Mental health practice guidance when considering referrals ... · This presents challenges to the...

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Once printed, this is an uncontrolled document Version: 1 FOI Status: Public Derbyshire County Council Adult Social Care Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and Undertaking Mental Health Act Assessments during the Covid-19 Pandemic Issued: April 2020 Review Due: June 2020 Derbyshire County Council Adult Social Care Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and Undertaking Mental Health Act Assessments during the Covid-19 Pandemic Name Job Title Date Jacqueline Ingerson Service Manager April 2020 Approved by: Andrew Bartle Group Manager (Performance) April 2020 Change History Version Date Name Reason V1 April 2020 J. Ingerson New Practice Guidance If you would like to make any comments, amendments or additions please email Phil RobsonPolicies and Procedures, [email protected]

Transcript of Mental health practice guidance when considering referrals ... · This presents challenges to the...

Page 1: Mental health practice guidance when considering referrals ... · This presents challenges to the AMHP service and the referral procedure has been reviewed and updated to take account

Once printed, this is an uncontrolled document

Version: 1 FOI Status: Public

Derbyshire County Council Adult Social Care

Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

Derbyshire County Council Adult Social Care

Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and

Planning and Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Name Job Title Date

Jacqueline Ingerson Service Manager April 2020

Approved by: Andrew Bartle

Group Manager (Performance)

April 2020

Change History

Version Date Name Reason

V1 April 2020 J. Ingerson New Practice Guidance

If you would like to make any comments, amendments or additions please email Phil Robson– Policies and Procedures, [email protected]

Page 2: Mental health practice guidance when considering referrals ... · This presents challenges to the AMHP service and the referral procedure has been reviewed and updated to take account

Once printed, this is an uncontrolled document

Version: 1 FOI Status: Public

Derbyshire County Council Adult Social Care

Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

Contents

1. Context ................................................................................................................................ 1

2. Definitions ........................................................................................................................... 1

3. Referrals – General Guidance ............................................................................................ 2

4. Referrals for a Mental Health Act (MHA) Assessment from Psychiatric Wards ................. 5

5. Referrals from Police Stations ........................................................................................... 5

6. Mental Health Act Assessments for Children and Young People ...................................... 5

7. MHA Referrals for those with Learning Disabilities or Autistic Spectrum Disorder (ASD) . 6

8. Expected Response from the AMHP team ........................................................................ 6

9. Guidance for the AMHP planning the MHA Assessment ................................................... 7

10. Guidance for the AMHP undertaking the MHA Assessment .............................................. 8

11. Guidance for the AMHP following MHA Assessments ....................................................... 9

12. Role of Other Agencies ...................................................................................................... 9

Appendix A…………………………………………………………………………………………...11

Appendix B Guiding Principles of the Mental Health Act 1983….……………………………...12

Appendix C Relevant paragraphs from the Mental Health Act Code of Practice……………..13

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Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

1

1. Context

1.1 The purpose of this guidance is to lay out what information is required in a Mental Health Act 1983 (MHA) referral to the Approved Mental Health Professional (AMHP) team, what response agencies can expect from the AMHP service, and the expectations that the AMHP service will have of other agencies. It also includes issues to consider during the planning and undertaking of MHA assessments.

1.2 Section 13(2) MHA states that “… an AMHP shall interview the patient in a

suitable manner and satisfy himself that detention in a hospital is in all the circumstances of the case the most appropriate way of providing the care and medical treatment of which the patient stands in need”. The AMHP service is currently undertaking MHA assessments at a time when public health measures have been implemented by the Government to contain the spread of the Covid-19 virus. This presents challenges to the AMHP service and the referral procedure has been reviewed and updated to take account of the change in working practices required during the Covid-19 pandemic.

1.3 The Coronavirus Act 2020 (when enacted) does not amend the duties of the

AMHP but it does require the AMHP service to interpret new terms such as ‘impractical’ and ‘unreasonable delay’. It is important that new ways of working are considered from point of referral through to conclusion of the MHA assessment in line with the Government guidance. The Explanatory Notes to the Coronavirus Act 2020 state that the purpose is to enable the right people from public bodies across the UK to take appropriate actions at the right times to manage the effects of the outbreak.

