Setting

This audit is particularly relevant to general adult or old age psychiatry inpatient services where patients are detained under the Mental Health Act 1983. However, it could be modified to cover forensic patients or patients subject to community treatment orders (CTOs) or guardianship.

Background

In November 2008, the mental health review tribunal was abolished and replaced by the First-tier Tribunal (Mental Health) within the Health, Education and Social Care Chamber for Tribunals. This tribunal hears applications and references for people detained under the Mental Health Act (MHA) and it has the power to discharge patients from orders under sections 2, 3, 7 (guardianship), 17A (CTOs) and 37.

Standards

In 2008, the First-tier Tribunal (Mental Health) introduced new guidance for professionals writing reports. The revised standards for the clinician's report listed below were obtained from the relevant Tribunals Judiciary – Practice Direction (Ministry of Justice, 2008). The report, which should be signed by the responsible clinician (RC) or countersigned by the RC if not actually prepared by the RC, should give the following general information:

ᐅ patient's full name

ᐅ patient's date of birth and age

ᐅ patient's address

ᐅ patient's first language

ᐅ whether an interpreter is required

ᐅ date of admission

ᐅ section of MHA under which the patient is detained

ᐅ name of hospital where detained

ᐅ name of patient's RC

ᐅ period spent under care of this RC

ᐅ name of patient's key worker

ᐅ details of any existing advance decisions to refuse psychiatric treatment

ᐅ date of clinician's report for the tribunal. The report should cover:

ᐅ relevant medical history

ᐅ patient's mental state and behaviour

ᐅ treatment for mental disorder

ᐅ previous self-neglect, self-harm, actual threat or harm to others when the patient was mentally unwell

ᐅ assessment of risk to self and others if the patient should be discharged

ᐅ management of these outstanding risks

ᐅ assessment of the patient's strengths

ᐅ if appropriate, the reasons why the patient might be treated in the community under a CTO as an alternative to continued detention in hospital.