Here is May’s update of the Southwark mental health carers forum. This is one of the 4 to 5 carer groups I run each month. All carer forums and support groups are run online via Zoom due to social distancing because of COVID-19. I feel families and carers still need to know what is happening with services especially when health and social care is under strain.

In attendance for the forum we had carers from Southwark and also from Lambeth since the Lambeth carers forum is not running at the moment. We were also joined by trustees of Southwark Carers, plus Southwark Healthwatch were in attendance. We were also joined by Maudsley’s NHS Southwark inpatient carer lead, plus a carer who co-runs their carer groups. The main presentation was from Bernadette Pickerell who is SLaM’s Mental Health Act Team Leader and Senior MHA Co-ordinator.

Bernadette was at the forum to present to carers about the Mental Health Act and what South London & Maudsley NHS Foundation trust are working towards. As a former carer, I feel carers not only need to take note of the Care Act, but also the mental health Act if caring for someone with a mental illness.

Before I update on the mental health Act presentation, forum members were given an update from David Meyrick who briefed carer members on the situation of the inpatient wards. David also feedback regarding a query on Covid-19 bereavement advice for family & carers.

I have placed the PDF here for download for carers who have a loved one under SLAM

Covid-19 bereavement advice family and carers

David also updated general points of the SLaM Lambeth and Southwark carer leads forum and also the SLaM community carer leads forum. I have been happy to be a part of those forums and it is great they are continuing to run online.

At the forum we had Southwark Carers who provide information, advice and support to carers, plus also raise awareness of the rights and needs of carers. They updated the forum on what they have been doing since the corona virus. Southwark carers offices are closed, but they have been able to continue to run many services.

Southwark Carers have many events happening during carers week, which I have added below

Carers Week at Southwark Carers

The trustees updated how key workers have been busy contacting carers across the borough and are able to run Zoom meetings.

Southwark carers have managed to update online information about changes to services. Southwark carers have been very busy preparing for Carers week 2020, carer members are very excited on what the activities will be as many carers are isolated and cut off from the community.

Annette Davies a carer and also peer supporter and co-chair of SLaM carer groups was interested if Southwark carers are managing to run their counselling services. Southwark carers as other carer centres have lost funding to provide counselling, but are doing all they can provide services and get funding back.

Carers from the Lambeth borough fed back what they thought of the Lambeth hospital consultation event, but due to the corona virus situation many want the consultation to be extended. Southwark Healthwatch mentioned that they are doing what they can to increase feedback and engagement regarding the consultation.

SLaM Mental Health Act Overview

The forum then moved on to the Mental Health Act Overview. Bernadette Pickerell provided an hour long breakdown of the Mental health Act and how SLaM is working with the MHA.

Bernadette spoke on the following.

• What SLaM’s Mental Health Law Team consisted of.
• The Mental Health Act and how it works.
• The MHA Overview.
• Summary of MHA Sections.
• Key Roles of staff when sections are used.
• The Nearest Relative Roles.
• Important Decision Makers.
• Code Participation Principles.
• Safeguards of the MHA.
• MHA on a wards.
• Use of Community Treatment Orders.
• Breakdown of Acronyms.
• Liberty Protection Safeguards (LPS).
• The Mental Health Act Review.
• MHA SLaM audit.
• The COVID19 Emergency Legislation.
• Plus The Coronavirus Act 2020.

I will cover some of the topics from my notes, although it would be far too large to put all the information off this blog post.

What SLaM’s Mental Health Law Team consisted of.

SLaM as with many other MH NHS Trusts have a Mental Health Act Law Team, which consist of up to 2 staff that each have offices based over 4 sites. Their AHM Administration is managed centrally.

Their department is final line of defence for ensuring lawful detention and lawful treatment of service users detained on a mental health act sectionn. The SLaM MHA department also manage the administration process for both MHT and AHM hearing appeals process for service users as well as monitoring AWOLs and Community Treatment Orders.

