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MENTAL HEALTH (CARE AND TREATMENT) (SCOTLAND) ACT 2003
TRANSITIONAL TRAINING GUIDE
INTRODUCTORY TRAINING FOR MENTAL HEALTH OFFICERS AND OTHER PRACTITIONERS
COMPULSORY TREATMENT ORDERS AND RELATED MATTERS
READER 3

ANNEX A
Answers to the third self-assessed test of knowledge (Reader 3):

1. Q: What are the time-scales for making the medical examinations for a CTO in relation to the deadline for the submission of the application by the MHO?

A: The medical examinations must be made within five days of each other and the 14-day period in which the MHO must complete his or her report and compile the MHO's Proposed Care Plan is triggered by the completion of the latter of these examinations. The application must be submitted to the Tribunal on or before the expiry of that 14-day period.

This is a crucial piece of knowledge and we would hope that you have these times firmly in mind by now.

2. Q: What are the maximum duration periods for a CTO and for an interim CTO?

A: CTO may last for up to 6 months in the first instance and is renewable for 6 months in the second instance. Thereafter it is renewable annually. An interim CTO is granted for up to 28 days.

We would hope that you know the duration of a CTO and its renewals from the old section 18, the time-scales for which it echoes. Consider the knowledge that an interim Order endures for up to 28 days as knowledge that gets you a bonus point.

3. Q: What measures may a Tribunal authorise in a CTO?

A: The detention of the patient in a specified hospital; the giving of medical treatment; the requirement to attend specified or directed places on specified dates or at intervals for the purpose of receiving medical treatment; the requirement to attend specified or directed places on specified dates or intervals for the purpose of receiving community care or other services; the requirement to reside at a specified place; the requirement to allow visits by the RMO, MHO or specified others involved in the delivery of services; and the requirements to obtain the MHO's permission to change address and to inform the MHO of that change before it takes place.

This is an extensive list and even as it appears here, we have paraphrased it from section 66. We do not anticipate that you will need to memorise such lists. If you have got the salient points correct (particularly detention, treatment, receipt of care services and the residence requirement) consider your answer good enough.

4. Q: What reports and documents are required for a CTO application?

A: The two medical reports by Medical Practitioners (one an AMP who is preferably the RMO), the Application by the MHO, the MHO Report and the Proposed Care Plan compiled by the MHO.

It is essential that you have this fixed in your mind as it is a starting point from which to quantify the process of application.

5. Q: Does anyone have to be consulted if the RMO needs to remove the patient to a specified place for the purpose of giving treatment because the patient is non-compliant with a measure requiring treatment in a CTO?

A: The RMO requires the consent of the MHO to do this.

You should have such knowledge of the structure of the Act by now that you should be able to guess the correct answer to this, based upon the assumption that virtually no restrictions may be imposed without MHO consent or application.

6. Q: If the patient is withdrawn into hospital under section 113, following a general failure to comply with measures of a community-based order, for how long may she/he be detained?

A: Up to 72 hours.

In a sense this is a question that requires you to have assimilated relatively small scale details of the Act. As such you might feel cause to be aggrieved that we expect you to have taken so much in so short a time. However, we would hope that you are beginning to do this. For example, if you confused the 72 hour period of detention under section 113 with the 6 hours that a patient may be held in order to comply with treatment under section 112, or the 28 days during which an order may be suspended in order to vary it under section 114, at least you are in the right ball park!

7. Q: Who may apply to the Tribunal to revoke Short-term Detention or extension or variation of an Order?

A: Either the patient or his or her named person.

8. Q: May ECT be given to a patient who is authorised to receive treatment under the Act, who is incapable of understanding its nature, purpose and likely effects and who resists or objects to it?

A: Yes, if it is urgently necessary to save the patient's life, to prevent serious deterioration in the patient's condition, to alleviate serious suffering, to prevent the patient behaving violently or to prevent the patient being a danger to self or others.

We deliberately asked a difficult question here to try and get at the differences between the treatment position here and in the 1984 Act. If you did not have the answer precisely correct do not worry. However, we would hope that you would be beginning to get the shape of these matters into your head. For example, if you answered 'no' to the question, out of an awareness that the treatment position for ECT in relation to consent and lack of capacity is more restrictive than it was in the old Act, you are still doing well in developing your knowledge.