1.4 This guidance will be reviewed regularly in order to ensure it remains reasonable and proportionate.

1.5 For up to date guidance around personal protective equipment (PPE) or other

issues please refer to the information in the Covid-19 folder on your desktop.

2. Definitions

2.1 An AMHP is a mental health professional qualified to perform certain roles and responsibilities required by the Mental Health Act 1983. One of the key roles is to co-ordinate assessments under the Mental Health Act, and to make an application for compulsory admission to hospital under Part 2 of the Mental Health Act, if they decide that this is the least restrictive option available.

2.2 Throughout this guidance the term ’duty worker’ refers to the Central AMHP

team duty worker.

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Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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2.3 Throughout this guidance an assessment with a view to compulsory admission under Part 2 of the Mental Health Act 1983 will be referred to as a MHA assessment and the Mental Health Act will be referred to as the MHA.

3. Referrals – General Guidance 3.1 In line with the first principle of the MHA, potential referrers need to ensure

that all least restrictive options to admission under the MHA have been considered before referring to the AMHP team.

3.2 Potential referrers should consider whether the necessary support can be

achieved by referral to the community mental health service, a review by social care for a change in the care package, or by referral to the Crisis team.

3.3 If the person is already open to community mental health services, and the

patient has not recently been seen, the doctor from the referring team should attempt to review the patient in person prior to referral. Depending on the circumstances, this might not be necessary if the doctor from the team is to be involved in the MHA assessment.

3.4 If the person is not open to community mental health services, in most

circumstances the GP should at least attempt to see the patient before a referral is made to the AMHP service.

3.5 During normal working hours if a referrer is unsure whether a referral should

be made, guidance and support should be sought from the duty worker (Tel: 01629 537904). Out of hours, the conversation should take place direct with the AMHP (via the Chesterfield Royal Hospital or Radbourne Unit, Royal Derby Hospital). In the event that there is a dispute, the situation should be escalated to the respective managers to resolve. It is important to remember that the AMHP only has to consider the request, they do not have to accept the referral. Referrals can come from many sources, typically:

Derbyshire Healthcare NHS Foundation Trust – psychiatrists, bleep holders, Community Practice Nurses, Occupational Therapists, nurses working on wards, members of the Criminal Justice team, Liaison team, and Crisis team.

mental health Prevention & Personalisation social workers

primary care such as GP’s, including those working for Derbyshire Health United (DHU)

police officers or forensic medical examiners

children’s social workers

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Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

3

generic Prevention & Personalisation social workers

East Midland Ambulance Service (EMAS) professionals

prisons, including healthcare

secure units

professionals working on general healthcare wards 3.6 The AMHP triaging the referral under S13(1) MHA needs to consider each

person’s case as rigorously as possible during this pandemic so as to avoid putting themselves and others at risk by undertaking MHA assessments unnecessarily. Decisions to prioritise referrals must take into account all other referrals and if necessary senior practitioners/managers/lead AMHP should be brought in to assist with the decision making.

The Mental Health Act Manual (22nd edition) by Richard Jones states “It is for the AMHP to decide how to proceed” (p125-6). This might include deciding against making an application purely on the basis of the available information, liaison with other services that results in another plan, seeing the person without doctors but perhaps with someone else. It is the presence of an AMHP considering the patient’s case that makes it a MHA assessment, not necessarily whether doctors are involved. Other factors to consider are the level of risk, urgency and whether an alternative plan of care can be provided in the meantime. The rationale for the decision must always be recorded in full. If the decision is taken not to proceed the AMHP should discuss this with their senior practitioner/manager/AMHP lead. This will ensure the decisions are made as robustly as possible and also act as an additional safeguard for the AMHP.

3.7 Collaborative work and effective liaison with other agencies may reduce the

number of MHA referrals and provide an opportunity to share risk management decisions that avoid use of the MHA.

3.8 At the point of referral, information must be obtained around whether the

patient or any members of their support network are showing any symptoms of Covid-19, where they have been in the last 7 days, and who they have been in contact with. If AMHPs have any concerns at this point please speak to your manager, senior practitioner or AMHP lead.

3.9 Information should also be obtained as to whether the person or anyone they

live with is in the high risk or increased risk category. This is important as the AMHP may intend to enter a person’s home and put them at increased risk of infection by forcing them to breach the Government advice on social distancing. The AMHP will need to ensure that if they do this, they have taken

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Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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all possible steps to mitigate this risk by ensuring they wear the appropriate PPE.

