Thursday, 26 June 2014

Ask the AMHP -- This Week: Sec.5(2), Conflicts of Interest, and the Isle of Man MHA

Ask The Masked AMHP for the answers to your thorny MHA related problems. He might know the answer. Or not.
A psychiatrist asks:
Can someone detained under Sec.5(2) who is in need of medical treatment for physical reasons be transferred to a medical ward in a general hospital?

The Masked AMHP replies:

No. Para 12.40 of the Code of Practice states unequivocally:  “It is not possible for patients detained under section 5 to be transferred to another hospital under section 19 (because they are not detained by virtue of an application made under Part 2 of the Act).”

It would be justifiable to admit them to a medical ward on the basis of urgent medical necessity, especially if the patient recognises they are in need of medical treatment, but it could not be done by the use of either transfer or Sec.17 leave.

Another psychiatrist asks:
What constitutes a conflict of interest when conducting an assessment under the MHA?

The Masked AMHP replies:

Para 7.9 of the Code of Practice states that:
“a conflict of interest for professional reasons will occur where:
  • the assessor is in a line management or employment relationship with one of the other assessors or the patient or the nearest relative (where the nearest relative is the applicant);
  • the assessor is a member of the same team as the patient; or
  • where there are three assessors, all of them are members of the same team.”
It continues:
“7.10 A line management relationship will exist whether an assessor manages, or is managed by, one of the other assessors, the patient or the nearest relative (where the nearest relative is the applicant). Similarly an employment relationship will exist whether the assessor employs, or is employed by, one of the other assessors, the patient or the nearest relative (where the nearest relative is the applicant).
7.11 For the purposes of the regulations a team is defined as a group of professionals who work together for clinical purposes on a routine basis. That might include a community mental health team, a crisis resolution or home treatment team, or staff on an in-patient unit (but not necessarily the staff of an entire hospital).”

To translate this into a typical scenario, where Dr A and Dr B assess a patient with AMHP C:
  • If Dr A supervises Dr B, there would be a conflict of interest.
  • If Dr A and Dr B are of equal status and not supervised by the other, but they both work in the same Community Team as AMHP C, then there would be a conflict of interest.

Someone emails The Masked AMHP to ask:
Is Sec.117 aftercare contained in the Isle of Man Mental Health Act?

The Masked AMHP replies:

This is an interesting question. Many people will be unaware that the Isle of Man, which is an island in the Irish Sea about 80 miles northwest of Liverpool actually has its very own Mental Health Act. The Isle of Man is a British Crown Dependency. It is 32 miles long and 14 miles wide, and has a population of around 81,000 people.

Since it never became part of the kingdom of Great Britain, it has its own Parliament and makes its own laws. This includes a Mental Health Act, which became law in 1998.

Much of the Act mirrors the English MHA 1983, although the Isle of Man still has Approved Social Workers. It even has provision for Aftercare under supervision. It also has an equivalent to Sec.117, which under the Isle of Man MHA is contained in Sec.115:
“(1) This section applies to persons who are-
(a) detained under section 3,
(b) admitted to a hospital in pursuance of a hospital order made under section 54(1) of the Criminal Jurisdiction Act 1993 or paragraph 2 of Schedule 2A to the Summary Jurisdiction Act 1989, or
(c) transferred to a hospital in pursuance of a transfer direction made under section 53 or 54 or a hospital direction, and then cease to be detained and (whether or not immediately after so ceasing) leave hospital.
(2) It shall be the duty of the Department, in co-operation with the Department of Health and relevant voluntary agencies, to provide, or to make arrangements for the provision of, after-care services for any person to whom this section applies until such time as the Department is satisfied that the person concerned is no longer in need of such services; but it shall not be so satisfied in the case of a patient who is subject to after-care under supervision at any time while he remains so subject."

The Isle of Man MHA also has its own Code of Practice. Chapter 27 deals with aftercare. Although most of the chapter equates aftercare with the English Care Programme approach, 27(3) does state:

"Section 115 of the Act requires the Department in conjunction with voluntary agencies, to provide after-care for certain categories of detained patients. This includes patients given leave of absence under section 17. The after-care of detained patients should be detailed in the care plan but because of the specific statutory obligation it is important that all patients who are subject to section 115 are identified and records kept of them. There is a section 115 after-care entitlement when the patient stays in hospital informally after ceasing to be detained under the Act, and also when a patient is released from prison, if they have spent part of their sentence detained in hospital."

I am afraid that I am unable to say whether or not aftercare under Sec.115 is chargeable. Perhaps an ASW in the Isle of Man could enlighten me.


  1. A couple of points:

    s5(2) - if it is to treat a physical need related to a mental disorder then the MHA can be used.

    s17 - leave with condition to go to another (physical/acute (sic)) hospital - do you say this would be illegal only under a s5(2) or more generally for other detained patients? Surely it's OK under s2/3/37 etc? I had a patient who was on s3 who needed treatment in a HIV unit in another hospital - they arranged it under s17 and they went and returned without issues. There was a very delicate discussion had with the AIDs ward team who had a blanket policy of not admitting under a section. On discussion this was because they didn't want the responsibility, so were perfectly happy once the psychiatric team said they would remain responsible and would come and review their patient if the AIDS team had problems.

  2. The other point was that Guernsey (and presumably the other Channel Islands and Gibraltar) are similar to the IoM - they still have ASWs under their own MHA