9 . Q: To whom may appeals against Tribunal decisions be made?

A: To the Sheriff Principal, who may remit the matter to the Court of Session.

10 . Q: What is a designated MHO?

A: Under section 229, the local authority has a duty to appoint a designated MHO for the purposes of having responsibility for the patient's case, as long as the patient is subject to a certificate, order or direction.

We have threaded so many references to the continuing, hands-on role for MHOs through this reader that we would hope that you recognised this longitudinal role in the term 'designated MHO', even if you were unable to locate its source in section 229.

ANNEX B
Comparison Between 2003 Act and 1984 Act

ANNEX C
MENTAL HEALTH OFFICER DUTIES/ROLE UNDER 2003 ACT

Warrant to Obtain Entry

• Under Section 35 there are three separate warrants which an MHO may seek in order to carry out the local authority's duty to inquire under Section 33: Section 35(1) is to provide access to premises; Section 35(4) is to detain a person for up to three hours for the purpose of facilitating a medical examination; and, Section 35(7) is to give access to a patient's medical records.

Emergency detentions

• Consent of relatives and / or nearest relatives no longer included in the Act in decisions about ( Section 36) emergency (72hr) and (Section 44) short term (28 day) detentions.

• Consent of MHO required wherever practicable for emergency detentions.

• Under Section 38, an Approved Medical Practitioner must see patient as soon as practicable after admission under emergency detention certificate. This will lead to them requesting input from MHO re consent to short term detention in many cases.

Short-Term Detentions

• Under Section 44 MHO consent is mandatory for short term detention. No longer is impracticability of securing consent able to be cited by medical practitioner.

• Under Section 45 the MHO must, where practicable, interview patient prior to deciding whether to consent to short term detention. MHO also must ascertain the name and address of the patient's named person; inform the patient of the availability of independent advocacy services; and, take appropriate steps to ensure the patient has the opportunity of making use of these services.

• If it is impracticable for the MHO to interview the patient and ascertain the name and address of the patient's named person before consenting to the granting of the short-term certificate, the MHO must also record the steps taken in relation to these duties related to the process of consideration of short term detention and give a copy to the AMP within 7 days from when first consulted by the AMP re consent to short term detention.

Extension of Short-Term detention

• Under Section 47, consent from an MHO must be obtained, wherever practicable, before an extension of a short term detention certificate pending an application for a compulsory treatment order can be granted. Under Section 48 the RMO must notify the Tribunal of the extension and indicate whether the consent of the MHO was obtained, and, if not, the reasons why it was impracticable to consult an MHO.

Revocation of Short-Term Certificates

• Under Section 50, the Tribunal must give the MHO who consented to the short term detention certificate the opportunity of making representation orally or in writing and of leading or producing evidence when a patient seeks to have the short term detention certificate revoked. The Tribunal may extend this right to any other MHO if the Tribunal feels that person has an interest in the application. This leaves it open for a designated MHO to be involved even if not the MHO who consented to the short term detention.

• Where an RMO revokes a short term detention certificate s/he must give notice under Section 49 as soon as practicable to the MHO.

• Where the MWC revokes a short-term detention certificate they must give notice under Section 52 to the MHO.

• Where the patient applies for a revocation of the short-term detention certificate, the MHO who consented to the short-term detention certificate would be given the opportunity to give evidence and may have to appear before the Tribunal.

Revocation of certificate suspending measure authorising short-term detention

• Where an RMO grants a certificate specifying a period during which the short-term detention certificate is suspended, and subsequently revokes this certificate under Section 54, the RMO must as soon as practicable after doing so give notice to the MHO.

Compulsory Treatment Orders

• Under Section 57 a MHO must apply for a Compulsory Treatment Order when in receipt of the relevant mental health reports from two medical practitioners. MHOs play a key role in the decision to apply for a compulsory treatment order as well as the related process of making the application.

• The MHO applicant must prepare a report, a proposed care plan and an application based on these as well as the 2 accompanying mental health reports. They must coordinate all this within a very tight timeframe - within 14 days of the last medical examination for the purposes of the mental health report.

