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Advance directive (also known as advance decision or living will)
A written or oral declaration which enables a mentally competent adult to refuse specified medical treatment if they lose mental capacity in the future. Advance directives are legally binding on clinicians for cases falling under the jurisdiction of the Mental Capacity Act 2005.
A written or oral declaration which patients to make their views known on the care and treatment they would like to receive if they lose the capacity to make decisions for themselves in the future. The statement must be taken into account by clinicians making decisions about the care and treatment of people who lack mental capacity but is not legally binding.
A person who assists a patient or their nominated person (usually a carer or relative) to express themselves and to take an active part in making decisions affecting their lives. The assistance may sometimes take the form of speaking on behalf of the patient but will more often comprise the provision of information about their rights and help in exercising those rights.
Social care and health services which are provided in order to meet the needs of a current or former mental health patient, aimed at reducing that person’s chance of being re-admitted to hospital. These services are currently not means tested for those who have been detained under certain sections of the 1983 Mental Health Act and must be provided free of charge.
AMHP (Approved Mental Health Practitioner)
This new role is created in the Mental Health Bill. It is a mental health professional who is responsible for co-ordinating and carrying out the assessment (along with two doctors) which determines whether compulsory powers should be used on a patient. The AMHP could be a social worker (the role replaces the functions of the Approved Social Worker, see below) but could also be a nurse or an occupational therapist.
ASW (Approved Social Worker)A social worker who has undertaken additional specialist training in the field of mental health. The ASW has specific duties and powers under the Mental Health Act 1983 in relation to the compulsory admission and detention of patients. The ASW role will be abolished under the Bill and replaced by the AHMP (see above).
The decision-making procedure which determines whether, for example, community services will be provided or whether a person is sufficiently unwell to require the use of compulsory powers, such as detention under the Mental Health Act 1983.
BNF (British National Formulary)
The BNF is a joint publication of the British Medical Association and the Royal Pharmaceutical Society of Great Britain. It provides prescribers, pharmacists and other healthcare professionals with up-to-date information and guidance about the use of medicines.
A person who cares for a relative or friend, often providing the help that person needs to stay living at home.
A written plan that describes the care and support that staff will aim to give a patient when they are in the community. Patients should be fully involved in developing and agreeing the plan. (See also CPA below.)
Under the Mental Health Bill, when a patient is registered at a hospital a clinical supervisor must be appointed. The clinical supervisor is the lead clinician responsible for their care. A clinical supervisor will normally be a consultant psychiatrist, but may also be a consultant psychologist.
CPA (Care Programme Approach)
An approach used by specialist mental health services to assess the care needs of, and provide a package of care for, people with mental health problems. For those assessed as needing an enhanced level of care the main elements are a comprehensive assessment, a named care co-ordinator, a written care plan and regular reviews by a multi disciplinary mental health team.
CMHT (Community Mental Health Team)
A multi disciplinary team offering assessment, treatment and care to people with mental health problems living in the community. The team will usually include a nurse, psychiatrist, psychologist, social worker and occupational therapist.
CTO (community treatment order)
A general term relating to any legal order which requires people with mental health problems who are living in the community to comply with specified care and treatment.
The conditions which must be satisfied before someone can be brought under formal powers and provided with treatment and care for a mental illness under compulsion.
ECHR (European Convention on Human Rights
The European Convention on Human Rights is a treaty under international law which declares certain human rights which are or should be protected by the state. It was signed in Rome in 1951,was ratified by the United Kingdom in 1951 and came into force amongst those states which ratified it in 1953.
ECT (electro-convulsive therapy)
Electroconvulsive therapy, also known as electroshock therapy, is a controversial treatment for mental illness involving the induction of an artificial seizure (fit) in a patient by passing electricity through the brain. It is mainly used for people with a diagnosis of severe depression who do not appear to be getting better or are not responding to medication.
Under the Mental Health Bill the examination is the first stage in the process to see whether someone meets the conditions for the use of compulsory powers. If the examination shows that the relevant conditions are met, then the person will become liable to assessment (see above). In most cases this decision will be made by two doctors and a social worker or other non-medical professional.
Certain behaviours or illnesses which are specifically excluded from the definition of mental disorder set out in legislation. Thus a person cannot be treated as being mentally disordered for any purpose under mental health legislation unless they have a mental disorder or the behaviour/condition leads to mental disorder. The Mental Health Act 1983 lists 3 exclusions: promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol and drugs. The current Mental Health Bill has no exclusions.
The Mental Health Bill proposes to create a panel of persons, known as the Expert Panel, to advise the new Mental Health Tribunal (see below), and the courts when required. The Panel will consist of experts from a range of disciplines such as general psychiatry, old age psychiatry, children and adolescents, learning disabilities, psychology and professionals with social care and mental health nursing backgrounds.
Human Rights Act
The Human Rights Act was passed by Parliament in 1998 and brought the European convention for Human Rights directly into United Kingdom law. It is intended to protect individuals against the power of the State and other public authorities by ensuring their individual human rights are upheld.
This concept is referred to in the Scottish Mental Health Act (2003) as one of the conditions which must be satisfied for compulsory powers to be used. It is a modified version of mental capacity (see above). Impaired decision making must be the result of a mental disorder and must be related to decisions about medical treatment, whereas mental capacity includes physical disabilities and covers a wider range of decisions.
A learning disability affects the way someone learns, communicates or does some everyday things. A learning disability is present throughout a person’s life. There are many different types of learning disability - the disability can be mild, moderate or severe.
