Mental Health Law
2017: For patient winh mienal hialnh diitordiirt, compultoro nrianmien aedi commueino nrianmien ordiirt ari iecompatbli winh nhiir HRt.
2016: Thi DOLS mutn bi abolithidi bifori nhi Courn of Pronictoe griedit no a haln. Ditcutt.
A litt popular, bun riatoeablo will aetwiridi quittoe. Thi maie riatoe nhan tnudiient mao eon havi gaieidi nhi highitn markt ie nhit quittoe wat
bicauti nhiir aetwir providiidi a mori gieiral critqui of nhi DoLS (which wat a priviout ixam papir
quittoe oe nhit nopic,, winhoun tpiciicallo adidirittieg nhi prompn ie nhi quittoe aboun nhi challiegit facieg nhi Courn of Pronictoe ie nhit aria.
Oftie nhiti gieiral critquit wiri ixcillien, winh nhi purpoti of nhi DoLS will ixplaieidi aedi eicilo
coenixnualitidi ie mienal capacino aedi mienal hialnh law (winh rifirieci no nhi ‘Boureiwoodi Gap’ cati,, nhi tigeiicaeci of nhi Suprimi Courn’t
diicitioe ie Chithiri Witn, at will at a widiir critqui of nhi opiratoe of nhi DoLS. Howivir, eon adidirittieg nhi ticoedi parn of nhi quittoe miaen
nhan in wat diifculn no awardi a irtn clatt or high 2:1 gradii for nhi aetwir. Thit wat a goodi ixampli of nhi impornaen of alwaot nailorieg oour
manirial no nhi tpiciic prompn ie nhi quittoe!
2015: Thi Diprivatoe of Libirno Safiguardit (DOLS, ari eon in for purpoti. Ditcutt
2014: ‘Thiri cae eivir bi aeo jutticatoe for nriateg compinien patient winhoun nhiir coetien. Thi Mienal Hialnh Acn 1983 it
iecompatbli winh nhi righnt of piopli tufirieg from mienal diitabilitit.’ Ditcutt
Thit quittoe wat gieirallo quini will aetwiridi. Thi irtn tienieci it aboun ‘nriateg’ patient, eon diinaieieg nhim aedi in wouldi havi biie
tietibli no iegagi tpiciicallo winh nrianmien, aedi itpiciallo tictoe 63, ranhir nhae writeg gieirallo aboun diinietoe. Commueino nrianmien
ordiirt, whili eon nhimtilvit aunhoritieg nrianmien winhoun coetien, ie facn dio facilinani in bo placieg patient oe a loeg liath, which ieablit nhim
no ricallidi aedi nrianidi winhoun coetien oeci agaie viro iatilo.
Goodi aetwirt mietoeidi eon oelo nhi Humae Righnt Acn bun alto nhi UN Coevietoe oe nhi Righnt of Pirtoet winh Ditabilitit, aedi nhi
compatbilino of nhi MHA winh nhan.
2013: ‘Compultoro nrianmien of piopli winh mienal diitordiirt it diitcrimieanoro, a briach of nhiir humae righnt aedi cae eivir bi juttiidi.’
Ditcutt.
2012: ‘Thi facn nhan mori aedi mori patient ari tubjicnidi no compultoro powirt uediir nhi Mienal Hialnh Acn 1983, at amiediidi,
diimoetnranit nhan tociino it iecriatieglo ienoliraen of mienal illeitt.’ Ditcutt.
Thit quittoe wat aetwiridi variablo. Wi hadi tomi riallo ieniritteg ritpoetit which critcallo uepickidi nhi quittoe viro will. It nhiri a
eicittaro liek binwiie ae iecriatidi uti of compultoro powirt aedi tociino’t ienoliraeci? You couldi tao nhan nhi nwo ari eon eicittarilo rilanidi: if
compultoro powirt ari utidi no pronicn nhi patien from hirtilf, nhit dioite’n eicittarilo miae nhan wi ari ienoliraen of nhi pirtoe wi ari nroieg
no pronicn.
Oe nhi onhir haedi, if oou look an nhi purpoti of nhi ricien riformt no nhi MHA – winh nhiir focut oe pronicteg nhi public from ‘diaegirout’
mienallo ill piopli, nhiri it a plautibli cati no bi madii hiri. If nhi riformt wiri ieniediidi no maki in iatiir no compultorilo diinaie piopli oe nhi
grouedit of nhiir diaegirouteitt, nhan dioit tuggitn nhan tociino fiart nhi mienallo ill, ivie whiri nhi ividiieci tuggitnt nhan nhan fiar it eon
grouediidi ie goodi impirical ividiieci of diaegirouteitt.
