Recommendation 8

HM Government · verbatim extract Accepted in Part

As set out in response to recommendation 3, we agree that where admission is absolutely necessary, it should be for the shortest time possible, with high quality, therapeutic care. We agree that care plans should be regularly reviewed to ensure a person is receiving safe, appropriate care and has a clear path towards discharge. In Chapter 1 and Chapter 2 of the Building the Right Support action plan, we set out a range of commitments to improve the quality of inpatient care and to make it easier for people to leave hospital when it is safe for them to do so. We accept this recommendation in part and set out the reasons for this below. In relation to part (I) of this recommendation, our planned amendments to the Mental Health Act will make fundamental changes to the way the Act will apply to autistic people and people with a learning disability. As set out in our response to recommendation 3, and in detail in our draft Mental Health Bill, we will limit the use of the Mental Health Act beyond 28 days for civil patients who have a learning disability or are autistic and who do not have a co-occurring mental health condition. In addition, we will revise the criteria for all patients to ensure that detentions are only made when there is otherwise a risk of serious harm to the patient or others, and when it will serve to provide a therapeutic benefit to the patient. Therefore, many of the longer term cases for which recommendation 4 (i) is intended, would no longer arise under the Act. Where they do arise, for civil patients, we are clear that it should provide a therapeutic benefit based on an assessment of the person’s needs and what is best for them. For the more limited number of individuals who may be admitted to a mental health hospital in our proposed restricted circumstances, we agree that inpatient care should be regularly reviewed and are taking action to strengthen existing processes. This will include a new review point after three months of detention under Section 3 of the Mental Health Act, while retaining the current check at 6 months, thereby creating an additional check of the need to detain. Similarly, the draft Mental Health Bill aims to provide for an additional right for a patient to appeal to the Mental Health Tribunal within the first year of detention. This increases the number of opportunities to appeal to the Tribunal from two to three times in the first year. We also intend to increase the frequency of automatic referrals to the Tribunal to ensure that patients who lack the ability and initiative to make an application to the Tribunal can benefit from the safeguard of a referral to the Tribunal on a more regular basis. A hospital manager must refer a section 3 patient to the Tribunal, three months from the day on which the patient was first detained under section 3, including any period in which a patient was detained under section 2 for assessment. Where a section 3 patient’s detention is renewed, the hospital managers must make a referral to the Tribunal, 12 months from the day on which the patient was first detained and thereafter on any subsequent renewal, a referral must be made on the expiry of each 12 months period of detention. Responsible Clinicians would be expected to review their caseloads routinely and discharge people who no longer meet the risk threshold, or for whom the treatment is no 12 The treatment of autistic people and people with learning disabilities: Government Response longer therapeutically beneficial. In doing this, they will consider the person’s Care and Treatment Plan (CTP). Where someone has received a C(E)TR this will inform their CTP. Therefore, if a C(E)TR indicates that detention is no longer therapeutic for that individual, this information should be available to the Responsible Clinician when they consider the individual’s ongoing detention. We also expect that planning for discharge should take place before admission occurs wherever possible. Family members–alongside the individual - should always be involved in decisions about the person’s care (unless it is inappropriate for their family to be involved). As we expect these reforms to the Mental Health Act to significantly improve current processes and to ensure that people who are admitted will receive therapeutic treatment for mental health conditions, we do not intend to implement weekly formal reviews in the way recommended by the Committee. We are also making wider improvements to existing review processes, which are set out below. As the Committee will be aware, people with a learning disability and autistic people who are admitted to inpatient settings should receive a Care (Education) and Treatment Review (C(E)TR). These are formal reviews that intend to improve the quality of care people receive through making recommendations for their safety, care, and treatment and to overcome any barriers to their discharge. C(E)TRs are an important part of discharge planning and avoiding inappropriate