3.10 When making a request for a MHA assessment, information will be required

as per Appendix A so please have this to hand when making a referral. 3.11 Section 13 (4) MHA places a duty on the AMHP to consider a request for a

Mental Health Act Assessment (MHAA) made by the nearest relative of the patient. If the AMHP decides not to make an application they should inform the nearest relative of their reasons for this in writing.

3.12 Information taken at point of referral must be recorded as follows:

when a referral is rung in (or going forwards, sent in electronically), full details of the MHA referral must be taken regardless of whether you think it might be passed to a different local authority to undertake and regardless of whether you don’t act on it (i.e. you advise an alternative plan of action)

this referral must be uploaded onto Mosaic after ensuring you have identified the correct individual’s records

a new record must be created if the individual is not known to Derbyshire

County Council (DCC)

if you are unsure as to whether you can identify the correct individual then create a new record on Mosaic - this will then need to be clarified once more information is known and the records merged as necessary with support from the service desk - the AMHP creating the new record must accept responsibility for this

if this referral is subsequently passed to a different local authority then once you know it has been formally accepted the referral details must be deleted via service desk with a case note confirming date referral received, who from, action taken, and rationale as to why details of the referral itself are being deleted (so as to avoid unnecessary long term capture of information)

the only caveat to taking full details of referrals is when it is immediately obvious that Derbyshire will not be undertaking the MHA assessment and in these circumstances you must inform the referrer accordingly and ask them to re-refer to the correct AMHP service - in these circumstances information should be recorded on the activity log only (just date, service user name & Pin, DOB, referrer details and outcome), specifics of the referral do not need to be recorded

due diligence must be shown - on every occasion we must provide a full rationale for our decision making, i.e. record what we have done and why

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Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

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4. Referrals for a MHA Assessment from Psychiatric Wards 4.1 Where a section 2 is due to expire, and the ward team are of the view that

further detention under section 3 is required, where possible the AMHP should be informed at least 4 days before the section 2 is due to expire. This should be done even if the psychiatrist is unsure whether or not they will be pursuing admission under section 3.

4.2 If the ward team have reason to believe that the nearest relative may object to

a future application under section 3 they should inform the AMHP service as soon as possible.

4.3 The AMHP service should be informed as soon as a patient is placed under

section 5 (2) MHA emergency holding powers, even if the ward psychiatrist has not yet decided whether or not to complete a medical recommendation.

4.4 If a psychiatrist on the ward is completing a medical recommendation for an

informal patient, at the point of referral it is important that they discuss with the duty worker the rationale for deciding on the use of section 2 or section 3 in accordance with paragraphs 14.4 and 14.5 of the MHA Code of Practice.

4.5 Referrals for involvement of an AMHP in the Community Treatment Order

(CTO) process should be made in line with the CTO policy.

5. Referrals from Police Stations 5.1 In the rare event that a patient is detained under section 136 at the police

station the section 136 policy should be followed. 5.2 Referrals for MHA assessments from police stations will normally come

through the nurse from the Criminal Justice Mental Health team. Where they are not available the AMHP may request that the Forensic Medical Examiner (FME) assesses the person first. The AMHP may still accept a referral without the FME seeing the person if the circumstances suggests that this is not necessary or appropriate.

6. Mental Health Act Assessments for Children and Young People 6.1 Section 13 MHA requires the Local Authority where the person is to arrange

the Mental Health Act assessment. Ordinarily, where practical, the Derbyshire AMHP service will arrange the MHAA for children and young people who are ordinarily resident in Derbyshire, or who are looked after children by Derbyshire, even if they are not in Derbyshire at the time that the assessment is needed. During this pandemic however AMHPs will need to heed the Government’s advice on unnecessary driving.

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Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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6.2 Where a request is made for an assessment outside of hospital we will require a community Child and Adolescent Mental Health services (CAMHS) consultant to have assessed the person first, and to be involved in the assessment.

6.3 The CAMHS consultant is responsible for finding a bed. 6.4 In most circumstances a lack of a bed should not prevent an assessment

taking place.

6.5 A dialogue should be started with the Central AMHP team as soon as an admission under the MHA is being considered. An AMHP may be allocated to contribute to care planning meetings or to the care, education & treatment review (CETR) process.