• In preparing the Mental Health Officer's report for the purposes of an application under Section 61, the MHO must interview the patient and inform them of their rights in relation to the application as well as the availability of independent advocacy services and must take appropriate steps to ensure that the patient has the opportunity of making use of these services. If meeting these duties proves impracticable, the MHO must state the reason why this was the case in the MHO report. The MHO must also, as soon as practicable after the duty to make the application arises and, in any event, before making the application, take such steps as are reasonably practicable to ascertain the name and address of the patient's named person which is needed for the MHO report.

• Under Section 62 an MHO must prepare a proposed care plan and in doing so must consult the medical practitioners who provided the mental health reports, and, where practicable, all relevant persons providing the medical treatment, community care services or other relevant services as outlined in the proposed care plan. Close attention must be paid to the considerable requirements in respect of proposed care plans outlined in Section 62.

• Under Section 60, the MHO must give notice in writing to the patient, the patient's named person and the Commission of their intention to make an application and they must do this as soon as practicable after that duty arises. The MHO can over-ride the RMO's decision not to give notice to the patient if they consider it appropriate to do so.

• The Tribunal before making a decision must afford the MHO applicant the opportunity of making representations either orally or in writing and of leading or producing evidence. The Tribunal system will result in closer scrutiny of the assessment and care planning process. This will result in a higher level of accountability for MHOs as well as others involved in the process.

Interim Compulsory Treatment Orders

• Where an application for a CTO is made under Section 63, anyone with an interest in the proceedings (therefore including an MHO) may apply to the Tribunal for an Interim Compulsory Treatment Order. Before making an interim order the Tribunal must afford any person having an interest in the application - which obviously includes Mental Health Officers - the opportunity of making representations either orally or in writing and of leading or producing evidence.

Measures that may be authorised by the Tribunal

• The Tribunal may impose a requirement on the patient under Section 66 to allow the MHO (or others involved in their care and treatment) to visit the patient in the place where the patient resides.

• The Tribunal may also impose a requirement on the patient to obtain the approval of the MHO to any proposed change of address.

• The Tribunal may further impose a requirement on the patient to inform the MHO of any change of address before the change takes effect.

Hospital Direction or Transfer for Treatment Directions

• Following the imposition of Hospital Directions and Transfer for Treatment Directions, procedures in respect of CTOs and the involvement of MHOs will pertain as outlined in Schedule 3 to the Act.

Interim Compulsory Treatment Orders: Review and Revocation

• Where an Interim CTO is revoked by either the RMO or the MWC they must under Section 74 and as soon as practicable after doing so, give notice of the determination and the reasons for it to the Mental Health Officer.

Reviews, Extensions, Variations and Revocations of CTOs

• MHO involvement is required in all reviews, extensions, variations and revocations of detention/compulsory treatment. Where the Tribunal makes any determination in respect of an order, they must first afford the MHOs an opportunity of making representation orally or in writing and of leading or producing evidence. The Tribunal may require the MHO to prepare and submit reports in relation to any determinations.

• The RMO has a responsibility to consult the MHO in carrying out all first mandatory reviews of CTOs as outlined in Section 77(3)(c)(i).

• The RMO must consult the MHO when carrying out further mandatory reviews under Section 78.

• Under Section 82 the RMO and the MWC must notify the MHO whenever they revoke a CTO.

Extension of CTO (a ' Section 86 determination' )

• Under Section 84, the RMO must give notice to the MHO of the intention to extend a CTO. This triggers the MHO's duties under Section 85 to interview the patient (wherever practicable) and to inform the patient in all cases of the RMO's intent, their rights in relation to this, and the availability of independent advocacy services. The MHO must also take appropriate steps to ensure that the patient has the opportunity of making use of those services.

• Following the interview of the patient when notified of the RMO's intent to extend the order, the MHO must advise the RMO of whether they agree with this decision and, if not, why not. The MHO must also inform the RMO of any other matter they consider relevant to the proposed extension. These views will then be expressed in the record made by the RMO of the extension which is forwarded to the Tribunal, the patient (unless the RMO feels that doing this would present a risk of significant harm to the patient), the patient's named person, the MHO and the Commission. The RMO must also record where the MHO failed to comply with their duties under Section 85.

• Where the MHO disagrees with the proposed extension of the order or has not advised the RMO of their views as required, the Tribunal must review the determination under Section 101. In such cases the MHO must be afforded the opportunity of making representations either orally or in writing and of leading or producing evidence.