SLaM have a service level agreements to Kings College Hospital, Guys and St Thomas’, Croydon University Hospital and University Hospital Lewisham.

The Mental Health Act and how it works

The Mental Health Act 1983, provides a legal framework for the assessment and treatment for someone with a serious mental health problem.

• The MHA is used either to bring someone into hospital, or to detain someone already in hospital.
• The Mental Health Act will restrict the person’s freedom of movement and choice of treatment due to the patient being at risk to themselves or others.
• There are of course Stigma due to being ‘sectioned ‘ – police / ambulance service may be involved in bringing someone to hospital.

MHA Summary of sections

Not all of the following sections are used at SLaM, so Berndatte was just explaining the different types. I have also added a few outside of the forum presentation for those who are interested.

SECTION 131: Informal Admission

Any person may request inpatient admission and can be admitted without any legal formalities, however Under Section 5 of the Mental Health Act, doctors and nurses can stop the patient from leaving if they are worried about the patient.

SECTION 2: Admission for Assessment

An application for the admission of the patient must be made by either an Approved Mental Health Professional (AMHP) or the Nearest Relative.

SECTION 3: Detention for Treatment

This admission is for up to 6 months which is then renewable initially for a further 6 months followed by periods of one year at a time for treatment.

SECTION 4: Emergency Admission for Assessment

Made either by an AMHP or the Nearest Relative based on a recommendation from a medical practitioner who must have
seen the patient within the last 24 hours.

SECTION 5(2): Emergency Holding Power – For Patients Already in Hospital

Remember this section under informal admission? Basically its used for detaining an informal patient who is already in hospital for up to 72 hours.

SECTION 5(4): Nurses Emergency Holding Power – For Patients Already in Hospital

Allows a nurse, to detain an informal patient who is already being treated for mental disorder, as an inpatient in hospital for up to six hours.

SECTION 136 – removal of mentally disordered persons without warrant.

A very common and infamous section. If a person appears to a police officer to be suffering from mental disorder then remove the person to a place of safety.

SECTION 135 – Warrant to Search and Remove

Allows a police officer to remove a person where there is reason to suspect that a person is suffering from a mental disorder and is being ill-treated, neglected or unable to care for themselves and lives alone.

SECTION 136B – extension of detention

The registered medical practitioner who is responsible for the examination of a person detained under section 135 or 136 may authorise the detention of the person for a further period not exceeding 12 hours.

SECTION 136C – protective searches

Where a warrant is issued under section 135 a police officer may search the person on reasonable grounds for believing that the person may present a danger to themselves or others.

SECTION 7: Application for Guardianship

Allows a patient to be placed under the supervision of a guardian

SECTION 17 – Leave of Absence

Section 17 allows the Responsible Clinician (RC) to grant a detained patient leave of absence from hospital. It is the only legal means by which a detained patient may leave the hospital site.

SECTION 20 – Renewal

This allows for the section to continue for a further period of either six or twelve months, dependent upon the length of time they have already been detained.

SECTION 23 – Discharge

This section empowers the Hospital Managers, the Responsible Clinician and the Nearest Relative to discharge a patient.

SECTION 17A: Community Treatment Orders (CTOs)

CTOs were introduced by the 2007 Act to replace section 25A Supervised Discharge. CTOs should be considered for any patient who is granted section 17 leave for more than seven consecutive days. A CTO gives the Responsible Clinician the ability to recall the patient to hospital.

SECTION 58A: Electro Convulsive Therapy
SECTION 62: Urgent Treatment

A treatment otherwise restricted by section 57 or section 58 may be given without the patient’s consent as being immediately necessary to save the patient’s life.

SECTION 15: Scrutiny and Rectification of Documents

Receipt and Scrutiny is the process of checking that the section papers for patients who are to be detained under the MHA or subject to CTO,s are legally correct.

