Section 17 Mental Health Act - Authorisation of Leave Policy for Detained Patients. Includes guidance on patients not legally detained

Transcription

1 Policy: Section 17 Mental Health Act - Authorisation of Leave Policy for Detained Patients Includes guidance on patients not legally detained Executive or Associate Director lead Policy author/ lead Feedback on implementation to Date of draft March 2012 Dates of consultation period March-May 2012 Date of ratification 24 May 2012 Clive Clarke Catherine Dixon Mental Health Act Administrator Catherine Dixon/Relevant Clinical and Assistant Clinical Director Ratified by Executive Directors Group Date of issue June 2012 Date for review May 2015 Target audience Staff with responsibilities under s17 of the Mental Health Act Version 2 revised following changes in the Mental Health Act. This policy replaces the previous version 1. This policy is stored and available through the SHSC intranet and internet. 1

2 Contents: Contents Page Section A Section 17 leave 3 Introduction 3 Definitions 3 Purpose of this policy 4 Duties 4 Scope of this policy 4 Purpose of Section 17 leave 4 When is Section 17 leave necessary? 5 Who may grant leave? 6 Planning leave 6 Assessment and review of leave 7 Recording of leave 7 Conditions 7 Leave to reside in another hospital 8 Role of nursing staff 8 Cancellation of leave 10 Recall to hospital 10 Absent without leave - AWOL 10 Section B Guidance for patients not legally detained 11 (Operational Duty) Section C Practicalities 13 Dissemination, storage and archiving 13 Training and other resource implications for this policy 13 Audit, monitoring and review 13 Implementation plan 13 Links to other policies, standards and legislation 13 Contact details 13 References 13 Appendix 1 Authorisation of Section 17 leave form 15 Appendix 2 Equality impact assessment form 16 Appendix 3 Human rights act assessment checklist 17 Appendix 4 Development and consultation process 18 2

3 Section A Section 17 Mental Health Act Authorisation of Leave Policy for detained patients 1. Introduction The Mental Health Act 2007 amends the Mental Health Act This policy is reviewed and amended in line with the amendments to the Mental Health Act. Section 17 Mental Health Act 1983 makes provision for certain patients who are detained in hospital under the Mental Health Act 1983 to be granted leave of absence. It provides the only lawful authority for a detained patient to be absent from the hospital. This policy is needed to ensure the Trust complies with the Mental Health Act 1983 and meets the requirements set out in the Code of Practice to the Mental Health Act. 2. Definitions The Act Refers to the Mental Health Act 1983 as amended by the Mental Health Act 2007 Patient For the terms of this policy a patient is someone who is liable to be detained under Part II of the Mental Health Act 1983, following an application by an Approved Mental Health Professional or by the patient s nearest relative. Any application must be supported by medical recommendations completed by appropriately qualified medical practitioners. Patients detained under Part III of the Act, being patients concerned in criminal proceedings or under sentence of the courts, have different conditions. Approved Clinician A person approved by The Secretary of State to act as an approved clinician for the purposes of this Act. Responsible Clinician The Responsible Clinician (RC) is the Approved Clinician with overall responsibility for the patient s case. The role is not delegable but temporary cover is permitted. Cover arrangements must be clear in order to avoid unlawful granting of leave Part 2 MHA: Compulsory admission to Hospital Part 2 Patient For the purposes of Section 17 leave, patients who became subject to compulsion under the Act by an application for detention by a nearest relative or an approved mental health professional i.e. someone detained under section 2 or section 3. 3