• Similar procedures follow from the Tribunal's responsibility to review an order when they have not been involved in a determination in respect of the patient during the past two years.

Extension and Variation of CTO (a ' Section 92 application' )

• Under Section 88, where an RMO is reviewing an order and feels that it needs to be extended and the order itself amended by modifying the compulsory measures, or any recorded matter, specified in it, the RMO must give notice to the MHO of the propose application. This then triggers off duties for the MHO which are the same duties as when an order is merely extended. The RMO's subsequent application under Section 92 must indicate whether the MHO agrees or disagrees with the application, and, if the MHO disagrees, the reason for this. Alternatively, the RMO must state where the MHO has failed to comply with their duties under Section 89.

• Where any person having an interest in the above proceedings makes an application to the Tribunal or the Tribunal itself considers that it would not be able to determine the application before the CTO expires, it may grant an interim order under Section 105 extending the order or extending and varying the order for a period not exceeding 28 days.

• The Section 92 application will be reviewed by the Tribunal and, before making a decision, the Tribunal must afford the MHO the opportunity of making representations orally or in writing and of leading or producing evidence.

• Regulations under Section 92(b) require an MHO to prepare a report for the Tribunal.

Variation of CTO (a 'Section 95 application')

• Section 93 requires the RMO from 'time to time' to consider whether the CTO should be varied by modifying the measures in it. If it appears to the RMO that this is the case, they must consult the MHO. If the RMO subsequently applies to the Tribunal under Section 95, the same rules apply in respect of the MHO as was the case with an application under Section 92.

• Regulations made under Section 95(b) require an MHO to prepare a report for the Tribunal.

Failure to provide recorded matter specified in the CTO

• Under Section 96 if it appears to the RMO that a service specified in a recorded matter is not being provided, they are under a duty to consult the MHO as soon as practicable and if satisfied that the recorded matter is not being provided must make a reference to the Tribunal, giving notice to the MHO when they do so.

• Section 98 also gives the MWC the authority to make reference to the Tribunal where they feel it is appropriate.

• When a reference is made to the Tribunal under Section 96 or 98, the Tribunal can vary the CTO by modifying the measures or any recorded matter specified in the order, or can revoke the order. Before making a decision, the Tribunal must afford the MHO the opportunity of making representations orally or in writing and of leading or producing evidence.

Application by patient for revocation of determination extending CTO or varying CTO

• Under Sections 99 and 100 a patient is given authority to apply to the Tribunal for an order under Section 103 revoking the RMO's determination to extend the order ( S.99) or vary the order ( S.100). Before making a determination on the application, the Tribunal must first afford the MHO the opportunity to make representation orally or in writing and of leading or producing evidence.

• The Tribunal can also approve interim extension and interim variation orders for a period not exceeding 28 days. .

Powers of Tribunal to require report from MHO

• Under Section 109 the Tribunal is given the authority when considering applications under Sections 92, 95, 99 or 100 to require an MHO in circumstances to be prescribed by Regulations to prepare and submit a report to the Tribunal.

Breach of Orders Reports

• Section 112 concerns situations where a patient subject to a compulsory order or interim compulsory treatment order which imposes an attendance requirement for medical treatment fails to comply with this, the RMO may take or authorise a person to take the patient into custody and convey them to any hospital or the place the patient is required to attend and detain them there for no longer than 6 hours only if the RMO consults the MHO and the MHO consents to this.

Detention pending review or application for variation

• When a patient is detained in hospital under Section 113 for up to 72hrs for general non-compliance with a community-based compulsory treatment order or community-based interim compulsory treatment order and when the RMO is considering whether the order should be varied by modifying the measures in it or is required to make an application to the Tribunal and when the RMO feels that if the patient did not remain in hospital there would be a significant deterioration in the patient's mental health, the RMO can under Section 114 grant a certificate authorising the continued detention of the patient in hospital for up to 28 days but only if s/he first consults the MHO and the MHO consents to this.

Suspension of Detention

• Before an RMO under Section 127 grants a certificate suspending the detention of a patient in hospital where this is a measure included in the CTO or Interim CTO for a period of more than 28 days, s/he must give notice to the MHO (and others) before granting the certificate.

