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Mental Health (Amendment) Act 1982

DHSS Health Circular

This circular notifies health and local authorities of the principal changes to be introduced when the Mental Health (Amendment) Act 1982 is implemented on 30 September 1983 and promises further guidance.

1. The Mental Health (Amendment) Act 1982 received Royal Assent on 28 October 1982. The new Act makes substantial amendments to the 1959 Mental Health Act. Its provisions will, for the most part, take effect from 30 September 1983, by which time it is hoped that all the amendments made to the 1959 Act will have been consolidated in a new Mental Health Act.
   
2. If it is enacted, the consolidated Act will, of course, look rather different from the 1959 Act, with different section numbers. The Department will be issuing an explanatory memorandum well in advance of 30 September 1983, to ensure that health authorities, local authorities and health and social services staff have time to familiarize themselves with the new provisions before they have to put them into practice.
   
3. Some of the changes made by the Mental Health (Amendment) Act 1982 are described briefly below.
   1. A special health authority to be called the Mental Health Act Commission is to be set up to protect the interests of detained mental patients. (There is power in the Act for some of the Commission's functions to be extended to informal patients, but this is unlikely to be brought into operation for a few years.) The Commission will be multidisciplinary and will have a key role to play in new provisions governing the treatment of patients. Its members will visit detained patients and investigate complaints and it will review the use of powers of detention. It will also produce Codes of Practice on admissions procedures for detained patients and on the treatment of mental disorder.
      
   2. New requirements regarding the treatment of detained patients for their mental disorder will be introduced. There will be three categories of treatments:
      1. Some treatments—such as psychosurgery and other treatments to be specified in regulations—will require both the patient's consent, independently attested, and a second opinion from a doctor appointed by the Mental Health Act Commission. (The special provisions for this very limited category of treatments will also apply to informal patients.)
         
      2. Other treatments, also to be specified in regulations—such as ECT and prolonged drug treatment—may be given without consent if an independent doctor appointed by the Commission agrees, after consulting two people from other professions who have been concerned with the patient's treatment.
         
      3. Other drug treatment may be given for up to three months without consent and without a second opinion, on the authority of the responsible medical officer.
         
      
      There will be special provisions to allow urgent treatment. Treatments under (i) and (ii) will be subject to periodic review.
      
   3. The period before detention for treatment has to be renewed is to be halved. This means that detained patients will have twice as many opportunities to apply to Mental Health Review Tribunals. Patients detained under the 28 day power will also be able to apply. There will be automatic Tribunal reviews after the first six months for non-offender patients and then every three years for all detained patients who have not applied in the meantime. (These are being phased in now—HN(82)25 refers.) Tribunals will have authority to discharge restricted patients and to recommend in respect of any patient one of a range of other options. Applicants to tribunals will be able to have legal assistance by way of representation, although this is not actually in the mental health legislation. (Guidance on this has already been issued in Circular HN(82)37.)
      
   4. The new term ‘mental impairment’ is being introduced instead of ‘subnormality’ for the few abnormally aggressive or seriously irresponsible mentally handicapped people who need to be detained. For those suffering from mental impairment or psychopathic disorder, detention for treatment will be possible only if the person is thought to be treatable.^*
      
   5. Tighter time limits will be imposed on compulsory emergency admissions on the signature of a single doctor (Section 29 of the 1959 Act) so as to avoid misuse of the emergency power.
      
   6. There will be a legal obligation on hospital managers to do what they can to ensure that detained patients understand their legal status and their rights and also to give written information to the patient's nearest relative if possible.
      
   7. Social workers will be more involved even where the nearest relative has applied for the patient's admission. From 20 October 1984 mental welfare officers will be replaced by approved social workers who will be specially trained for their work under the Act.
      
   8. Where a doctor is not immediately available, certain nurses will be authorized to detain, where necessary, someone already in hospital as an informal patient for up to six hours.
      
   9. New powers will enable a Court, after appropriate consultation, to remand a person to hospital for a report or treatment or to make an interim hospital order, so that the Court can assess whether a mentally disordered person appearing before them ought to be made the subject of a hospital order. These remand and interim order provisions will be phased in gradually in the next two to three years.
      
   10. Regional Health Authorities will be required to give information to the Courts, on request, about what hospital places are available for a mentally disordered offender.
       
   11. Provisions concerning legal proceedings against staff carrying out their work under the Act are being changed so that permission for criminal proceedings will be sought from the Director of Public Prosecutions rather than the High Court. The word ‘substantial’ has been deleted from the requirement to show grounds of bad faith or lack of reasonable care on the part of the member of staff before permission is given.
       
   12. From 1 April 1983, informal patients in mental hospitals will be able to make a declaration which allows their names to be included on the 1984 electoral register.