4 Part 3 MHA: Patients Concerned in Criminal Proceedings or Under Sentence Unrestricted Part 3 Patient A patient who is liable to be detained in hospital on the basis of a Hospital Order (section 37) or Hospital Direction (section 45A) who never was or is no longer subject to Ministry of Justice (MoJ) restrictions or limitations (sections 41 and 49 respectively). Restricted Part 3 Patient A patient who is subject to Ministry of Justice (MoJ) restrictions or limitations. (Sections 41 and 49 respectively). Leave cannot be granted by the RC without the written permission of the Minister of State for Justice Hospital Under the Mental Health Act 1983, hospital has the meaning given to it by the National Health Service Act 2006 (MHA manual, 14 th ed), that is any institution for the reception and treatment of persons suffering from illness. However now those hospitals may be divided into units and may not be coterminous with managers, a hospital, for the purpose of section 17, leave can be defined as only those buildings on a particular site that are adjacent to each other and have the same NHS Managers. It is the responsibility of each site to ensure it has a working definition of its boundaries. 3. Purpose of this Policy This policy provides guidance for nursing, medical staff and other staff who are involved in the care and treatment of patients detained under the Mental Health Act 1983 and those who are not detained but to whom the operational duty applies. It describes who may grant leave, management of the process of the leave, systems for recording and the role of the staff within this. The purpose of this policy is to ensure that those who implement the provisions of the Act work within its boundaries and are aware of the scope of these boundaries. 4. Duties All staff implementing the provisions of the Mental Health Act must be aware of their duties and responsibilities under the Mental Health Act and the guidance of the Code of Practice. This policy seeks to ensure this is followed. Specific duties are described in detail in Section 6 5. Scope of this Policy This policy applies to all who are involved in the care and treatment of those detained in hospital under the Mental Health Act 1983 and those who are not detained but to whom the operational duty applies this particularly relates to patients / service users who are not legally detained. 6. Specific details 6.1 The purpose of section 17 leave Section 17 makes provisions for certain patients / service users who are detained in hospital under the Mental Health Act 1983 to be granted leave of 4

5 absence for any reason. It provides the only lawful authority for a detained patient / service user to be absent from the hospital. Section 17 leave applies to patients / service users detained under sections 2, 3, 37 and notional 37. Section 17 applies technically to sections 47 and 48 if unrestricted, but in practice such transferred prisoners will normally be subject to restrictions. Section 17 applies to those patients / service users detained and restricted or subject to limitations under Sections 37/41 and 45A; however approval must first be sought from the Secretary of State for Justice. It does not apply to those patients / service users detained under Sections 4 or 5 or to those patients / service users who have been remanded in hospital under Sections 35 & 36 or who are subject to interim hospital orders under Section When is formally authorised Section 17 leave necessary? Whenever a detained patient / service user has official leave from the hospital site Section 17 leave is necessary, this applies to short leave (e.g. to the local shops), longer leave, escorted leave, unescorted leave and periods of stay in another hospital where transfer under Section 19 would not be appropriate (e.g. general hospital) For part 2 & unrestricted part 3 patients Section 17 leave is not required for the patient / service user to leave the ward and remain within the hospital grounds, however if two or more hospitals are located within the same ground but managed by different Trusts, leave must be given to move from the detaining hospital to another. Section 17 leave authorisation is required for the patient / service user to attend a different site belonging to the same Trust. If this includes an overnight stay the patient / service user should be transferred. Where the courts or the Secretary of State have decided that restricted patients are to be detained in a particular unit of a hospital. Those patients require leave of absence to go to any other part of that hospital as well as outside the hospital. For part 2 & unrestricted part 3 patients / service users longer term leave may granted but when considering authorising a period of leave which would be more than 7 consecutive days the Responsible Clinician must first consider whether Supervised Community Treatment would be the better option. If, after consideration, the Responsible Clinician still feels that longer term leave is the better option, the Responsible Clinician will need to show that both options have been considered. The decision and reasons should be recorded in the care records, which should include a record of the MDT discussion. Supervised Community Treatment Orders (CTO) cannot be considered for patients / service users detained under restriction orders. CTO does not apply to restricted patients / service users. The conditions on CTOs were designed to emulate the conditions that persist under Section 41 when restricted 5

6 patients are granted conditional discharge by the Secretary of State/Ministry of Justice or Tribunal. If a patient / service user who is detained under one section is granted leave but subsequently becomes detained under another section a new authorisation of leave should be completed. The Role of the Responsible Clinician 6.3 Who may grant leave? Part 2 patients & unrestricted part 3 patients Only the patient / service user s Responsible Clinician may authorise Section 17 leave. This role may not be transferred or delegated to another doctor. In the absence of the Responsible Clinician (by illness or leave or out of hours), leave may only be granted by the Approved Clinician who is for the time being acting as the patient / service user s responsible Clinician. In the absence of the RC the duty consultant would take over the over the role RC. Restricted patients / service users Leave may be granted to patients / service users detained under a restriction order but authorisation must first be sought form the Secretary of State for Justice by the Responsible Clinician (only the Responsible Clinician can make this request). The Secretary of State should be given as much notice as possible, together with full details of the proposed leave. 6.4 Planning leave Leave should only be granted after careful planning and risk assessment. The decision for leave to be granted should be discussed and agreed in the MDT available at the time and should involve the patient / service user, family, carers and the CMHT / other community services where appropriate. The benefits of granting leave need to be balanced against any risks that leave may pose to the protection of the patient / service user and others. The Responsible Clinician must also be aware of any child protection, child welfare issues, adult protection or domestic abuse issues. Consideration must also be given to what support the patient / service user would require and whether this can be reasonably provided. The decision to grant leave and rationale should be recorded in the patient / service user s notes and on the relevant Mental Health Act Documentation (Authorisation for leave form). At this point consideration should be given as to the taking of photographs as per local procedure of appropriate. The patient / service user should be involved in the decision to grant leave and should be asked to consent to any consultation with others that is thought necessary. It is the Responsible Clinician s responsibility to undertake any appropriate consultation. If a carer or relative is involved in or affected by the leave they should be consulted and if they are taking the service user out under their care/accompany them then their responsibilities should be explained and this conversation then documented in the patient / service user s notes. Risk assessment should also take place immediately prior to the patient / service user going out on the planned leave (as it may be a few days since the leave was discussed and agreed) i.e. prior to each episode of leave. The shift co-ordinator (RMN) and contact nurse with input from the ward team and 6