7. MHA Referrals for those with Learning Disabilities or Autistic Spectrum Disorder (ASD)

7.1 The AMHP should be involved from the start of the process wherever

possible. A request can be made for an AMHP to be involved in the care and treatment review (CTR) process before the threshold for a MHA assessment is reached. Referrers should liaise with the AMHP service at the earliest possible opportunity and be given the opportunity to speak to all concerned and gather all relevant information.

. 7.2 Where admission to hospital is indicated the local area emergency protocol

(LAEP) process is triggered. The process of completing a MHA assessment can be started alongside, or as part of, this process. In most circumstances the LAEP referral should be made by the person who knows the patient best.

7.3 Unavailability of a bed should not delay a MHA referral being made.

8. Expected Response from the AMHP team 8.1 In most circumstances referrals will be responded to within 2 hours. 8.2 Although it is the responsibility of the assessing psychiatrist to secure a bed

for the patient, lack of a bed should not, in most circumstances, prevent a MHA assessment from taking place.

8.3 The duty worker is available 9.00am to 5.00pm Monday to Friday to discuss

any potential referrals or for advice and support around mental health legislation and its application. Consideration should be given to contacting the duty worker in advance to involve an AMHP in being part of planning someone’s care where there is concern that it may potentially lead to a MHA assessment. For example, this may involve the AMHP attending a

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Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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multidisciplinary meeting, or a time limited period of joint working with the care coordinator to explore different options.

8.4 Referrals should be made as early as possible in the day to reduce the impact on the service user and to avoid the need to pass work to the Out of Hours AMHP service.

9. Guidance for the AMHP planning the MHA Assessment 9.1 Please plan the MHA assessment carefully and remain mindful that quality

communication with a patient continues to be vital in ensuring a thorough and lawful assessment. Consider where the MHA assessment is to take place; if it is to be undertaken in the person’s home then ask about the size of the rooms and whether, if necessary, there is an outside area that can be used. Also consider the need for PPE for your protection and that of the service user.

9.2 Consider and risk assess each environment you’re being asked to work in. If

the MHA assessment needs to take place in hospital (e.g. emergency department, section 136 suite, ward) ask for a large room and if this is not forthcoming escalate this before undertaking the MHAA.

9.3 Consider who is likely to be in the vicinity and ensure only one person is there

to support the service user if absolutely necessary. Ensure as far as you are able that there will be space for you to maintain the 2 metre distance required. Whilst ordinarily a person has the right to have someone with them during the assessment, this needs to be carefully considered during this period. It might be that the individual can be supported by telephone instead. Social distancing must be observed and adequate PPE used.

9.4 Carefully consider whether you need a 2nd worker to attend the MHA

assessment. If a 2nd worker does attend then they should travel separately and wait in their car until you know they’re required wherever possible.

9.5 Please consider what PPE is available to you and if necessary ask the Trust if

they have any additional PPE which could be utilised for the purpose of the assessment. Please consider whether a face-to-face assessment is appropriate and consider whether this may impact negatively on the person’s responses and their reactions. For example, if a person is acutely psychotic and is experiencing delusional thinking, being assessed by an AMHP in full PPE may not be a 'suitable manner’ in which to conduct the assessment. In fact a remote assessment, where the AMHP is not required to wear PPE, may provide for a more comfortable environment and facilitate a better quality assessment. Equally, if the patient is refusing to adhere to social distancing guidance and there is a real risk that the patient may put you, or other professionals at risk, a remote assessment may be appropriate in the circumstances (please refer to paragraph 9.7 below).

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Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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9.6 Before the MHAA ensure that all discussions take place by phone/skype/with the 2 metre safe distance maintained.

9.7 Carefully consider use of technology and if you feel you can use technology to

undertake the MHAA remotely then do so but please discuss this with your manager/senior practitioner/lead AMHP before proceeding. You must consider each case individually on its own facts and consider whether a remote assessment would be reasonable and proportionate, having properly considered all of the circumstances (including the information obtained in accordance with paragraphs 3.8 and 9.5 above). You should also consider whether the process of a remote assessment may impact negatively on the person’s responses and their reactions. For example, if someone is acutely psychotic and their delusional thinking focuses on technology, then a remote assessment may not be a ‘suitable manner’ in which to conduct the assessment.

