Relatives are frequently unaware of their right under
Sec.13(4) MHA to request an assessment of their relative under the Mental
Health Act.
Those who are aware of this, are often under the
misapprehension that this will inevitably trigger a visit to their relative by
an Approved Mental Health Professional and two doctors.
Sec.13(4) states:
(4) It shall be the duty of a local social services authority,
if so required by the nearest relative of a patient residing in their area, to
make arrangements … for an approved mental health professional to consider the
patient’s case with a view to making an application for his admission to
hospital; and if in any such case that professional decides not to make an
application he shall inform the nearest relative of his reasons in writing.
The new extended 2015 Reference Guide has very little to say
to enlarge upon this, other than referring the reader to the new 2015 Code of
Practice, and stating that “the nearest relative can require the local
authority (verbally or in writing)…to arrange for an approved mental health
professional (AMHP) to ‘consider the patient’s case’ including whether there is
a need for compulsory admission to hospital.” (p.21).
The Code of Practice only refers to this section in two
paragraphs, at para14.36, and para14.102. The only thing that para13.36 adds is
to state that the local authority must respond not only to a direct request from
the Nr, but also to a request “on behalf of” the NR.
So what does all this mean to the nearest relative and to
the AMHP receiving a request under Sec.13(4) from the nearest relative?
The NR does not need to put the request in writing, but can
make a request by phone. They can also ask someone else to make a request, such
as another relative, or their GP, and this must be considered as if it were a direct request from the NR.
The local authority AMHP service has to respond to this
request. But this does not necessarily mean that they will conduct a formal
assessment. An AMHP only has to “consider the patient’s case”. If, having done
this, they do not think that an assessment is merited, there is no requirement
to assess.
From the AMHP point of view, there may be many reasons why
it is not appropriate to assess the patient under the MHA. A typical reason may
be that other arrangements are being, or have been made. This might include a
GP referring the patient to the local crisis team for assessment. It would
therefore be wrong to pre-empt this assessment, under the principle of the
least restrictive option.
Another reason might be that the patient is already involved
with a community mental health team, who are managing the patient’s condition
and would not welcome and AMHP’s intervention, or do not consider that a MHA
assessment is necessary.
It may be that, while the relative is concerned about the
patient, the patient has not actually seen a doctor recently. In which case, I
would always advise the relative that they should arrange for the patient to
see a doctor first.
In some cases, the request may be “mischievous”; in other
words, the relative may have made frequent or recent requests for their
relative to be assessed, and unless there has been any significant changes in
the patient’s condition, it would be oppressive to keep formally assessing the
patient.
I recall one such case, where the mother of the patient, a
pregnant single parent with a young child, reported that she was expressing a
range of alarming paranoid delusions, especially around her unborn baby. The
ex-partner of the patient also corroborated this.
I went out with the GP and a psychiatrist, to find her
preparing tea for her daughter and a school friend. Everything appeared
completely normal, and she spoke politely and rationally to us for about an
hour. We were unable to elicit any symptoms of mental illness, but based on the
reports of the relatives, we rather heavy-heartedly decided to detain her, and
she was detained under Sec.2 for 28 days.
During that time she was not given any medication, and did
not provide any evidence to ward staff of any mental illness.
On another occasion, I received a request from the husband
of a woman. They were recently separated. His concerns seemed to boil down to
the view that since his wife did not want to talk to him, and would not agree
to what he wanted to happen to the property and children, then she must be
mentally ill. I did not respond to this request.
Once an AMHP has considered the case, and has either decided
not to undertake a formal assessment, or has assessed and has decided not to
detain, they have a legal requirement to write to the referring relative. These
letters have to be very carefully written. The Code of Practice states: “Such a
letter should contain, as far as possible, sufficient details to enable the
nearest relative to understand the decision while at the same time preserving
the patient’s right to confidentiality.”(para14.102)
Sec.13(4) requests from nearest relatives always used to be
a fairly rare occurrence. Recently, however, our local AMHP service has
received a mysterious increase in these requests. Could it be that relatives
are becoming better informed about their rights under the Mental Health Act?
I don’t actually think so. We have discovered that relatives
have been contacting the patient’s community mental health team because of
concerns about their mental health, who have then advised them to make a
referral to the AMHP service.
This appears to be due to service cuts or staff shortages.
It appears that increasing numbers of patients are active to community teams,
but have not got an allocated care co-ordinator, and the over worked duty
worker has the idea that, if their team cannot make a timely response, then the
AMHP service can always conduct an assessment under the MHA.
We have been working hard to disabuse community mental health services of this notion.