7 the Consultant, if required, should ensure that the leave remains appropriate and safe to do so based on the current health of the patient / service user. Prior to every episode of leave a record should be made of what the patient / service user is wearing particularly if there is an increased risk of AWOL The RC retains overall responsibility for granting or refusing leave 6.5 Assessment/Review of Leave Every period of leave must be recorded in the nursing notes. This should include dates and time of departure and return. The outcome of each period of leave along with an assessment of its relative success should also be recorded. Patients / service users should be encouraged to contribute by giving their views and particular note should be made of any benefits or concerns raised by the patient / service user or any escorting staff, relatives or friends. 6.6 Recording of leave The decision to grant leave must be recorded in the patient / service user s care records together with details and condition of leave. A section 17 leave form must be used for this purpose. (Appendix A). The date and time that a patient / service user goes on Section 17 leave the must be documented. The date and time of the patient / service user s return to the ward must also be documented. A qualified member of staff should record this information. A ward manager or deputy should check compliance with this on a daily basis when possible or weekly as a minimum standard. As part of the regular monitoring of records the documentation relating to Section 17 leave and correlation with the patient / service user s care record must be checked. The information must be clearly detailed e.g. whether the patient / service user is to be escorted and by whom, how often the patient / service user may leave the hospital. Day leave must state the times during which leave can be taken and the maximum time which may be spent away from the hospital. Overnight leave should state the time and date leave can commence and the date and time leave ends. Phrases such as as per care plan are insufficient. Nursing staff may be given the authority to negotiate actual times when leave is taken. This must be recorded as part of the MDT decision making and planning. The Inpatient Care Plan should be used to support the leave granting, planning and risk assessment. 6.7 Conditions/Role of the Responsible Clinician The Responsible Clinician may place any condition upon the granting of leave considered to be in the interest of the patient / service user or for the protection of others. The conditions of leave should be clearly given and recorded, including escort details. It may be appropriate to authorise leave subject to the condition that a patient / service user is accompanied by a friend or relative. If that is so the Responsible Clinician should specify that the patient / service user is to be escorted/accompanied by the friend or relative only if it is appropriate for that person to be legally responsible for the patient / service user and that person understands and accepts the consequent responsibility. 7

8 Escort by hospital staff should include consideration as to who is best placed/qualified to do this and whether this is within their scope of practice and job description. This should be discussed and recorded at both the planning MDT and as part of the arrangements for each episode of leave. This will also be reflected in the immediate/prior to each episode risk assessment. A care plan for leave should be drawn up and this should incorporate a contingency plan including contact numbers. Leave should not be used as an alternative to discharge, although it may be used to assess an unrestricted patient s suitability for discharge. The duty to provide aftercare under Section 117 (for those eligible) includes patients / service users who are on leave. A patient / service user granted leave under section 17 remains liable to be detained and the provisions of Part 4 of the Act, Consent to Treatment, still apply. Patients / service users on leave retain the right of appeal to the Mental Health Review Tribunal or Hospital Managers. 6.8 Leave to reside in another hospital Leave can be given to authorise the patient / service user to reside in another hospital but consideration should first be given to whether it would be more appropriate to transfer the patient / service user under section 19. When a patient / service user is given leave to reside in another hospital the overall responsibility of the patient / service user s care remains with the Responsible Clinician granting the leave. 6.9 Role of nursing staff Nursing staff have a vital role to play in the effective implementation, recording and evaluation of section 17 leave. The granting and planning of leave should include the contributions of nursing staff as part of the MDT and be clear on the role they are to play in facilitating this i.e. risk assessment prior to each episode of leave. There must be a correlation between the Section 17 leave form and the subsequent note in the daily record, risk assessment and care plan for safety and audit purposes. The nurse in charge/shift coordinator must ensure that a Section 17 leave form has been completed before the patient / service user is allowed to leave hospital. This task can be delegated to another registered nurse. This form should be accessible to staff at all times. Copies of the form are to be stored on each ward as well as be scanned onto the patient / service user record system. Replacement supplies can be ordered via Medical Records. Copies of the form should be handed to the patient / service user and copies given to any relatives, friends or carers who may require the information (subject to the patient / service user s consent). 8