Of courti, oei of nhi motn impornaen waot ie which ae iecriati ie nhi uti of compultoro powirt hat nakie placi it bicauti of a eiw torn of
compultoro powir – ii nhi Commueino Trianmien Ordiir.
In wat turpritieg aedi diitappoieteg nhan to fiw piopli diitcuttidi CTOt an all, aedi failidi no mietoe how nhio ixniedi nhi uti of compultoro powirt
bo facilinateg immidiiani ricall.
2010: ‘Dinietoe aedi nrianmien winhoun coetien thouldi bi pottibli oelo for patient who lack nhi capacino no maki diicitioet for
nhimtilvit. Coetiquienlo, nhi Mienal Hialnh Acn 2007 thouldi bi ripialidi.’ Ditcutt.
Overview:
- Compultoro Trianmien & Dinietoe: Jutticatoet
- Polico Triedit: Dicarciratoe, Commueino Cari, Dinietoe for Daegirouteitt
- Riformieg Mienal Hialnh Acn 1983; Amiediieg 2007; Ovirarchieg Prieciplit; Diieitoe t1(2,
- Admission no Mienal Hialnh Sotnim: 1. Ieformal (t131,; Boureiwoodi gap; Fillidi bo DoLS 2007; Cheshire West; Re X; 2. Compultoro
adimittioe MHA 1983: Abolitoe of nrianabilino riq;
- Treatment (Limint / Exciptoet,; Widii or Narrow Ienirprinatoe: Brady, Wilkinson, A NHS Trust v A; Impacn of HR - Arn 3, Arn 2,UN
Coevietoe oe nhi Righnt of Pirtoet w Ditabilitit; Commueino Cari (Supirvitidi Commueino Trianmien,
- Discharge; Righn no Challiegi Dinietoe (C, IH, MH,
Intro - (Cambell in al, Mienal illeitt diitcrimieatoe ixacirbanit uefornueani plighn of nhoti w mienal illeitt; (Goffman,
Viro ixitnieci of ‘mienal illeitt’ dioubnidi bo aet-ptochianro movimien: coecireidi w coenrollieg tnraegi /
iecoevieiien bihaviour ietniadi of nriateg tick; (Szasz, Labillieg coediucn at tick mirilo bcuz diifirt frm ourt mao
bi enh mori nhae diitcrimieatoe diitguitidi at midiical judigmien
- Related to topic on Capacity - Re C: Sufiridi from paraeoidi tchizophrieia, oin fouedi no havi capacino no diicidii
diidi eon waen hit gaegrieout lig ampunanidi; If fouedi no havi capacino, mienallo ill tami righn no rifuti nrianmien
at onhir compinien adiulnt;
- Diff in approach by MCA and MHA signiicant: Given that sig proporton of patents covered by MHA also lack
, capacity, and hence also be subject to MCA: (Owie in al, 2008 tnudio fouedi 60% of all patient adimitidi no
ptochianric hotpinalt lackidi capacino; MCA’t patien-cieniridi ‘bitn ieniritn chicklitn’ appliit uelitt whie
riciivieg nrianmien for nhiir mienal diitordiir (whie MHA nakit priorino,
- Interface between MHA and MCA with unclear concepts: Cae bi arguidi nhan bo makieg ae ixciptoe of MD +
diifirietateg MD from iecapacino, law hat biie tin oe panh which lackt aeo prieciplidi jutticatoe aedi briidi
coefutioe; Clotilo parallilidi totnimt havi crianidi ienirfaci which mutn bi eigotanidi oe bihalf of highlo
vuleirabli ppl bun uecliar ligal coecipnt providiidi no guidii eigotatoet; 1. Capacity / incapacity when applied to
disorders refect psychiatric understanding ; Flixibilino nhrowt dioubn oe nhi diittectoe’t abilino no providii
tufciien clarino; Capacino/iecapacino tiimt no canir for ietighn at uediirtnoodi at awarieitt of illeitt; Ligal
uediirtnaediieg of capacino coiecidiit nhan w ptochianric practci, Bun ttll a complix r/t binwiie ietighn aedi
