Try the Masked AMHP's quiz.. |
This post is prompted by a situation I encountered recently
while working as the duty worker for our local AMHP Service. It related to a
dispute with an AMHP from another local authority concerning who was
responsible for responding to a request to make an assessment under Sec.3 MHA
for a patient detained under Sec.2 MHA.
Briefly, this was the scenario.
The patient (P) normally lived in our area (Local Authority
A). P was admitted informally to a private specialist hospital located in Local
Authority B, without any involvement with our local AMHP service. P was
subsequently placed on a Sec.5(2) by the hospital, and an AMHP in Local
Authority B assessed and detained under Sec.2 MHA for assessment.
P was then transferred to another private specialist
hospital in Local Authority C. That hospital subsequently requested an
assessment for detention under Sec.3 for treatment.
The question was: which local authority was responsible for
undertaking this assessment?
Was it:
A) Local Authority A
B) Local Authority B
C) Local Authority C
To answer
this question we need to look at what the Mental Health Act itself says, and
also the Reference Guide and the Code of Practice.
At times the
wording in the MHA can be a little confusing, and Sec.13, which is concerned
with the duty of AMHPs to make applications for
admission or guardianship.
Sec.13 says:
(1) If a local social services authority have reason to think that an
application for admission to hospital … may need to be made in respect of a
patient within their area, they shall make arrangements for an approved mental
health professional to consider the patient’s case on their behalf.
(1A) If that professional is—
(a) satisfied that such an application ought to be made in respect of
the patient; and
(b) of the opinion, having regard to any wishes expressed by relatives
of the patient or any other relevant circumstances, that it is necessary or
proper for the application to be made by him, he shall make the application.
Then it gets even more complicated in Sec.13(1B), which invokes
Sec.13(1C). Here it is in all its convoluted beauty:
(a) a local social services authority makes arrangements under
subsection (1) above in respect of a patient;
(b) an application for admission for assessment is made under subsection
(1A) above in respect of the patient;
(c) while the patient is liable to be detained in pursuance of that
application, the authority have reason to think that an application for
admission for treatment may need to be made in respect of the patient; and
(d) the patient is not within the area of the authority.
(1C) Where this subsection applies, subsection (1) above shall be construed
as requiring the authority to make arrangements under that subsection in place
of the authority mentioned there.
Bear in mind in reading this that Sec.13(1A), (1B) & (1C) were
inserted into the MHA by the 2007 Act specifically in order to clarify the situation regarding
local authority responsibility for assessments under Sec.3 MHA.
Thankfully, the Reference Guide offers an easy to understand
translation. Para8.16 states:
Local authorities must
arrange for an AMHP to consider a patient’s case on their behalf, if they have
reason to believe that an application for admission to hospital may need to be
made in respect of a patient who happens, at the time, to be within their area.
It does not matter whether the patient lives in the area.[my highlighting]
Crucially, Para8.18
continues:
In certain cases, local
authorities must also arrange for an AMHP to consider the case of a patient who
is in a hospital outside their area. This applies where the patient concerned
is already detained for assessment on the basis of an application made by an
AMHP acting on behalf of the local authority in question. If that local
authority has reason to think that an application for admission for treatment
may now be needed for the patient, it is that local authority, rather than the
one for the area in which the hospital is, or where the patient lives, which is
under a duty to arrange for an AMHP to consider making the further application. [my highlighting]
The code of
Practice spells this out even further. Para14.37 says:
If a patient
is already detained under section 2 as the result of an application made by an
AMHP, the local authority on whose behalf that AMHP was acting is responsible
for arranging for an AMHP to consider the patient’s case again if the local
authority has reason to believe that an application under section 3 may be
necessary. This applies even if the patient has been detained outside that
local authority’s area.
To go back to
the original scenario, the correct answer is Local Authority B, the local
authority that initially made the Sec.2 application, even though the patient,
who did not normally live in their area, is now in a hospital in another area.
So when I was
contacted by the AMHP I mentioned at the beginning of this post, I reminded him
of what Sec.13 said. He countered by suggesting that it was not appropriate for
his local authority to undertake the assessment, but it was appropriate for
ours to do it.
He was
clearly relying on the last sentence of para14.37, which reads:
These duties
do not prevent any other local authority from arranging for an AMHP to consider
a patient’s case if that is more appropriate.
However, that
does not place any obligation on our AMHP service to consider the case, which I
pointed out.
He replied
that it would involve a 2 hour journey to get to the hospital 80 miles away. My
response was to point out that one of our AMHPs would have to travel 150 miles,
which would take at least 3 hours, for a patient about whom we had less
knowledge than Local Authority B. He then concluded that they would probably
decide not to accept responsibility for the assessment.
As I thought
that it was an interesting response for a local authority to refuse to
undertake a task that was their legal duty, I decided to write this post.
But what
about Local Authority C? P was definitely in their area, and not far for them
to travel? Surely they would do the assessment on behalf of Local Authority B?
Unfortunately
not. I had already had dealings with C’s AMHP service in the past, following a
request for a Sec.3 assessment for a patient that we had detained under Sec.2.
Their policy was to refuse any requests where they did not have a duty to
respond. In that situation, an AMHP did have to travel 150 miles, and take an
entire day, to do the assessment.
It’s all to
do with duty versus power. Where AMHP’s have a duty to act, they have to act. Where
they have the power to act, such as a situation where a patient in Local
Authority X is taken by police under Sec.136 to a Sec.136 suite in Local Authority
Y’s area, they could choose to do the assessment or not, while the AMHP in
Local Authority Y would have to do it.
Our local
authority, being a large, predominantly rural county, has several private
hospitals which accept patients from all over the country. It is not uncommon for
patients to be admitted under Sec.2 to these hospitals, and then be required to
be assessed under Sec.3. Our AMHP service policy is generally to do these
assessments, as long as the responsible local authority asks us nicely.
But we don’t
have to.
.... and of course it's all the same tax payers money! The division of budgets means that so much is wasted on a £300 round trip but "not out of my pot mate "..... This is the real madness in our society!
ReplyDeleteI often say that to people about public moneysaving but now half if where we work is no longer public money...
ReplyDeleteIf P is from area F but in a general hospital in area a. Whos duty is it to assess under the MHA if there is no section in place but a request from the hospital.
ReplyDeleteArea A. LA has duty to assess someone in a hospital in their area, regardless of where they're from, if on s.5(2) or informal.
ReplyDelete