Rectifiable & non rectifiable errors on MHA forms

 

This fascinating yet also informative post is all about how to fill in statutory MHA forms correctly.

This is vitally important, as an invalid form could lead to the patient being subject to unlawful imprisonment and they could sue.

It’s all in the Mental Health (Hospital, Guardianship and Treatment Regulations) 2008, which were amended in 2020 to accommodate electronic production and transmission of forms. This states that there are certain statutory forms that have to be used for compulsory admissions and other legal aspects of the MHA, and these regulations give the wording that has to be used on the forms.

Traditionally, these forms are pink, although they don’t have to be. It’s the wording on the forms which is statutory, not the forms themselves – you could write them out by hand if you wanted, as long as you used the wording set out in the Regulations.

These forms present the information that has to be provided to the managers of a hospital in order for them to be able legally to receive and detain the patient. As the Code of Practice says:

People who sign applications and make the supporting medical recommendations must take care to comply with the requirements of the Act. People who act on the authority of these documents should also make sure that they are in the proper form, as an incorrectly completed or indecipherable form may not constitute authority for a patient’s detention.

The Code goes on to say:

If admission documents reveal a defect which fundamentally invalidates the application and which cannot, therefore, be rectified..., the patient can no longer be detained on the basis of the application.

Because of the potential risk of a form being invalid, it tends to be best practice to go with, or at least to follow, the patient to hospital, and then not leave until someone authorised to do so has scrutinised the documents and made sure they are legally sound. That way, if there are any mistakes, at least on the AMHP’s form, they can be rectified while the AMHP is still there.

The current chronic shortage of psychiatric beds has meant that patients often have to be transported long distances to mainly private hospitals, so this can make going with the patient impracticable. In those cases, it’s a good idea to fax or email the forms to the hospital beforehand, so that they can be checked and approved before the patient arrives.

There are rectifiable and non rectifiable errors, and s.15(1) MHA allows 14 days for rectifiable errors to be corrected.

Many years ago, the CQC issued useful guidance on scrutinising and rectifying statutory forms. It gives examples of errors that can be rectified (although it’s a bit more vague when it comes to defining non-rectifiable errors). This document says that:

Documentary irregularities fall into three broad groups:
♦ Those that are both incapable of retrospective correction and sufficiently serious to render the patient’s detention invalid.
♦ Those that may be rectified within 14 days after admission, but which, if not rectified, are sufficiently serious to render the application invalid at the expiry of that period.
♦ Errors and omissions that, even if they are not corrected within the statutory period, are not sufficiently serious to render the admission application invalid.

Rectifiable errors are usually fairly minor things, like minor errors in the address or name of the patient, or not crossing out things that needed to be, or leaving blank spaces where you should have written something. An example might be not crossing out the bit on the application referring to being unable to identify the nearest relative, when in fact you have identified the nearest relative. But they can be bigger errors, such as two doctors from the same clinical team providing recommendations. But as long as you get another medical recommendation within 14 days, you’re all right.

Non rectifiable errors include things like naming the wrong hospital, or failing to sign a form. Another one would be a form completed by someone not authorised to complete the form, for example an application made by someone who was not actually an AMHP.

Another would be using the wrong forms. I can remember an occasion when I was called out to do an assessment by a GP. However, by the time I arrived at the patient’s home, the patient had already gone off to hospital in an ambulance. When the ambulance arrived at the hospital, the patient was brought onto the ward, clutching a single piece of pink paper in their hand. This turned out to be a Nearest Relative Application form. The Nearest Relative had completed the first part of the form, and the GP had then written in a space on the back “I certify that this person should be detained under the Mental Health Act” and had then signed it.

But anyone can make a mistake, especially when things get a little bit out of control. I’ll tell you about an occasion in which I made a fatal error.

One day, I was called to assess a patient who was well known to me, and who had been detained several times before under s.3. I set up the assessment at her house, and arranged for two doctors to meet me there. When I arrived, she was in the street behaving in an erratic manner. The police had been called, and took her to the police station under s.136.

I let the doctors know before they arrived, and they then went to see her at the police station, which was being used as a place of safety.

By the time I got there, they had already assessed her, and gave me a completed joint medical recommendation. I then assessed her myself, completed an application under s.3, and arranged for an ambulance to take her to hospital.

I followed in my car, with the pink forms on the passenger seat, I happened to glance at the paperwork as I was driving, and realised with horror that the doctors had completed a form for a s.2, not a s.3, as I had assumed. So I pulled into the next layby and hurriedly completed an application for a s.2 to make the whole thing legal again.