Suspension of Other Measures

• Before an RMO under Section 128 grants a certificate suspending any measure other than detention in hospital this is limited to a period of three months, s/he must first give notice to the MHO (and others) of the measures and the period that s/he proposes to specify in the certificate and the reasons for proposing to specify these measures

Revocation of Suspension of Measures

• When the RMO revokes a suspension of measures s/he must as soon as practicable after doing so give notice to the MHO (and others).

Social Circumstances

• Section 231 requires MHOs to provide to the MWC and the RMO a Social Circumstances Report within 21 days of a 'relevant event' occurring, unless they formally state in writing to the patient's RMO and the MWC why doing so would serve little, or no, practical purpose. Regulations will prescribe the content of SCRs.

• Relevant events include:

• • The granting of a short term detention certificate and the making of:

  • Interim compulsory treatment orders

  • Compulsory treatment orders

  • Assessment orders

  • Treatment orders

  • Interim compulsion orders

  • Compulsion orders

  • Hospital directions

  • Transfer for treatment directions

Assessment of needs for community care services

• Sections 227 and 228 essentially state that when an MHO believes that a patient (i.e. anyone with a mental disorder) may be in need of community care services and requires a formal assessment of needs under Section 12A of the Social Work (Scotland) Act 1968, or believes that the needs of a child should be formally assessed under the Children (Scotland) Act 1995, they can request in writing to the local authority that this assessment takes place. This then places the local authority under a duty to respond within 14 days whether they intend to undertake the assessment, and, if not, the reason why this is the case. Similarly, if the MHO believes that the patient has need for services provided by a Health Board, they are given the authority to make a request for an assessment of these needs to the Health Boards who must respond within 14 days as to whether they intend to undertake the assessment, and, if not, the reasons why.

Designation of Mental Health Officer

• Section 229 requires the local authority as soon as reasonably practicable after the occurrence of a relevant event to designate an MHO who has responsibility for the case for as long as the patient is subject to the certificate, order or direction to which the relevant event relates. At any point in time the local authority can appoint another MHO in place of the designated MHO.

Consultation re certificates relating to Consent to Treatment

• Section 245 requires RMOs to consult with any person who appears to be principally concerned with the patient's medical treatment before granting a certificate under Sections 235, 236, 239 and 241. Given the definition of medical treatment in Section 329, this may involve an MHO.

Named Person

• Section 255 outlines the MHO's duties in respect of named persons, some of which have been referred to within the specific relevant event sections above. This section spells out that where an MHO either establishes that the patient has no named person, or is unable to establish whether they have a named person, they must make a record of the steps as were reasonably practically taken to determine whether the patient had a named person and who that person is. In doing so they must as soon as practicable give a copy of this record to the Tribunal and the MWC.

• Section 257 gives the MHO the authority to make an application to the Tribunal requesting the appointment of a person named on the application to be appointed as the named person or the acting named person where they have established that the person does not have or appear to have a named person or where the named person or apparent named person appears an inappropriate person to act as the named person.

Detention in conditions of excessive security

• When an application is made to the Tribunal under Section 264 declaring that the patient is being detained (in the State Hospital) in conditions of excessive security, before making a decision the Tribunal must afford the MHO the opportunity to make representations orally or in writing and to lead or produce evidence.

• Where a Tribunal makes an order under Section 264 requiring a Health Board to transfer the patient to another hospital within 3 months and the Health Board fails to do so, Section 265 requires that there be a hearing before the Tribunal and the Tribunal may decide if they feel that the patient does not require to remain in conditions of excessive security to specify that the Health Board transfer the patient to a suitable hospital within a period of 28 days. Before making such a determination, however, the Tribunal must afford the MHO the opportunity to make representations orally or in writing and of leading or producing evidence.

• Section 266 relates to situations where the Health Board again fails to transfer the patient and another hearing before the Tribunal requires to be held. Again, before making a decision the Tribunal must afford the MHO the opportunity to make representations orally or in writing and to lead or produce evidence.

• Where an application is made by Scottish Ministers, a Health Board or (in certain cases) an RMO to the Tribunal to recall an order made under Sections 264, 265 or 266, before making a decision the Tribunal must afford the MHO the opportunity to make representations orally or in writing and to lead or produce evidence.

• Sections 268, 269, 270 and 271 outline processes which are the same as those outlined above except they relate to situations where the patient is detained in conditions of excessive security in a hospital other than the state Hospital.