9.8 Further advice around the use of technology will be issued as soon as

possible and discussions are taking place as to what technology is available to assist with this within different environments. Be mindful that you cannot record the MHA assessment and principles of data protection and confidentiality should be followed.

9.9 Before undertaking the MHA assessment consider issues of hygiene, i.e.

wash your hands, use sanitising gel, and use gloves. Don’t take any belongings into the MHA that you don’t need.

10. Guidance for the AMHP undertaking the MHA Assessment 10.1 During the MHA assessment ensure safe distances are maintained at all

times, don’t touch surfaces unless you have gloves on, don’t pack clothes without wearing gloves.

10.2 If you feel you are unable to complete the MHA assessment for reasons of

safety or simply not feeling as though you can properly assess please escalate to your manager/senior practitioner/Lead AMHP before commencing/ continuing.

10.3 Once the MHA assessment has concluded please consider hygiene, wash

your hands, go home, shower, change your clothes, etc. (daytime and OOH). 10.4 Health professionals are being encouraged to spend no more than 15 minutes

with their patients currently. Whilst this is a good benchmark it may not be possible to adhere to, in which case the AMHP should aim to spend no longer than is absolutely necessary with the person being assessed. Ensure, if any discussions are required, that they occur away from the environment in a ‘safe’ place. Ensure wherever possible that you wait in your car (on your own) for the ambulance.

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Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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10.5 Do not convey patients in your car at this time. 10.6 Appendices B & C contain the MHA Guiding Principles and relevant

paragraphs from the Code of Practice respectively. This information is still required to inform your assessment and decision making.

11. Guidance for the AMHP following MHA Assessments 11.1 If you are asked to undertake back to back MHA assessments, please

consider this carefully and escalate if necessary. Every effort will be made to complete MHA assessments when they come in during the daytime so as to avoid passing work to colleagues on the next shift. Daytime AMHPs should equally only undertake one MHA assessment before going home. Outline reports can be written up to accompany the patient. Full reports should be written once you are at home and have considered all hygiene measures.

11.2 These are extraordinary circumstances and it is expected that our practice will need to change. It is imperative that you retain a written record of your rationale in order to evidence that appropriate, defensible decisions were made in each case. Please promptly record within your MHA assessment, all your considerations, the balancing exercise you have undertaken and your decision as to how best to proceed with a MHA assessment.

12. Role of Other Agencies 12.1 Where possible a psychiatrist from the community team should prioritise

involvement in a MHA assessment over other commitments. This is because a doctor from the team is best placed, at the point of the assessment, to decide whether treatment can be provided in a less restrictive way than admission to hospital under the MHA.

12.2 Where a psychiatrist from the community needs to complete a medical

recommendation prior to the assessment, they will need to agree with the duty worker, or the allocated AMHP, whether they should complete a medical recommendation for admission under section 2 or section 3. Where possible they should send a copy of their completed medical recommendation through at the time of referral.

12.3 When the patient is open to a referring team, the psychiatrist from that team is

responsible for securing a bed for the patient. 12.4 Referrers may assess that they are unable to support a patient on the basis

that the patient is unwilling to engage. The assessment that they are not willing to engage should be based on failed attempts to engage and not on reports from others that suggest that this may be the case, e.g. reports that they have failed to engage with the GP. Patients may be able to engage

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Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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where assertive support is offered, or they will sometimes have the capacity to understand that engagement with a referrer is preferable to the alternative of assessment and subsequent admission under the MHA.

12.5 Where a patient is not engaging with services, potential referrers should

consider whether the risks indicate that a MHA assessment is required, or whether the patient could be referred to community mental health services for further attempts to engage.

12.6 After a referral has been made the duty worker will pass the referral to an AMHP to collect information to ascertain whether an assessment is required, and to then set up the assessment if so needed. Referrers will therefore need to ensure they remain available after making the referral to discuss the referral with the allocated AMHP.

