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The MHA 2001 from a
Clinician's Perspective
Dr Maria Morgan
Consultant Psychiatrist
How MHA 2001 impacts on
clinical practice
●“Picture Boy” for civil libertarianism?
OR
●“A watered down” 1945 MTA ?
MHA 2001-a huge leap forward
●improved protection for people admitted
involuntarily for treatment of mental illness
●Provi...
Mental Health Tribunals
●Primarily serve as an independent review board to
determine whether the patient is suffering from...
Shortcomings
Review by the DOHC found that BOTH
mental health service users and providers
reported a range of difficulties...
●Conduct of Tribunals-issue of process and
setting rather than the Act itself
●Problems with the timing in the process-not...
●College of Psychiatrists of Ireland said it
was incompatible with recommendations
made in
●VISION FOR CHANGE 2006
●Disruption to therapeutic activities at approved
centres
●Administrative uncertainties
●Extra responsibilities on RCP e.g...
●Experience of psychiatrist in other
jurisdictions reflected the views in ROI
●65%-”voluntary patients had suffered as a
r...
●National study by O Donoghue Moran et al ,
●238 psychiatrists were interviewed, 70%
response rate. 32% of responders felt...
●Study of Irish GP attitudes (Jabbar, Kelly et al)
●1200 GPs were sent questionnaires, 820
responded
●Staggering 75% provi...
●Review of MHA 2001, 5 years after
implementation- there was a small decrease in
the rate of involuntary admission but no ...
●In other studies by clinicians examining the rates of
involuntary admissions under MHA 2001- no change
in demographic and...
Solutions??
●Report of Expert Group on Review of MHA 2001 was
released earlier this year
●Guiding principle of “best Inter...
Solutions 2
●Consensus that people with intellectual disability
and severe dementia alone, should not be
detained in psych...
Solutions 3
●Section 26 leave of absence for a max of 14 days
●Some would argue that this may prolong detention
●Change of...
Solutions 4
●Section 60, administration of meds without consent-
reduced to a max of 21 days
●Awareness of rights and comp...
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Maria Morgan: The Mental Health Act 2001 from a Clinician's Perspective

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Dr Maria Morgan, Consultant Psychiatrist
The Mental Health Act 2001 from a Clinician's Perspective
Presented at Mental Health Law Conference 2015 - Centre for Criminal Justice & Human Rights, School of Law, University College Cork and Irish Mental Health Lawyers Association
25 April 2015
http://www.imhla.ie
#mhlaw2015

Published in: Law
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Maria Morgan: The Mental Health Act 2001 from a Clinician's Perspective

  1. 1. The MHA 2001 from a Clinician's Perspective Dr Maria Morgan Consultant Psychiatrist
  2. 2. How MHA 2001 impacts on clinical practice ●“Picture Boy” for civil libertarianism? OR ●“A watered down” 1945 MTA ?
  3. 3. MHA 2001-a huge leap forward ●improved protection for people admitted involuntarily for treatment of mental illness ●Provided for setting up of the MHC, drawing welcome attention to issues of policy and codes of practice ●Inspired by ECHR
  4. 4. Mental Health Tribunals ●Primarily serve as an independent review board to determine whether the patient is suffering from a mental disorder as defined in Section 3 MHA and to ensure they have been legally detained ●Occasionally to authorise transfer of a patient for specialist treatment in the CMH ●Ancillary functions-e.g. MHTS can also help the clinician to focus on treatment goals and a discharge plan.
  5. 5. Shortcomings Review by the DOHC found that BOTH mental health service users and providers reported a range of difficulties with the new legislation Some issues had been flagged before the “roll-out” of the Act
  6. 6. ●Conduct of Tribunals-issue of process and setting rather than the Act itself ●Problems with the timing in the process-not getting a true picture of the clinical condition ●Adversarial nature -negative effect on therapeutic alliance ●“Side-lining” of voluntary patients because of excessive administrative workload associated with compliance. ●Insufficient resources to compensate for time spent on the tribunal process.
  7. 7. ●College of Psychiatrists of Ireland said it was incompatible with recommendations made in ●VISION FOR CHANGE 2006
  8. 8. ●Disruption to therapeutic activities at approved centres ●Administrative uncertainties ●Extra responsibilities on RCP e.g. ●form filling, preparing for and attending MHTs, liaising with solicitors and second opinion psychiatrists, teaching junior doctors about the Act and codes of practice
  9. 9. ●Experience of psychiatrist in other jurisdictions reflected the views in ROI ●65%-”voluntary patients had suffered as a result” ●59%- their own out of hours workload had increased ●Patient groups in Scotland also highlighted this disruption to care for voluntary patients (Smith et al) Psychiatr Bull 2007
  10. 10. ●National study by O Donoghue Moran et al , ●238 psychiatrists were interviewed, 70% response rate. 32% of responders felt care of involuntary patients had improved, but 48% felt that Voluntary patients care had deteriorated. Junior doctor training had been reduced in 57% of placements, and 87% reported an increase in on call workload. Only 23% reported sufficient increase in consultant personnel in their service.
  11. 11. ●Study of Irish GP attitudes (Jabbar, Kelly et al) ●1200 GPs were sent questionnaires, 820 responded ●Staggering 75% provided negative comments ●e.g. difficulty with transporting patients to approved centres, time requirements, form fillings
  12. 12. ●Review of MHA 2001, 5 years after implementation- there was a small decrease in the rate of involuntary admission but no change in the representativeness of the diagnoses of individuals admitted involuntarily ●Tribunals were held for 57% of those admitted involuntarily and interestingly, 46% of service users found that MHT made the involuntary process easier to accept. One year post discharge, 60% reflected that it had been necessary.
  13. 13. ●In other studies by clinicians examining the rates of involuntary admissions under MHA 2001- no change in demographic and clinical characteristics of individuals compared with the previous legislation ●One study (Clancy et al) 2008 found an increase in age of detainees under the MHA ●Ng and Kelly (2012) found a higher rate of detention (67.7 per 100,00) in North Inner City Dublin compared with the national average (38.5 per 100,000) ●Immigrants are also more likely to have involuntary status -
  14. 14. Solutions?? ●Report of Expert Group on Review of MHA 2001 was released earlier this year ●Guiding principle of “best Interest” to be replaced by “wills and preferences” paradigm ●Term “mental illness” should remain but definitions and thresholds for involuntary admission should be higher ●Need for greater clarity on how the severity of a mental disorder is determined
  15. 15. Solutions 2 ●Consensus that people with intellectual disability and severe dementia alone, should not be detained in psychiatric institutions – previously criticised by European Committee for Prevention of torture ●Definition of treatment -should include other tests required for purpose of safeguarding life and restoring health ●Should exclude provision of a safe environment only.
  16. 16. Solutions 3 ●Section 26 leave of absence for a max of 14 days ●Some would argue that this may prolong detention ●Change of status would require an authorised officer instead of a second psychiatrist ●Administration of treatment to a patient who lacks capacity – only after consultation with another mental health professional of a different discipline
  17. 17. Solutions 4 ●Section 60, administration of meds without consent- reduced to a max of 21 days ●Awareness of rights and complaints procedure ●Care plans should be called recovery plans with a discharge plan to be included ●Inspections of approved centres every 3 years, ●Register all CMHTs, hostels, Day hospitals and centres.

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