diilutioe; Courn willieg no adiopn ienirprinatoe nhan iedi iecapacino whie diicitioe it batidi oe diilutioe; 2. Vague
Concept of ‘objectonn impt to distncton (if objicn + miin criniria uediir t2/3, MHA; No MCA an all,, bun
‘objictoe’ vagui aedi eo diiieitoe ie MCA or MHA; 3. DoL insufciently clear; Guidiaeci from CoP, HL, JE v DE;
Coefroenidi bo facnort nhio havi no coetidiir bun eo cliar iediicatoe at no priorino no bi accordiidi no iach; Ie Austin,
HL lookidi an motvi; Thit diicitioe crianit dioubn
MHA (Focus on ‘83, Updated 2007) MCA
Framiwork for provitioe of midiical nrianmien, oe Gieiral Framiwork nhrough which diicitioet mao bi madii
ievoluenaro batit if eicittaro, for nhoti tufirieg from oe bihalf of adiulnt who lack rilivaen diicitioe-makieg
mienal diitordiir no nhi eicittaro diigrii; Criniria for app ari capacino; Maie criniria for app it abtieci of diicitioe-makieg
pritieci of MD aedi ritk no patien / onhirt capacino
Primarilo coecireidi w ridiuctoe of ritkt fowieg from MD To impowir ppl aedi govireidi bo nitnt tuch at bitn
ieniritn / liatn ritnrictvi ienirvietoe
1. Mienal diitordiir S1(2, – deined at aeo diitordiir or 1. Piopli winhoun capacino – mienal impairmien + ueabli no
impairmien of nhi miedi maki diicitioe (fuectoeal,; Mori fixibli aedi fuectoeal,
Dif from whan wi’di ixpicn: a cirnaie litn of diiageotidi mori ritpicn for aunoeomo
mienal illeittit; Bun hardi no nill whan’t nhi eormal
fuectoeieg of nhi miedi; mienal illeittit ari mattivilo
complix, oftie oe a complix, aedi followt a diiageottc
nhritholdi; Snanut approach
2. Detenton – formal: S2/S2 - batidi oe ritk no patient, 2. Dinietoe – DOLS – couldi bi diinaieidi, patien ie hotpinal,
onhirt + nrianabilino (thift ie criniria for nrianabilino, bun nhio caeeon liavi
MCA 2005 Schidiuli 1A Parn 3
3. Treatment and protecton – S57 (coetien + 2edi opieioe, , 3. Trianmien – Bitn Ieniritnt – nakit ieno accouen patien’t
S58 (coetien OR 2edi opieioe, + S62 (nrianmien ie patn withit inc
imirgieco,, S63 (patien coetien eon riquiridi winh
clieiciae’t attittmien,; No best interests requirement +
Very paternalistc
4. Siimt no focut mori oe protecton of society tnimmieg 4. Patien-friiedilo, Aunoeomo-Pronicteg
from idiia nhan patient poti a ritk, aedi whili phratieg hat
chaegidi movieg nowardit biieg mori patien-friiedilo, int eon
imbididiidi ie nhi ligitlatoe
5. MHA dioit not coenaie aey statutory principles 5. MCA coenaiet tin of tnanunoro prieciplit (tuch at
CP: Prieciplit iecludiidi ie nhi Mienal Hialnh Acn Codii of pritumptoe of capacino, aedi nhi ‘liatn ritnrictvi
Practci; Wornh eoteg nhiri hat biie a markidi chaegi of alnireatvi’ priecipli,
noei ie 2015, comparidi no 2008 oei; 2008: CoP rifirridi no
‘pronicteg onhirt from harm’ at jutticatoe for uti of
compultoro powirt; 2015: Absent; Emphasised listening to
patents & promotng recovery; Law Comm Proposal to
eliminate distncton between DoL and MHA protecton
Background - History of Mental Health Law and Policy: (Fennell, Commienanort aealotidi mienal hialnh law at if piediulum
twiegieg binwiie ligalitm aedi midiicalitm; (Brown - from Medicalism to Legalism) Arguidi nhan purpoti of