SECTION 140 Notification of hospitals having arrangements for special cases

Clinical commissioning groups (CCGs) are responsible for commissioning mental health services to meet the needs of their areas. Under section 140 of the Act, CCGs have a duty to notify local authorities in their areas of arrangements

SECTION 18 – Absence Without Leave

This section provides powers for retaking detained patients who are absent without leave from hospital or who fail to return from leave either at the end of leave or when recalled.

SECTION 117- Aftercare

It is the duty of the health authority & local social services to provide, in co-operation with relevant voluntary organisations and aftercare services. Those subject to S117 are patients on (or have been on) S3, S37, 45A, S47 & S48.

Breakdown of Acronyms

RC – Responsible Clinician, sole person who is in charge pf the patients care and treatment, can grant leave and end sections.
AMHP – Approved Mental Health Professional.
SOAD – Second Opinion Doctor
NR – Nearest relative as defined in s26 ( not the same as next of kin)
MHT – Mental Health Review Tribunal
AHM – Associate Hospital Manager
AWOL – Absent without Leave
IMCA – Independent Mental Capacity Advocate
IMHA – Independent Mental Health Advocate
MOJ – Ministry of Justice
DOH – Department of Health
CQC – Care Quality Commission
CoP – Code of Practice

The Mental Health Act Review.

Sir Simon Wessely’s review of the Mental Health Act 1983 was published in December 2018.  The report is approximately 300 pages long grouped by reference to a series of principles, namely:

Truth and autonomy
The use of least restriction
Therapeutic benefit
The person as an individual

The UK Government will now consider the report and which of its recommendations to adopt, if any.

• Change s26 nearest relative to nominated person
• S131 Informal admission to sit above s2 & s3
• S2 to be reviewed after 14 days
• Advance Choice Documents, patients can express their views about future care and treatment (to be recorded when the patient has capacity)
• Advocacy to be extended to informal patients
• Children 16-17 years should not be admitted and treated purely on the basis of parental consent
• Police cells not used as a “Place of Safety”

The COVID19 Emergency Legislation.

The Coronavirus Act 2020 is a new law to help deal with the coronavirus (COVID-19) outbreak. It applies across the UK, including in English and Welsh law. Legal changes introduced by the new Act may affect how the Mental Health Act 1983 works in England and Wales.

The changes introduced by the Coronavirus Act 2020 will only apply for a certain period of time, known as the ’emergency period’.

There are different emergency periods for different areas of the law affected by the new Act.
There are specific provisions for the Mental Health Review Tribunal for.
The emergency period for the Mental Health Act 1983 has not yet started.

Other MHA Presentation information

Carer members of the Southwark MH Carers forum were very interested in the role of the nearest relative and were concerned about the Mental Healths Act review on the role of nearest relatives. A lot of interest was also on the COVID19 emergency legislation and if it would increase members of the BAME community into section due to lack of community resources.

Healthwatch Southwark Update

Alice from Southwark Healthwatch updated the Southwark carers forum on what they do. Basically Healthwatch Southwark is part of Community Southwark, a charity which works with the local voluntary and community sector.

There is a Healthwatch in every area of England, and an umbrella body – Healthwatch England.

HW Southwark listen to peoples experiences of health and care services in order to drive improvements.

HW Southwark also do the following

1. Provide information and signposting on local health and care services.
2. Promote and support the involvement of patients and service users in the design, provision and scrutiny of local health and care services.
3. Listen to Southwark residents about your needs, and your experiences of health and social care services.
4. Plus voice the views and concerns of local people in order to make health and social care services better.

Healthwatch Southwark have been doing a lot of work in the borough and a number of things stand out as a major interest to the Southwark MH carers forum. HW Southwark have been working on The Impact of Caring on Unpaid Carers.

You can find out more from their report below.

The Impact of Caring on Unpaid Carers

Due to running out of time HW Southwark will be back in June to present more of their work, plus some other healthwatches will be in attendance along with an MP updating how Southwark and Lambeth have been supporting Carers Week 2020.

This concludes the May update of the Southwark MH carers forum.