9 Although only the Responsible Clinician and in the case of restricted patients / service users the Secretary of State for Justice can authorise leave, it may be managed by nursing staff. Nursing staff should assess a patient / service user s clinical state and conduct a risk assessment prior to each period of leave, even if the taking of leave is not contingent upon the approval. Particular attention should be paid to the risk posed to the patient / service user or to others. There must be an awareness of any child protection, child welfare issues, adult protection or domestic abuse issues. Consideration must also be given to what support the patient / service user would require and whether this can be reasonably provided. The risk assessment should be recorded in the locally agreed format, and take into account the recent history, e.g. use of as required medication and the reason, incidents on the ward, events outside, bad news, anniversaries of significant events, speech incongruent with behaviour etc. Nursing staff have the discretion to withhold leave if they have any doubts about the patient / service user s fitness. Reasons for refusal should be documented in the notes Any decision to grant leave under circumstances that might be taken to reasons to refuse it (such as the clinical opinion that time away from the ward after a period of disturbed behaviour would be beneficial) must be carefully documented and the reasons for leave being deemed safe explained in the record. Consideration should be given to who should escort the patient / service user i.e. staff or relative / carer. Escort by hospital staff should include consideration as to who is best placed/qualified to do this and whether this is within their scope of practice and job description If staff are escorting the patient / service user they should have a mobile phone with them in case of emergency and be clear what action to take in case of an emergency. When relatives are taking a patient / service user on leave they should be made aware of what to do in the event of an emergency, they should be given the ward contact details and asked to alert the ward as soon as possible if any untoward issues arise. Guidance notes for relatives / carers should be given prior to the first period of leave. If a carer or relative is involved in or affected by the leave they should be consulted and if they are taking the patient / service user out under their care/accompanying them. The responsibilities of the escort (as defined in the guidance) should be explained and this conversation then documented in the service user s notes. Every period of leave must be recorded in the nursing notes and within the overall recording and safety system of the ward (which allows staff to see who is on and off the ward). This should include dates and time of departure and return. The outcome of each period of leave along with an assessment of its relative success should also be undertaken and recorded. Patients / service users should be encouraged to contribute by giving their views and particular note should be made of any benefits or concerns raised by the patient or any escorting staff, relatives or friends. 9

10 An up to date description of the patient / service user should be recorded on the notes, or a photograph taken in order to improve the effectiveness of the missing persons procedure in the event of absconding or failure to return from leave. Any request to amend the leave plan to an alternative venue of increased length of time should be considered in light of a full risk assessment which should consider the risks to the service user and others and involve other professionals as necessary Cancellation of leave Should escorted leave have to be cancelled due to lack of staff escort an incident must be completed with rationale for the decision being provided and a record made in the patient / service user s notes If leave is cancelled for other reasons this should be assessed as to whether this is incident reportable but at the very least a note made in the patient / service user record Recall to hospital The Responsible Clinician may recall a patient / service user on leave when it is necessary in the interest of the patient / service user s health or safety or necessary for the protection of others. This must be in writing to the patient / service user and any other relevant persons (i.e. carers, escorts etc). The reasons for the recall must be explained to the patient / service user and a record of the explanation should be made in the patient / service user s notes. It is unlawful to recall a patient / service user to hospital to facilitate the renewal of the patient s detention under section 20 (see R v Hallstrom Ex p. W; R V Gardner Ex p. L[1986]2 All ER 306). However a patient s detention may be renewed whilst s/he is on leave even if the leave is for an extended period and the patient s contact with the hospital is modest (see R(on the application DR v Mersey Care Trust [2002] EWHC 1810(Admin)). A restricted patient / service user s leave may be revoked either by the Responsible Clinician or the Secretary of State for Justice. Patients may not be recalled from leave once they have ceased to be detained Absent without leave Section 18 of the Mental Health Act refers to patients being AWOL. When this occurs the Missing Person s Policy must be implemented. If a patient / service user fails to return from section 17 leave, the date and time and action taken must be recorded and the Missing Patients Policy should be followed. 10