Duty to minimise impact of compulsion on parent/child relationships

• Section 278 places a duty on MHOs as well as others exercising functions under the Act to take all reasonable and practicable steps to limit the effects of compulsory powers on the relationship and contact between a parent and child, whether it is the parent or the child who is subject to compulsion under the Act.

Cross-border transfer of patients subject to requirements other than detention

• Section 289 gives authority for Regulations to be made in connection with the removal of a patient subject to a community-based compulsory treatment order to a place outwith Scotland. These Regulations can require the RMO to authorise a warrant in respect of such a transfer. The RMO in such circumstances must first notify the Mental Health Officer.

Cross-border transfer of patients subject to detention requirement or otherwise in hospital

• Where Regulations make provisions under Section 290 in respect of the cross-border transfer of certain patients, a warrant issued by Scottish Ministers is required authorising the transfer. Scottish Ministers are required to notify MHOs in such circumstances at least 7 days before the date proposed for the patient's removal. Regulations under Section 290(1) may require the provision of an MHO report following transfer of patient to Scotland.

Applications to Tribunal in relation to unlawful detention

• An MHO may apply to the Tribunal for an order requiring the managers of a hospital to cease to detain a patient who is in hospital on an informal basis.

Warrant to enter premises for purposes of taking patient

• Under Section 292 a warrant may be granted by a sheriff, or justice of the peace authorising any MHO (and any other duly authorised person) to enter the premises specified in the warrant for the purposes of an authorised person taking the patient to any place or taking or retaking into custody the patient where the patient is liable to be taken or retaken. The authorised person in this context relates to a person who has already been authorised by another provision of the Act to take a patient into custody (for example, where the patient has absconded).

Removal Order

• Section 293 gives MHOs the authority to apply to a sheriff for an order to remove a person to a place of safety where it is believed that the person has a mental disorder and is subject or exposed to ill-treatment, neglect or some other deficiency in care, or treatment or because of the mental disorder the person's property is suffering loss or damage or is at risk of suffering loss or damage, or where the person is living alone or without care and is unable to look after himself or his property or financial affairs. The removal order can authorise the MHO before the expiry of 72hrs to enter the premises, to remove the person to a place of safety and to detain the person in that place for a period not exceeding 7 days.

• Section 294 allows the MHO to apply to a justice of the peace where making an application to the sheriff is impracticable or would cause a delay that would likely be prejudicial to the person who would be the subject of the application.

• Section 295 stipulates that an application can be made to the sheriff to recall the removal order. Regulations stipulate that the sheriff before deciding on the application must afford an MHO the opportunity to make representations and lead or produce evidence.

Nurses' power to detain pending medical examination

• Section 299 gives nurses of a prescribed class the authority to detain a patient in hospital for a period of up to two hours for the purposes of enabling arrangements to be made for a medical examination of the patient to be carried out and where they do to inform a mental health officer as soon as practicable after the holding period begins.

Absconding

• Under Section 303 an MHO is specified as a person who has authority to take into custody any patient liable to be taken into custody who has absconded. They are also given authority to return the patient to the hospital in which the patient was or was to be or if that is not appropriate, any other place considered appropriate by the patient's RMO detained. The MHO may also take the patient to such other place as they absconded from or at which they failed to reside, or, if not practicable, to any other place considered appropriate by the patient's RMO.

Long unauthorised absences ending more than 14 days before expiry of Compulsory Treatment Order

• Section 305 pertains where the unauthorised absence of a patient has lasted longer than 28 consecutive days and ceased before the beginning of 14 days ending with the day when the compulsory treatment cease to authorise the measures specified in it. In such circumstances, the order ceases to have effect at the end of the 14 days when the patient's unauthorised absence ended. Within this 14 day period, the RMO must carry out a review in respect of the CTO and must consult the MHO in doing so.

• Section 310 outlines procedures for patients on unauthorised leave who are liable to be detained or subject to compulsion under other procedures (Assessment Orders, Treatment Orders, Temporary Compulsion Orders under Section 54, Interim Compulsion Orders, and Compulsion Orders) and may involve an MHO.

False statements

• Section 318 makes it an offence for any person to knowingly make an entry or statement which is false in a material particular or with intent to deceive, makes use of any such entry or statement knowing it to be false.

