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What are they key changes to the Mental Health Act Code of Practice?

Our People - Maria Nicholas
13 April, 2015

The Code of Practice to the Mental Health Act 1983 (MHA) has been substantially revised. The new version came into force on 1 April 2015.

The Code applies to any decisions made in relation to a patients’ care, support or treatment provided under the MHA. The Code is statutory guidance (i.e. it is binding) for many professionals such as Responsible Clinicians, or Approved Mental Health Practitioners. For those in the independent and voluntary sectors involved in commissioning or providing services the Code is not statutory, but it is considered beneficial, and the introduction to the Code itself says that “it is important that these persons have training on the Code and ensure that they are familiar with its requirements”.

Key changes

  • The introduction of five, new overarching principles
  • New chapters on equality and  health inequalities, care planning and human rights
  • New guidance on when to use the MHA and when to use the Mental Capacity Act 2005, and deprivation of liberty safeguards
  • Additional guidance on blanket restrictions, supporting patients with dementia and with autism and learning disability, and on physical healthcare
  • Revisions to the guidance on restrictive interventions, including in relation to segregation
  • A new list of policies and procedures that have to be issued by hospital managers and local authorities. 

Guiding principles

Five overarching principles have been introduced into the Code, which must be followed. Any departure from the principles will have to be explained and justified. 

The principles are:

Least restrictive option and maximising independence

Wherever possible a patient should be treated without being detained under the MHA, if this can be done safely and lawfully. This means that those involved in providing care should work together with other relevant services to prevent mental health crises and to reduce the use of detention through prevention and early intervention. Patients’ independence should also be encouraged and supported.

Empowerment and involvement 

Patients should be fully involved in decisions about their care, support and treatment, bearing in mind that they may need support to participate in this way. Consideration should be given as to whether the patient needs an advocate to assist them in expressing their views. The views of their family, carers and other appropriate individuals should also be fully considered.

Respect and dignity

Patients, their family and carers should be treated with respect and dignity.

Purpose and effectiveness

Decisions about care and treatment should be appropriate to the patient, and have clear therapeutic aims, promote recovery, and adhere to national or best practice guidelines from professional bodies. Care plans for detained patients should focus on maximising recovery and ending detention as soon as possible. Care plans should also address physical healthcare needs, including the promotion of healthy living and reducing any side-effects of treatment.  

Efficiency and equity 

Providers, commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental health services are of high quality, and are given equal priority to physical health and social care services. All services should work together to facilitate timely, safe and supportive discharge from detention. Staff must have sufficient skills, information and knowledge about the MHA to support their patients.

Head of Court of Protection
Maria Nicholas is a Solicitor and Director at GN Law, and the Head of the Court of Protection and Community Care Departments. Maria advises on issues of mental capacity, best interests, deprivation of liberty and all aspects of community care law.

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