11 Section B Guidance for patients / service users not legally detained (Duty of Care) Patients / service users who are not legally detained in hospital have the right to leave at any time. They cannot be required to ask permission to do so, but may be asked to inform staff when they wish to leave the ward. (Code of Practice). However In the case of voluntary or informal patients / service users where there is a real and immediate risk of suicide, the Supreme Court has ruled (February 2012) that the NHS has a positive duty (the operational duty) to protect life under Article 2 of the European Convention on Human Rights. In effect, this ruling requires leave for informal or voluntary patients / service users at risk of suicide to be managed as is if they were detained. Detention under the MHA must be considered in these circumstances which include Section 5(4) nurses holding power and Section 5 (2). For all other patients / service users in an acute inpatient setting, by the very nature of that setting must be seen as having risks, being vulnerable which need to be considered. Many of the process and considerations applied to patients / service users legally detained should be considered for those who are informal or voluntary. If a patient / service user wishes to leave the ward careful planning and risk assessment should take place. This should be discussed and agreed in the MDT, where appropriate and should involve the patient, carers and the CMHT / other community services where appropriate. This should be balanced against any risks that leave may pose to the protection of themselves and others. Consideration must also be given to what support the patient would require and whether it can be provided. Any discussion and decision should be recorded in the patient / service user s notes and as part of care planning. If a carer or relative is involved in or affected by the leave they should be consulted and this conversation then documented in the patient / service user s notes. Risk assessment should also take place immediately prior to the patient / service user going out. The shift co-ordinator (RMN) and contact nurse with input from the ward team and the Consultant, if required, should ensure that the leave is appropriate and safe to do so based on the current health of the patient / service user. Prior to every episode of leave a record should be made of what the patient / service user is wearing particularly if there is an increased risk of AWOL Every period of leave must be recorded in the care record. This should include dates and time of departure and return. The outcome of each period of leave along with an assessment of its relative success should also be recorded. Patients / service users should be encouraged to contribute by giving their views and particular note should be made of any benefits or concerns raised by the patient / service user or any escorting staff, relatives or friends. 11

12 Nursing staff may be given the authority to negotiate actual times when leave is taken. This must be recorded as part of the MDT decision making and planning. The Inpatient Care Plan should be used to support the leave, planning and risk assessment. 12

13 Section C Practicalities 1. Dissemination, storage and archiving This policy will be posted on the SHSC intranet and internet. In addition Clinical Directors and Ward Managers will be asked to ensure all staff are made aware of this policy. The previous policy will be removed from the Trust website by the Integrated Governance Team. Ward Managers will be responsible for ensuring that it is also removed from any policy and procedure manuals or files stored on the wards A paper version of previous policies will be archived in the Mental Health Act Administration Department. 2. Training and other resource implications The Trust delivers training on the Mental Health Act and the process of Section 17 leave forms part of that training 3. Audit, monitoring and review The completing of the section 17 leave form will be audited along with other Mental Health Act requirements on a quarterly basis to meet Mental Health Act Commissioner standards. 4. Implementation plan For dissemination, storage and archiving see 7 above This policy has been reviewed in and amended in keeping with the changes to the Mental Health Act 1983 and these changes will be included in the Training plan for the Mental Health Act. This policy needs to be operational from Lead Roles - Executive Director with responsibility for Mental Health Act, Fulwood House/ Mental Health Administrator, Michael Carlisle Centre * A local implementation plan is required for each service where this policy applies 5. Links to other policies Trust guidelines on Community Treatment Orders Missing Patients Policy 6. Contact details Catherine Dixon, Mental Health Act Administrator, Michael Carlisle Centre regarding MHA leave 7. References Mental Health Act 1983 Mental Health Act 2007 Code of Practice to the Mental Health Act Mental Health Act 1983 Revised Code of Practice Chapter 21 Draft Reference Guide to the Mental Health Act 1983, paras to Mental Health Act Manual, Richard Jones 10th Ed, paras to1-180 Mental Health Act Commission Guidance Notes Issues surrounding section & 19 of the Mental Health Act