Least restrictive alternative
The provision of care and treatment in a way which intrudes as little as possible into a person’s life, and which restricts as little as possible the rights of that person, whilst being compatible with ensuring the health or safety of the patient or other people.
Mental Capacity Act 2005
The Mental Capacity Act 2005 provides a statutory framework for people who may not be able to make their own decisions, for example because of a learning disability, an illness such as dementia or brain injury or severe or incapacitating mental health problems. The law sets out who can make decisions for a patient, in which situations, and how they should go about this. The Act is due to be implemented in April 2007.
When clinicians determine whether it is necessary to use compulsory powers under mental health law, they must first determine whether the person suffers from a mental disorder. The 1983 Act gives a broad generic definition of mental disorder and then four specific categories: mental illness, mental impairment, severe mental impairment and psychopathic disorder. The Mental Health Bill defines mental disorder as: "an impairment of or a disturbance in the functioning of the mind or brain resulting from any disability or disorder of the mind or brain", and does not specify categories of disorder.
Mental Health Order
The Mental Health Bill allows a court to make a Mental Health Order for an offender diagnosed as mentally disordered without convicting the person, for treatment under the law. The order can state that the person must receive treatment in hospital or in the community.
MHRT (Mental Health Review Tribunal)
The Mental Health Review Tribunal is a legal body empowered under the 1983 Act to review whether or not a mental health patient should be detained. Under the Act patients and nearest relatives can apply to the MHRT for a hearing. A Tribunal is always presided over by a legal member and also includes a medical and lay member. The MHRT has the power to direct the discharge of a patient or decide that the patient should continue to be detained.
Mental Health Tribunal (MHT)
The Mental Health Bill proposes to abolish the Mental Health Review Tribunal (see above) and replace it with a Mental Health Tribunal. As well as deciding whether or not a patient should continue to be detained, the tribunal will also provide authority for the use of formal powers for all cases beyond 28 days.
MHAC (Mental Health Act Commission)
The Mental Health Act Commission was established in 1983. Its main function is to keep under review the operation of the Mental Health Act 1983. It consists of some 100 members (Commissioners) including laypersons, lawyers, doctors, nurses, social workers, psychologists and other specialists. Its main activities include visiting and interviewing detained patients and investigating complaints.
The ‘nearest relative’ is the person identified under the 1983 Act who is given a number of important rights and functions, including the right to order a patient’s discharge from hospital and to apply for detention in hospital. To identify a person’s nearest relative the Act provides a list of relatives and people who are ranked in order of priority. Under the Mental Health Bill, the "nearest relative" is replaced by a "nominated person" (see below).
Under the Mental Health Bill the role of ‘nominated person’ replaces the ‘nearest relative’ (see above). The role of the nominated person is to be consulted at various stages while the patient is under compulsion. A nominated person is appointed by an Approved Mental health Professional (see above) and will normally be a person selected by the patient.
NRO (non-resident order)
Under new proposals, patients fulfilling the conditions for care under the Mental Health Act can be treated in the community instead of in hospital, under "non-resident orders". The order could include a requirement for a patient to attend certain appointments, live at a specified place and/or refrain from specified conduct.
The part of the Mental Health Act 1983 and the Mental Health Bill that deals with the criminal justice system. It deals with situations where people can be placed under compulsory powers as a result of a court order. It also covers situations where the Home Secretary can direct people to be transferred from prisons into hospital.
Personality Disorder (PD)
A disputed classification which does not fit into any obvious diagnostic category.. The term is sometimes used to describe a person who has difficulty coping with life and whose behaviour persistently causes distress to themselves or others. Many people believe that there is no such thing as PD.
Place of safety
Under the 1983 Act (and proposed new legislation) the police have the power to remove a mentally disordered person to a ‘place of safety’. This can be a hospital, care home or police cell.
An explicit statement on the face of legislation, setting out the values which underpin the law and provide a reference point for people responsible for operating the law.
A doctor who specialises in mental health problems and is trained to deal with the prevention, diagnosis and treatment of mental and emotional disorders.
Psychologist (Also known as a Clinical Psychologist)
A professional trained in different forms of psychological therapy and specific types of counselling.
The practice of performing surgery on the brain to treat or alleviate mental disorder.
The principle that where the state imposes an obligation on an individual with a mental disorder to comply with compulsory treatment and care, it should also impose a parallel requirement on mental health services to provide appropriate services following discharge, such as free ongoing services.
The courts can issue Restriction Orders on a convicted mentally disordered offender who they believe should be sent to hospital for treatment and whom they feel is a serious risk to the public. The main restrictions are that the patient can only be given leave of absence or transferred to another hospital with the approval of the Home Secretary. He/she also can only be discharged by the Home Secretary or a Tribunal. A restriction order can also be made by the Home Secretary when transferring prisoners to hospital.
RMO (Responsible Medical Officer)
Every patient who is compulsorily admitted to hospital under the Mental Health Act 1983 is allocated a ‘responsible medical officer’ who is a doctor on the staff of the hospital who has responsibility for that particular patient.
The principle that any treatment and support provided to a mental health patient must be likely to bring about an improvement in the symptoms, or signs, of mental disorder, or reduce or prevent deterioration in the person’s mental health.
The legal test under the 1983 Act for the detention of people suffering from psychopathic disorder or severe mental impairment under section 3. The Act requires that medical treatment must alleviate or prevent deterioration in their condition.
A written document which sets out the medical treatment that will be provided to a patient while they are in hospital.
See Mental Health Tribunal.