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Appendix A Client’s Information: Name D.O.B NHS Number Ethnicity Home Address Contact Number (s) Current Location GP Information: Name Surgery Telephone Number Next of Kin Information: Name Relation Address Contact Number(s) Worker Details: (CPN/Social Worker/Support Worker/Consultant Psychiatrist) Name Number Team Office Address Referral Information: MH Diagnosis Other Health Diagnosis Expiration date of current Section of MHA if relevant. Date and time S5 (2) was commenced. Time S136 was commenced. Information to be faxed to business services on 01246 275198 Safety Plan (preferably updated for the purposes of the referral but at the very least updated within the last month.) Most recent Care Plan/ CPA Outpatient Letters and the last discharge summary. Medication Lists (and any other information of relevance)

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Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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Appendix B

Guiding Principles of the Mental Health Act 1983

Least restrictive option and maximising independence - Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. Wherever possible a patient’s independence should be encouraged and supported with a focus on promoting recovery wherever possible. Empowerment and involvement patients should be fully involved in decisions about care, support and treatment. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Respect and dignity - patients, their families and carers should be treated with respect and dignity and listened to by professionals. Purpose and effectiveness decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current available best practice guidelines. Efficiency and equity providers, commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. All relevant services should work together to facilitate timely, safe and supportive discharge from detention.

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Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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Appendix C

Relevant paragraphs from the Mental Health Act Code of Practice

14.4 A person can be detained for assessment under section 2 only if both the

following criteria apply: 1. The person is suffering from a mental disorder of a nature or degree which

warrants their detention in hospital for assessment (or for assessment followed by treatment) for at least a limited period, and

2. The person ought to be so detained in the interests of their own health or safety or with a view to the protection of others.

14.5 A person can be detained for treatment under section 3 only if all the following

criteria apply: 1. The person is suffering from a mental disorder of a nature or degree which

makes it appropriate for them to receive medical treatment in hospital 2. It is necessary for the health or safety of the person or for the protection of other persons' that they should receive such treatment and it cannot be provided

unless the patient is detained under this section, and appropriate medical treatment is available.

14.6 Local arrangements should, as far as possible, ensure that assessments are carried out by the most appropriate AMHP and doctors in the particular circumstances. 14.7 Unless different arrangements have been agreed locally between the relevant authorities, AMHPs who assess patients for possible detention under the Act

have overall responsibility for co-ordinating the process of assessment. In doing so, they should be sensitive to the patient’s age, sex, gender identity, social, cultural or ethnic background, religion or belief, and/or sexual orientation (see chapter 3 for more information). They should also consider how any disability the patient has may affect the way the assessment needs to be carried out.

14.8 Doctors and AMHPs undertaking assessments need to apply professional

judgement and reach decisions independently of each other, but in a framework of co-operation and mutual support.

14.9 Unless there is good reason for undertaking separate assessments, patients

should, where possible, be seen jointly by the AMHP and at least one of the two doctors involved in the assessment.

14.10 While it may not always be feasible for the patient to be examined by both

doctors at the same time, they should both discuss the patient’s case with the person considering making an application for the patient’s detention.

Page 16: Mental health practice guidance when considering referrals ... · This presents challenges to the AMHP service and the referral procedure has been reviewed and updated to take account

Version: 1 FOI Status: Public

Derbyshire County Council Adult Social Care

Derbyshire Approved Mental Health Professional Service Practice Guidance when Considering Referrals, and Planning and

Undertaking Mental Health Act Assessments during the Covid-19 Pandemic

Issued: April 2020 Review Due: June 2020

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14.11 Everyone involved in an assessment should be alert to the need to provide support to colleagues, especially where there is a risk of the patient causing physical harm. People carrying out assessments should be aware of circumstances in which the police should be asked to provide assistance, in accordance with arrangements agreed locally with the police (see paragraph 14.48), and how to use that assistance to maximise the safety of everyone involved in the assessment.

14.12 Although AMHPs act on behalf of a local authority, they cannot be told by the

local authority or anyone else whether or not to make an application. They must exercise their own judgement, based on social and medical evidence, when deciding whether to apply for a patient to be detained under the Act. The role of AMHPs is to provide an independent decision about whether or not there are alternatives to detention under the Act, bringing a social perspective to bear on their decision, and taking account of the least restrictive option and maximising independence guiding principle.

14.13 If the doctors reach the opinion that the patient needs to be admitted to

hospital, it is their responsibility to take the necessary steps to secure a suitable hospital bed; it is not the responsibility of the applicant. In some cases, it could be agreed locally between the local authority and the relevant NHS bodies and communicated to the AMHP that this will be done by any AMHP involved in the assessment.