SOP was approved November 2019

Next review due November 2022

Disclosure Status ‘B’ can be disclosed to patients and the public

Documents

Hospital Managers’ Hearings - bcpft.nhs.uk