Coronavirus Act - Temporary Changes to the Mental Health Order

The Coronavirus Act (2020) makes temporary changes to the Mental Health Order (Northern Ireland) 1986, which will affect someone if they are assessed and compulsorily admitted to hospital.

The Coronavirus Act (2020) has introduced temporary changes to the Mental Health Order (Northern Ireland) 1986, which allows for the treatment of people who have severe mental illness to continue even if the workforce is reduced to the Coronavirus (Covid-19) outbreak.

 

Who Can Assess

Applications to compulsorily admit someone to hospital will not have to be made by an Approved Social Worker (ASW)

The 1986 Order (4) requires an application for compulsory admission to hospital for assessment to be made by an approved social worker.

In an emergency applications now can, in addition to approved social workers, be made by a relevant social worker, if an approved social worker is not available. 3(1)-(3) and (5) – (10)

  • “Approved Social Workers” Approved social workers have special training and can carry out some tasks under the Mental Health (NI) Order 1986, such as recommending a compulsory hospital stay. Approved social workers also have a particular duty to look at alternatives to hospitalisation, for example by looking at the range of community care available that may allow the person with a mental illness to stay in their community.
  • A “Relevant Social Worker” is a person who is registered as a social worker with r the Northern Ireland Social Care Council (NISCC), has at least 5 years’ experience in the 6 last 10 years working as a social worker. The relevant social worker must believe that the assessment is an emergency in which involving an Approved Social Worker would cause a delay which would put the person, or others, at risk.

 

When someone should be seen in person

 In an emergency, the timeframe in which a medical professional and the Approved Social Worker should have seen the person, in person, has increased to five days

The 1986 order states that:

  • The Approved Social Worker (ASW) making the application for admission to hospital should have seen the person, in person, in the past 2 days. [5 (2)]
  • The Medical Practitioner (often this will be a psychiatrist) who is completing a medical report in support of the application should have seen the person, in person, in the past 2 days. [6 (a)

The temporary changes increase these timescales so that the approved, or relevant, social worker and medical practitioner need to have seen them in person within the last 5 days. [3 (4), 4]

 

Holding powers on voluntary patients

The length of time that doctors and nurses can use “holding powers” on voluntary inpatients has increased

The 1986 Order [7 (2), 7 (3)] states that, in emergencies, medical professionals have the power to detain someone if they are a voluntary patient. This is stop them from leaving hospital if they are a risk to themselves, or to others. These, “holding powers” mean that they can be “held” until an assessment is made for compulsory admission.  Under the Coronavirus Act:

  • Doctor’s holding powers [5 (1)] are to be extended from 48 hours to 120 hours
  • Nurse’s holding powers [5 (2)] to be extended from 6 hours to 12 hours.

These timescales have been extended so that doctors and nurses have longer to assess the person.  These are the only changes which are being made to the holding powers of medical professionals.

 

When will someone be examined

The person will now be examined on admittance to hospital within 12 hours

The 1986 Order requires that the person be “immediately examined upon admission” for assessment in hospital. [9 (1)]

The Coronavirus Act amendments provide that this must be done as soon as possible, and not later than 12 hours after admission. [6 (1)]

 

Someone can be detained longer for assessment

The period of detention for assessment can be increased from 48 hours to 120 hours in certain circumstances

When someone is compulsorily admitted into hospital for assessment, they must be examined and a record of the examination made [9, (1)].

If the medical practitioner who examined the person is not the Responsible Medical Officer (RMO) or a Part II appointed doctor, under the 1986 Order, they could be detained for 48 hours, during which time they must be examined by the RMO, or a Part II appointed doctor (who must be at least at the level of Consultant Psychiatrist, if the detention is to continue. [9(4) and (5)]

What has changed under the Coronavirus Act 2020

If a person other than the RMO or the Part II appointed doctor makes the examination report, the person can be detained for up to 120 hours if the doctor:

  • Has at least 5 years’ experience in the last 10 working with mental health patients, and
  • considers that it wouldn’t be practical to wait for the RMO or Part II appointed doctor to carry out the examination within the 48 hours. [6(2) and (3)]

In an emergency someone can be detained longer for assessment

  • Under the 1986 Order [9 (8)], a person can be detained initially for up to seven days for assessment. If the RMO or Part II appointed doctor are of the opinion that the criteria for detention for assessment are met, the period of detention for assessment can normally be extended for 7 days, for a total detention period of 14 days (7 + 7 days).
  • Under the Coronavirus Act [6 (4)], in an emergency, this further period of detention is extended from 7 to 21 days, to a total period of 28 days (7 + 21 days) for assessment.

A "Relevant Doctor" can make the report for further detention

 In an emergency, a, "Relevant Medical Practitioner" can write an assessment report

  • Under the 1986 Order, only a Part II doctor is able to examine the person before their period of assessment ends, and write a report that recommends that they are detained for a further period of time (if they meet the criteria). [12 (1)]
  • Medical Practitioners at Consultant Psychiatrist level, with specialist experience in the diagnosis or treatment of mental disorder, who meet the conditions set out by RQIA, are eligible to apply for appointment as a Part II Medical Practitioner.
  • The changes made to the Order in the Coronavirus Act allow that, in an emergency, a “Relevant Medical Practitioner” can examine the person and write a report. [8]

A, “relevant medical practitioner” means a medical practitioner who is not an appointed Part II doctor, and who has at least 5 years’ experience working with mental health patients, of which at least 1 year’s experience was working with patients who were detained for treatment.  This may be a psychiatrist.

  • If a “Relevant Medical Practitioner” makes the report, the person must be assessed by a Part II Practitioner within 28 days.
  • Detention under the Mental Health Order (1986) will never exceed 6 months from the date someone was compulsorily admitted.

Mistakes in applications

 If a mistake is made in the application to admit someone, there is now a longer period of time to correct these. 

  • The 1986 Order allows errors in the application for assessment, the medical recommendation or any report to be corrected within the first 14 days of the date of admission for assessment. [11 (7)]
  • The changes made to the Order in the Coronavirus Act allow the correction of errors within 28 days of the date of admission. [7]

How CAUSE can help

CAUSE empowers those that use our advocacy services to take a lead in securing the rights and services to which they and their loved ones are entitled.  

While we accept that emergency provisions are necessary at this time, we are concerned that some of the temporary changes mean that people are at risk of being detained for longer than necessary, or that people who are in need of treatment will not receive timely assessments – ultimately significantly impacting on their families, carers and supporters.

CAUSE will continue to actively bring carers issues to the fore, including the use of the Coronavirus Act 2020 and to engage with services in making sure carer’s voices are heard