14 Appendix 1 Authorisation of leave Form 14

15 AUTHORISATION OF LEAVE UNDER SECTION 17, MHA, 1983 I, the undersigned RC hereby grant leave of absence for the patient named below, under section 17 Mental Health Act Patient s Name... Insight No D.O.B MHA Section RC:. Hospital...Ward: Type of Leave Short Term Local Leave (i) Purpose/destination (ii) For a period of Hours Repeatable Yes/No - If Yes state timeframe.. Day Leave (i) Purpose/destination. (ii) Between the hours of.am/pm and...am/pm (iii) For the period of Hours..Days Repeatable Yes/No - If Yes state timeframe.. Overnight Leave (i) Purpose/destination. (ii) From: Date. Time: (iii) To: Date.. Time: (iv) Total Number of nights... Repeatable Yes/No- If Yes state timeframe.. Extended Leave (i) From:.. To: (If the leave is for more that 7 days document in the notes whether Supervised Community Treatment has been considered) Address of Leave... Conditions of leave, if any are, as follows: Is an escort required yes / no. If so please indicate: Family / friend / carer escort (Please record name or relationship to the patient).. Formal staff escort (please indicate role of staff i.e. RMN or Support Worker) Other conditions of leave e.g. is the leave restricted to a specific area or are there areas the patient may or may not reside / go... Risk assessment: The following leave is granted on the basis of a recorded risk assessment. An assessment of risk should also be carried out immediately prior to leave by the allocated nurse and a record made of this. Signed by: Date and Time Copies to: Patient yes / no GP yes / no Carer / relative yes / no Other professionals please specify yes / no 15

16 Appendix 2 Equality Impact Assessment Form Yes / Comments No 1. Does the policy / guidance affect one group less or more favourably than another on the basis of: Race No There may be cultural issues with consent to providing photographs Ethnic origins (including No gypsies and travellers) Nationality No Gender No Decisions to grant leave should be carefully considered when there is potential domestic abuse Culture No Religion or belief No Sexual orientation No including lesbian, gay and bisexual people Age No Disability learning No Support may be required to disabilities, physical facilitate leave for patients / disability, sensory service users with a impairment and mental disability health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal or justifiable? 4. Is the impact of the policy / guidance likely to be negative? 5. If so can the impact be avoided? 6. What alternatives are there to achieving the policy / guidance without the impact? 7. Can we reduce the impact by taking different action? Yes No No No No No Some BME groups are over-represented, particularly young African Caribbean men This is a national pattern and is as a result of a wide range of societal influences, almost all of them outside the mental health service. The introduction of Supervised Community Treatment / Community Treatment Orders needs to be monitored to establish patterns of use amongst BME groups The issue of certain BME groups and their overrepresentation in MH Act terms is being addressed within the Trust and PCT The issue of BME groups was placed on the Risk Register of the two Adult Directorates Continue to ensure that BME issues are considered when applying the MH Act Action The policy references the need for local procedure regarding this if photographs are to be taken for this purpose This has been specified in the policy in sections 6.7 and 6.9 The policy states that reasonable steps should be taken to facilitate leave in this situation 16

17 Appendix 3 Human Rights Act Assessment Form Introduction The 2007 Mental Health Act implementation within the Sheffield Health and Social Care Trust is within the context of primary legislation from the UK Government. The presumption is therefore that all elements of the Act have been assessed as being within the Human Rights Act. Human Rights Act Articles. Right to life - Not appropriate Prohibition of Torture - Not appropriate Prohibition of slavery and forced labour - Not appropriate Right to liberty and security - The legal framework within which the issue of compulsion sits is clear. Right to a fair trial - As above No punishment without law - As above Right to respect for private and family life - As above Freedom of thought, conscience and religion - These freedoms are clearly addressed within the Act Freedom of assembly and association - As above. Right to marry - Not appropriate. Prohibition of discrimination - These are clearly addressed within the Act. Greg Harrison Reviewed March

18 Appendix 4 POLICY DEVELOPMENT AND CONSULTATION PROCESS This is a revision of an existing policy. The policy has been revised specifically in order to comply with changes in the Mental Health Act. The policy has been developed and consulted via the Mental Health Act Group and the Policy Governance Group. January April 2012 A further review of the policy was undertaken which involved consultation with medical and nursing staff as well as Senior Managers within the Acute / inpatient Directorate. The policy was reviewed with the lead for equality and diversity and amended as a result. 18