The 1984 Mental Health (Scotland) Act provides the legal framework in Scotland for compulsory admission and treatment of patients suffering from mental disorder. A new Act - the Mental Health (Care and Treatment) (Scotland) Act 2003 - has been passed by the Scottish Parliament and is expected to come into effect after October 2004. Until it does, the 1984 Act remains in force.
GPs can be involved in using the Mental Health Act in a variety of circumstances:
- Emergency recommendation for detention (Section 24): This is used where admission is urgently required and use of Section 18 would introduce undesirable delay. Admission under Section 24 allows for a period of 72 hours of assessment. Any doctor can legally make the recommendation, but the consent of a mental health officer (MHO; a social worker with special training) or a near relative must be obtained, wherever practicable.
- Non-emergency admission for up to six months (Section 18): This is used where admission is required less urgently (eg where the patient's mental state deteriorates over time). In practice, this mainly used for patients known to the service. An application is required from a MHO (or occasionally the nearest relative) and recommendations from a Section-20-approved doctor (usually a psychiatrist, and, where the patient is known to the service, the patient's own consultant psychiatrist) and the GP or another doctor with previous knowledge of the patient.
- Power of Entry (Section 117): This might need to be used where a patient with possible mental disorder in the community refuses assessment and help. For example, the patient may be behaving eccentrically, live in very poor conditions, be ill-treated or neglected by others or alone and unable to care for themselves. This warrant is obtained by a MHO from a Justice of the Peace. It allows a police officer, accompanied by a doctor, to force entry. The person may then be removed to a place of safety with a view to assessment for admission under Section 24.
Treatment of a patient who is on leave of absence: A detained patient may be allowed out of hospital on `leave of absence' for up to one year. GPs must only prescribe psychiatric medications that are consistent with the agreed treatment plan, set out on form 9 (where the patient is consenting to treatment) or form 10 (where the patient is not consenting to treatment) - see http://www.show.scot.nhs.uk. GPs should expect to be told of the conditions of the leave of absence, of the circumstances in which the patient is likely to be recalled to hospital and the arrangements in relation to treatment.
Last edited: 10/2/2004
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