Other sections

Section 135 and 136
involve the police and allow for someone to be taken from a public place or their own home to a place of safety for 72 hours, so that they can be fully assessed.

Section 37
is sometimes use by the courts to order a mentally disordered person who has committed an offence to be detained in hospital at sentencing

Section 45a
can be used by the Crown Court to order a mentally disordered person who has committed an offence to be detained in hospital at sentencing with the option that he can be transferred back to prison from hospital.

Section 47 and 48
allow for someone in prison who is suffering from a mental disorder to be transferred to hospital.

Supervision in the community

Section 7 (Guardianship)

of the Act sets up a framework in which a patient can receive care and therapy in the community, with the support of a Guardian responsible for them. A Guardianship order emphasises a person's social needs and often the Guardian will be the person's Social Services department. The Guardian gives the person close attention and support, and has some specific rights over the person.

A Guardianship order can only work with the co-operation of the patient as many of the Guardian's rights are not enforceable.

Guardianship orders can be made for people aged 16 or older. An application for Guardianship can be made by an Approved social worker, or the patient's Nearest Relative, supported by two doctors. One of the doctors must have been approved to do this under the Act and one should know the patient. The person making the application must have seen the patient in the past 14 days, and the doctors must have seen the patient within five days of each other. The patient does not have to be in hospital for an application for Guardianship to be made. The doctors involved need to confirm that:

In my opinion this patient is suffering from mental illness, severe mental impairment, psychopathic disorder or mental impairment of a nature or degree which warrants the patient's reception into guardianship under the Act.

Guardianship is initially for a period of six months, which may be renewed for a further six months initially then for periods of one year. The RMO is responsible for renewing the order. There is a right of appeal to a MHRT.

Powers of the Guardian
The Guardian has the power to require the person subject to the order to:
reside at a specified place
attend at places and at specified times for the purposes of medical treatment, occupation, education or training
give access to the place the person subject to the order is living in, to any medical practitioner, approved social worker or other person specified by the guardian.

With the exception of the power to retake a patient, the powers given to the guardian are not enforceable, but rely on the co-operation of the patient.
Guardianship does not give the right to detain in or remove someone from a particular place, but if the person leaves the place where they are required to live without their Guardian's consent, they can be taken into custody and returned. There is no right to use force to make the person attend for treatment or therapy, and the person's consent is required for medical treatment.

Duties of the Guardian
The Act says 'It shall be the duty of a private guardian' -

  • to appoint a registered medical practitioner to act as the nominated medical attendant of the patient
  • to notify the responsible local social services authority of the name and address of the nominated medical attendant
  • in exercising the powers and duties conferred or imposed upon him by the Act and these regulations, to comply with such directions as that authority may give
  • with regard to the patient as the authority may from time to time require to notify the authority - on the reception of the patient into guardianship, of his address and the address of the patient, except in a case to which paragraph (i) applies, of any permanent change of either address, before or not later than 7 days after the change takes place
  • where on any permanent change of address, the new address is in the area of a different local social services authority, to notify that authority; of his address and that of the patient, of the particulars mentioned in paragraph (b), and to send a copy of the notification to the authority which was formerly responsible
  • in the event of the death of the patient, or the termination of the guardianship by discharge, transfer or otherwise, to notify the responsible local social services authority as soon as reasonable.

Supervised discharge

Section 25a
This section of the Act sets up a framework in which a patient can receive care and therapy in the community, with the support of a Supervisor responsible for them. A Supervised Discharge order emphasises a person's medical needs, and identifies a Community Responsible Medical Officer (CRMO) who is responsible for the medical care and a Supervisor who co-ordinates their care. The CRMO may be the patient's hospital RMO and the Supervisor is normally the patient's key worker, usually the community psychiatric nurse, and has some specific rights over the person. A Supervision order can only work with the co-operation of the patient as many of the rights are not enforceable.

An application for Supervision can be made by a RMO, who may also be the CRMO, supported by a medical recommendation and an ASW's recommendation. The medical recommendation should be made by the CRMO, or if the CRMO is making the application, the patient's GP. There are no time limits associated with making the order, but the doctor and the ASW should see the patient within a week of each other. The patient can be on section 17 leave when the order is made.

Before the application is made, the RMO must consult:

  • the patient, but the patient's consent is not needed
  • at least one member of the hospital care team
  • at least one member of the social services department providing 117 care
  • any non-professional carer who will be providing substantial care
  • the Nearest Relative, the patient can object to this, though if the patient has a tendency to violent or dangerous behaviour towards others this can be overridden
  • other agencies that are involved, eg voluntary or housing.

The doctors to confirm that:
the patient is over the age of 16 years,
the patient is not subject to a restriction order and is liable to be detained under a treatment section, section 3, 37, 47 or 48,
the patient is suffering from mental disorder, being mental illness, severe mental impairment, psychopathic disorder or mental impairment,
there would be a substantial risk of serious harm to the health or safety of the patient or of other people, or of the patient being seriously exploited, if he did not to receive the after-care services under section 117, and
supervision is likely to help to ensure that he receives the care.

A Supervision order is initially for a period of six months, which may be renewed for a further six months initially then for periods of one year. The CRMO is responsible for renewing the order. There is a right of appeal to a MHRT in each period of the detention.

Powers of the Supervisor
The Supervision order will state which conditions the patient will be placed under, these can include a requirement to:

reside at a specified place, attend at places and at specified times for medical treatment, occupation, education or training, give access to the place where the person subject to the order is living, to any medical practitioner, approved social worker or other person specified by the guardian, With the exception of the power to retake a patient, the powers given to the Supervisor are not capable of enforcement, but rely on the co-operation of the patient.

A Supervision order does not give the right to detain someone in or remove them from a particular place, but if the person leaves the place where they are required to live without their Supervisor's consent, they can be taken into custody and returned, thought there is no power to restrain them from leaving again. There is no right to use force to make the person attend for treatment or therapy, and the person's consent is required for medical treatment.

Professional responsibilities
The Supervisor takes the lead in co-ordinating the patient's care once in the community and will usually be the keyworker. The Supervisor should,
make sure that the care plan is being implemented and ensure that the care team liase to make sure that reviews of the care plan are carried out.
The Supervisor will need close working links with the Community Responsible Medical Officer to fill this role. The Community Responsible Medical Officer takes responsibility for the patient's psychiatric treatment in the community. The CRMO ought to be experienced in the diagnosis and treatment of mental disorder and may have been the patient's hospital RMO. The CRMO has the power to renew or terminate the Supervision order and to reclassify the patient's disorder.

The patient's GP does not have a statutory responsibility in Supervised Discharge, though the GP may provide a recommendation or act as the CRMO if qualified. Good practice will be to address the physical health needs of the patient in the community by involving the GP in the delivery of the patient's care plan.

Rights of the Supervisor
The rights of the supervisor are similar to those of the Guardian available under s7 of the Act, but the Supervisor has the additional power to convey the person under supervision set out in s25D:
(4) A patient subject to after-care under supervision may be taken and conveyed by, or by any person authorised by, the supervisor to any place where the patient is required to reside or to attend for the purpose of medical treatment, occupation, education or training.
This does not give the Supervisor the right to force entry to get access to the person or to hold the person by force.