CRIMINAL PROCEDURES ACT PROVISIONS

Assessment Orders

• Section 52D of the CP(S)Act 1995 (Assessment Order) is a 'relevant event' under Section 232 and as such requires the appointment of a 'designated MHO' (S 229) and the provision of an SCR unless the designated MHO states in writing to the RMO and MWC why providing such a report would serve little, or no, practical purpose.

Treatment Orders

• Section 52M of the CP(S) Act 1995(Treatment Order) is also a 'relevant event' and places the same responsibilities re the appointment of a 'designated MHO' and the subsequent provision of an SCR as under Section 52D.

Interim Compulsion Orders

• Section 53 of the CP(S) Act 1995 (Interim Compulsion Order) is also a relevant event and imposes the same duties as above.

Compulsion Orders

• Generally speaking, the duties placed upon MHOs and upon RMOs are the same after someone has been made subject to a Compulsion Order as they are after someone is made subject to a Compulsory Treatment Order.

• Under Section 57C of the CP(S) Act 1995 a Mental Health Officer's report may be required by the Court when considering a Compulsion Order. In such cases an MHO is required to interview the offender wherever practicable and prepare a report stating the name and address of the offender; if known, the name and address of the offender's primary carer; in so far as relevant for the purposes of this section of the Act, details of the personal circumstances of the offender; and any other information the MHO considers relevant for the purposes of that section.

• Under Section 232 a Compulsion Order is a 'relevant event' and as such requires the appointment of a designated MHO and the provision of a social circumstances report by a Mental Health Officer for the RMO and the MWC within 21 days after the order is imposed (unless the MHO states in writing to them why they feel providing such a report would serve little, or no, practical purpose).

• Section 138 imposes a duty on MHOs as soon as practicable after a Compulsion Order is made to take such steps as are reasonably practicable to ascertain the name and address of the patient's named person.

Mandatory reviews of Compulsion Orders by RMO

• Section 139 consultation with MHO by RMO required re first review of order.

• Section 140 consultation with MHO by RMO required re further reviews.

• Section 141 consultation with MHO by RMO required before making a determination during mandatory reviews that the patient no longer meets the criteria for continued detention and revokes the order.

• Section 144 notification to MHO of revocation of order required by RMO.

• Section 145 consultation with MHO by RMO required re mandatory reviews of order.

• Section 146 consultation with MHO by RMO required where there is a proposed extension of order at first review.

• Section 147 imposes duties on MHO triggered by above. MHO must interview the patient wherever practicable and must, in any case, inform the patient of the RMO's proposal, of their rights in relation to the proposed application, and of the availability of independent advocacy services. They must also take appropriate steps to ensure that the patient has the opportunity of making use of those services. In addition the MHO must inform the RMO as to whether the MHO agrees or disagrees with the proposed application and if they disagree, the reasons why this is the case and must inform them as well of any other matters that the MHO considers relevant. The RMO must inform the Tribunal in any subsequent application under Section 149 of the MHO's views and why they disagree with the order if they do. They must also advise the Tribunal in the application where the MHO failed to comply with the duties imposed by Section 147.

• In any application to the Tribunal under Section 149, before making a determination the Tribunal must first afford the MHO the opportunity of making representation orally or verbally and of leading, or producing, evidence.

• Section 150 consultations with MHO by RMO required in respect of proposed extension of order at further reviews.

• Section 151 imposes duties upon the MHO triggered by above which are the same as those imposed under Section 147.

• Section 152 imposes a duty on RMOs to consult with the MHO during further reviews of the order before making a determination.

• Section 153 requires that the RMO give notice to the MHO (as well as the patient, the patient's named person, the Tribunal and the MWC) of the determination that the order is to be extended. The RMO must also advise the Tribunal of whether the MHO agrees or disagrees with the determination and if they disagree, the reasons for this. They must also advise the Tribunal where the MHO failed to comply with their duties under Section 151. Where the MHO disagrees the Tribunal has a duty under Section 165 to review the determination.

• Before making a decision the Tribunal must afford the MHO the opportunity to make representations orally or in writing and of leading or producing evidence.

Extension and variation of Compulsion Order

• Section 154 requires the RMO to give notice to and consult with the MHO where the RMO is proposing extending and varying the order.

• Section 155 imposes duties on MHO triggered by above which are the same as under Sections 147 and 151.