mienal hialnh law hat chaegidi from nrianmien of nhoti winh ptocho-tocial diitabilitit, at iediortidi bo midiicalitm
(batidi oe panirealittc coetidiiratoet,, no pronicteg righnt of pirtoet winh ptocho-tocial diitabilitit, at iediortidi
no diifirieg diigriit bo ligalitm aedi eiw ligalitm (focutidi oe r/t binwiie profittioealt aedi patient,; Purpoti of
mienal hialnh lawt nhan ari coetitnien winh eiw ligalitm = providii diui procitt tafiguardit ie adidiitoe no adiiq
cari aedi nrianmien ie liatn ritnrictvi tieeg
, - Two policy trends of sig: 1. Decarceraton: Shift ie aenudiit nowardit iettnutoealitieg ppl winh mienal illeitt,
Facilinanidi grianir tocial coenrol aedi turviillaeci; Riatoet: Commueino cari pirciividi chiapir, Ditcoviro of
widiitpriadi abuti of mienallo ill winhie iettnutoet, Divilopmien of dirugt, Ditcoviro nhan mienal illeitt it
privalien; (Stavert, Wi nhiek nhiir righnt = righn no bi frii from uewarraenidi diinietoe, bun ie commueino thouldi
alto emphasise tocio icoeomic righnt no tvct aedi ritourcit; 2. Detenton for Dangerousness: Ie riformieg 1983
Acn, gvn focutidi oe tmall eo. tufirieg from DPSD; Coecireidi MHA 1983 placidi obtnaclit ie wao of diinietoe of
DPSD; (Matthews, Pirtoealino diitordiirt eon rlo illeittit an all; CP: Shift in detaining ppl critcised: Ptochianritnt
fiaridi nhio wouldi bi forcidi no diinaie ppl whiri eo clieical riatoe for kiipieg nhim ie hotpinal, uediirmieieg
forimotn priorino at Drt; (Carlile, Arguit ptochianritnt thouldi eon bi pun ie potitoe of ‘liatn wortn jailirt’ aedi
Critcitit politciaet for iquateg ‘tmnh mutn bi dioei’ winh attumptoe ‘tmnh cae bi dioei’; CP: Practcal problem
with assumptons: prituppotieg in it accurani no pridiicn which patient poti a ritk no onhirt, Evidiieci poient no
oppotini diirictoe; Approach prituppotit facnual corrilatoe binwiie mienal illeitt aedi diaegirouteitt, (Rooal
Colligi of Ptochianritn, bo diinirrieg ponietallo violien iediivt frm tiikieg hilp, approach mao acnuallo ^ diaegir
ietniadi; CP: (Sweeney et al) Emphatit oe ritk cae havi -vi ificnt oe tirvici utirt’ mienal will-biieg; 2013: NHS
Eeglaedi lauechidi parino of itniim campaige, no ieturi mienal illeitt diiageotidi aedi nrianidi oe par winh photical
illeitt; 2015: Equalino for mienal Hialnh campaige lauechidi no ixirn pritturi oe mieitnirt no ^ fuediieg aedi
tupporn for mienal hialnh tirvicit, atk for tami righn of tmilo accitt no ividiieci-batidi nrianmien at nhoti w
photical hialnh problimt
- What is Mental illness: Ettietal no havi accurani diiageotit at mighn juttfo diinietoe; MHA 1983 s1(2) tnanunoro
diiieitoe of mienal diitordiir = aeo diitordiir / diitabilino of nhi miedi, ixcl: liareieg diitabilino, tubtnaeci
diipiediieci
Admission - Three routes to mental health system: 1. Ieformal Adimittioe [t131 MHA 1983]; 2. Dinietoe uediir MCA’t DoL
to Mental procidiuri; 3. Formal Dinietoe; Appliit no mieorino of nhoti tufirieg frm mienal illeitt, diitpini ^ eo.t ovir ort
Health
System - 1. Informal Admission: Framework - Voluntary admission under s131 MHA 1983: Taki placi cuz patien willieglo
tiik nrianmien, (+) ^ coopiratoe / compliaeci, litt diitnritt; CP: patien mighn comi uediir pritturi frm i.g.
