Consultation on Updates to the Code of Practice for the Mental Health (Care and Treatment) (Scotland) Act 2003 - easy read version

Mental Health Code of Practice - Chapter 17. When security in hospitals feels too high

Introduction

This document is about security in hospital in Scotland. It explains how a patient can ask the Mental Health Tribunal if they are being kept in the hospital with more security than they need.

We call this an excessive security application. Mental Health Tribunal is an independent group who look at decisions to keep patient in a psychiatric hospital.

Who is this for?

This is for:

• Patients detained in psychiatric hospitals. Detained means not allowed to leave.
• Families and carers.

• Named persons, welfare guardians and welfare attorneys. These are people with legal power to make decisions for a patient.
• Staff who support patients.

What does security mean?

Hospitals use security to keep people safe. It can be:

• locked doors and fences
• staff watching closely
• rules about visits and leaving the ward.

The law says security should be the lowest level that is safe for patient.

When can someone apply?

An application can be made if all these things are true:

1. The patient is detained in hospital units covered by rules.

2. The patient has been detained more than 6 months.

3. It is not the first 6 months of the detention.

4. An application has not already been made in the last 12 months.

5. The application comes with a supportive report from an Approved Medical Practitioner. Approved Medical Practitioner means a doctor with special approval under mental health law.

Who can make application?

It can be made by:

• the patient
• the patient’s named person
• a welfare guardian or welfare attorney
• other people who can act for the patient in law

• the Mental Welfare Commission. It is a government service that supports people with mental illness.

What the Tribunal looks at

The Tribunal will only look at the level of security.

The Tribunal will not look at:

• which hospital you will move to
• smaller daily ward rules

If the Tribunal agrees that your security is too high, then the Health Board must find a hospital with lower security.

The Supportive Approved Medical Practitioner (AMP) report

The report must be sent with the application. It must say that:

• the patient does not need the special high security or
• the medium secure unit is more secure than necessary for the patient

The report must explain the reasons based on patient’s condition. It also should explain the patient’s risk at the time the report is written.

The doctor should:

• look at the patient’s mental health and needs now
• look at risks to the patient and to other people
• use their own independent opinion.

The report does not need to name another hospital.

What happens after the application is sent?

The Tribunal will check the application includes:

• the Approved Medical Practitioner report
• the right legal statement in the report
• confirmation the doctor is an AMP

The Tribunal will then arrange a hearing.

At the hearing, people can give their views, including:

• the patient
• the named person
• welfare guardian and welfare attorney
• the Responsible Medical Officer. This is the doctor in charge of care and treatment
• the Mental Health Officer. This is a specially trained social worker
• hospital managers
• the Mental Welfare Commission

If the patient is restricted, Scottish Ministers can also take part. Restricted patients have special rules.

What decisions can the Tribunal make?

The Tribunal can decide that security is not too high. Nothing changes.

The Tribunal can decide that security is too high. The Tribunal can make an order saying the patient is detained in too high security conditions. An Order is a legal document saying what to do.

The order will say how long the Health Board has must find a new hospital. It is usually up to 3 months.

The new hospital must have a lower level of security that is right for the patient.

What if there is a delay finding a place?

If the patient has not moved by the time in the order, the Tribunal will hold another hearing.

If the Tribunal still thinks security is too high, it can make another order and set a new time limit.

Restricted patients and Scottish Ministers

Some patients are restricted. This means there are extra legal controls because of serious risk issues.

For restricted patients:

• Scottish Ministers are told about the application
• Scottish Ministers can give their views to the Tribunal
• If an order is made Scottish Ministers must agree to the new hospital before a transfer

Can the order be recalled?

Yes. After an order is made the Health Board and the Responsible Medical Officer can ask the Tribunal to recall the order.

Recall means take back.

For restricted patients Scottish Ministers can ask for recall. The Tribunal will hold a hearing before deciding.

Getting support

You may want help to understand or make an application. You can ask for support from:

• an independent advocate
• a solicitor
• the ward team
• your Mental Health Officer
• the Mental Welfare Commission