The Mental Health (Care and Treatment) (Scotland) Act came into effect in 2005 and describes how individuals with ‘mental disorders’ should be treated in hospitals and in the community. The Acts defines ‘mental disorder’ as any mental illness, personality disorder, or learning disability and confirms:
– when you can be taken into hospital against your will
– when you can be given treatment against your will
– what rights you have in receiving care and treatment
– what safeguards are in place to protect your rights
Ten Key Principles
The Act is guided by Ten Key Principles and health professionals must respect these principles when providing treatment.
The Key Principles are:
– people with mental disorders enjoy the same rights and entitlements as those with other health needs (Non-discrimination)
– all powers under the act should be exercised without discrimination on grounds of physical disability, age, gender, sexual orientation, language, religion or national, ethnic, or social origin (Equality)
– service users should receive care and treatment in a manner that respects them as individuals and which respects their age, gender, sexual orientation, ethnic group, social, cultural and religious background (Respect for Diversity)
– when society compels an individual to accept treatment or care, it also obliges health and social care authorities to provide safe and appropriate services, including ongoing care after discharge (Reciprocity)
– wherever possible care, treatment and support should be provided to people without compulsion (Informal Care)
– service users should be heavily involved in all aspects of their care, assessment, treatment and support. Their past and present wishes should be respected and Advance Statements must be respected. Patients must be provided with information which supports them to be fully involved in decisions, and information should be provided in an easy to understand manner (Participation)
– those who care for service users should be respected for their experience. They should receive helpful information and their views must be respected (Respect for Carers)
– service users should receive care, treatment and support in the least invasive and least restrictive manner while taking account of other people’s safety (Least Restrictive Alternative)
– any treatment or support provided under the Act should produce a benefit for the service user that couldn’t be achieved except by intervention (Benefit)
– the welfare of children with mental disorders should be paramount in any interventions imposed under the Act (Child Welfare)
The Act allows for people to be placed under three different types of compulsory order.
This allows someone to be detained in hospital for up to 72 hours in cases where hospital admission is urgently required, and will only occur if recommended by a doctor. Wherever possible, the doctor should also obtain the agreement of a mental health officer, the main purpose of this being to allow assessment of the person’s condition.
This allows a patient to be detained in hospital for up to 28 days to be assessed or treated. This will only take place if a psychiatrist recommends it, and the psychiatrist must obtain the agreement of a mental health officer who must meet the person first.
Compulsory Treatment Order (CTO)
This sets out conditions relating to a person’s care in order for them to receive treatment against their will. A CTO has to be approved by a Tribunal, and people have the right to legal representation and raise objections against the CTO at the Tribunal. A CTO lasts for six months and can be extended for a further six months and then for 12 months where necessary. A CTO can be based in a hospital or in the community and these conditions may change during the course of the CTO. A mental health officer has to apply to the Tribunal, and the application must include two medical recommendations and a plan of care detailing the care and treatment proposed for the patient. The patient, the patient’s named person and the patient’s primary carer can raise objections at the Tribunal and are entitled to free legal representation.
These three powers can only be used when:
– the person has a diagnosed ‘mental disorder’
– medical treatment is available which could improve their condition
– there would be a significant risk to that person and/or others if medical treatment wasn’t provided,
– the patient’s ability to make decisions about medical treatment is impaired due to their mental disorder.
– it is necessary to urgently detain the patient in hospital in order to provide necessary medical treatment, or determine what medical treatment should be provided for the mental disorder
The Act provides three safeguards to protect people’s rights. These include:
People covered by the Act can make an Advance Statement setting out how they want to be treated if they become unwell and are unable to express their views clearly. Advance Statements must be respected when deciding on a person’s treatment.
Anyone affected by the Act can choose a Named Person to support them and help protect their interests when powers under the Act are used. They are entitled to free legal representation at any Tribunal hearing.
The Mental Health Tribunal for Scotland
The Tribunal makes decisions on Compulsory Treatment Orders (CTOs) and Care Plans and has three members – a lawyer, a psychiatrist and a person with social care experience. The Tribunal aims to be fair, impartial and accessible and service users or carers are free to challenge CTOs. Services users can make Advance Statements and the Tribunal must take these Statements into account.
People affected by the 2003 Act also have the right to independent advocacy to ensure their views are heard and respected.
Care Programme Approach
The Act also recommends a Care Programme Approach for treating mental disorders. Everyone with a mental disorder should be involved in an assessment of their needs, and a plan should be drafted outlining their Care Package. This Care Programme Approach (CPA) should identify the carer(s) involved, outline how they should be involved, and recognise the need for a carers’ assessment.
Click to print an Advance Statement Form