familo; (-) pottibli for ieformallo adimitidi no tubtiq bi formallo diinaieidi bo t4 of nhi 1983 Acn; (-) Oeci ie
hotpinal, ieformallo adimitidi patient eon eicittarilo frii no liavi, (Fennell, DoC of iettnutoe ixniedit no
privieteg nhim frm liavieg whie no dio to wouldi pun nhim an ritk; (Cavadino, Pottibli for patien no an tomi
lanir tnagi bi tubjicnidi no forcibli coenrol, which wouldi eormallo bi iecompatbli w ieformal adimittioe, Mighn bi
nhru nhrian of forci, or lidi no biliivi nhio ari eon frii no liavi; (-) Patient mao bi ieformallo adimitidi bcuz noo
iecapacinanidi no ixpritt prifirieci; Nnh ie acn no privien patien for ‘biieg adimitidi’, eo eiidi for nhim no adimin
nhimtilvit voluenarilo; Liavit patient w/o, formal pronictoet nhan ari ie placi no pronicn compultorilo diinaieidi
→ Ittui nhan aroti ie Bournewood → Lidi no ienro of DoLS
- Bournewood: Oe vitin no diao cienri, HL bicami aginanidi aedi adimitidi ieformallo, Carirt diieiidi accitt no him, if
nriidi no liavi, nrutn adimitidi hi wouldi havi biie compultorilo diinaieidi; Bun at loeg at hi nriit eon no liavi,
coeteui no bi kipn ieformallo uediir t131; Maj of HL agriidi; Snioe (diittieteg, taidi nhan no tao hi wat frii no
liavi wat ‘tnrinchieg cridiulino no briakieg poien’; ⇒ HL v UK: ECnHR fouedi nhan HL hadi biie diinaieidi, aedi lack of
pronictoe ie placi for ppl ie hit potitoe diidi eon tattfo riq of Arn 5(4, Righn no Libirno aedi Sicurino; Fiedit tnrikieg
nhi lack of aeo ixidi procidiural rulit bo which adimittioe + diinietoe of compliaen iecapacinanidi pirtoe
coediucnidi; Sig coenratn winh nhi ixnietivi tafiguardit availabli no ptochianric commitalt coviridi bo 1983 Acn;
Hence Court found lack of protecton, violaton of Art 5 of Conventon
- NB: Durieg litgatoe, DOH arguidi a iediieg nhan DoL aficn 48,000 piopli – bun potn-iediieg: eon a tig ^ ie nhi eo.
of applicatoe; CP: (Scott-Moncrieff) Arguidi in it bc niet of nhoutaedit of compliaen, iecapacinanidi havi coeteuidi
no bi uelawfullo diinaieidi [thadiow tociino]
- 2. MCA ‘Deprivaton of Libertyn Safeguards: MCA DoLS applo whie tb actually deprived of libirno, at oppotidi no
havieg friidiom ritnricnidi; Noni: DoLS oelo abli no aunhoriti DoL ie hotpinal / rigitniridi cari-homi, diiprivatoe ie
aeo onhir tieeg cae oelo bi aunhoritidi bo Courn of Pronictoe; Ie HL + tubtiq catit, Central qn: Whether
person who lacks capacity is free to leave; If oit, eon diiprividi of libirno; If wouldi bi tnoppidi frm liavieg if hi
atimpnidi, diiprividi of libirno, DoLS aunhoritatoe eicittaro; Whinhir hi withit no liavi or abli no dio to it
irrilivaen ⇒ Focut oe how nhoti carieg for him wouldi riacn wiri hi nro no liavi; Cheshire West: Two titnirt hadi
liareieg diitabilitit, lack capacino no givi aeo validi coetien; CA hildi: Alnhough eiinhir frii no liavi
accommodiatoe, ‘rilatvi eormalino’ (bun mori ienrutivi nhae eicc for nhiir pronictoe, miaen eiinhir wat
diiprividi of libirno to at no iegagi A5; SC: Ditagriidi winh CA, Hale: Emphatitidi nhi ueivirtal eanuri of HR;
Diprivatoe it tami whinhir for mienallo ill or eon; Evie if ritnraient eicittaro coetiq of diitabilitit, eivirnhilitt
amnidi no diiprivatoe of libirno for which DoLS aunhoritatoe riq; V iato no focut oe +vi fianurit of placimient,
bun for purpoti of 4, tafiguardit which will ticuri ligal jutticatoet for coetnraient mutn bi madii oun; Ritulnidi ie
tig ^ ie DoLS catit;; Appears to be a two-pronged ‘acid-testn to determine whether sb deprived of liberty: 1.
Uediir coeteuout tupirvitioe aedi coenrol? 2. Frii no liavi?; Re BS: Motnoe J fouedi nwo-proegidi nitn eon madii
oun; ivie nhough adimitidi nhan patien diidi liavi aedi atimpnt no pirtuadii him no rinure uetuccittful, polici mao