• Section 157 places a duty on RMOs to give notice to MHOs where an application is to be made extending and varying a compulsion order. The application must state whether the MHO agrees or disagrees that the application should be made and if they disagree, the reasons why they do.

• Section 158 requires that the Tribunal, before deciding on an application for an extension and variation of a Compulsion Order, must afford the MHO the opportunity to make representations orally or in writing and of leading or producing evidence.

Variation of Compulsion Order

• Section 159 imposes a duty on RMOs to consult with MHOs as soon as practicable but before deciding to make an application when it appears to them that the compulsion order should be varied by modifying the measures specified in it.

• Any subsequent application under Section 161 must include a statement as to whether the MHO agrees or disagrees with the application, and if they disagree, the reasons for this. The application must also indicate where the MHO failed to comply with the duties imposed under Section 159. Before making a decision the Tribunal must afford the MHO the opportunity of making representation orally or in writing and of leading or producing evidence.

Reference to Tribunal by MWC re Compulsion Orders

• Section 162 requires the MWC to give notice to the MHO when they refer a case to the Tribunal. In such circumstances the tribunal may make an order varying the compulsion order in respect of which the reference is made, or revoking the order. Before making a decision the Tribunal must give the MHO the opportunity to make representations orally or in writing and of leading or producing evidence.

Application to Tribunal by patient/named person for revocation of extension and/or variation of Compulsion Order

• Section 163 relates to the Tribunal's duty to review a determination to revoke an extension of a compulsion order. Before making a decision, the Tribunal must afford the MHO the opportunity of giving evidence orally or in writing and of leading or producing evidence.

• Section 164 relates to situations where the patient or the patient's named person applies to the Tribunal to revoke a compulsion order or vary it by modifying the measures specified in it. When this happens, before making a decision the Tribunal must afford the MHO the opportunity to make representations orally or in writing and of leading or producing evidence.

Application for Interim Variation of Order by person with interest in proceedings

• Under Section 169, an MHO would be considered to be a person with an interest in the proceedings under the above sections and as such could make an application to the Tribunal to make an interim order (for up to 28 days) varying the compulsion order by modifying the measures specified in it.

Failure to attend for medical treatment when attendance requirement is specified in Compulsion Order

• Section 176 effectively states that Section 112 in respect of patients subject to Compulsory Treatment Orders and the consequent involvement of MHOs applies to same situation where patients are subject to Compulsion Orders.

Non-compliance generally with Compulsion Order

• Section 177 effectively states that the civil provision sections of the Act relating to non compliance generally with Compulsory Treatment Orders and the consequent involvement of MHOs applies to same situation where patients detained under Compulsion Orders.

Compulsion Orders and Restriction Orders

• Section 181 applies where a person is subject to a Compulsion Order and a Restriction Order and imposes a duty on the MHO to take such steps as are reasonably practicable to ascertain the name and address of the patient's named person.

Review of Compulsion Order and Restriction Order

• Section 182 requires the RMO to consult with the MHO in undertaking their mandatory annual review of patients subject to a Compulsion Order and a Restriction Orders.

Reference to Tribunal by Scottish Ministers re Compulsion Order and Restriction Order

• Section 185 relates to situations where an RMO has submitted a report to Scottish Ministers under Section 183 (2) that includes a recommendation that the Compulsion Order be revoked or has submitted a report under Section 184. In such circumstances Scottish Ministers must make a reference to the Tribunal and must as soon as practicable give notice to the Mental Health Officer that a reference is to be made.

• Under Section 186 the MWC has authority to require Scottish Ministers to make reference to the Tribunal in respect of a person subject to a Compulsion Order and a Restriction Order. In such cases Scottish Ministers are required under Section 187 as soon as practicable after receiving notice from the Commission to make reference to the Tribunal. When reference is made, Scottish Ministers must as soon as practicable give notice to the MHO that the reference is to be or has been made.

• Where an application is to be made to the Tribunal by Scottish Ministers under Section 191, Scottish Ministers must as soon as practicable after the duty to make the application arises give notice to the MHO that the application has been or is to be made.

• Before the Tribunal makes a decision in relation to any reference made to it under Sections 185(1), 187(2) or 189(2) or any application under Section 191 or 191(2) they must afford the MHO the opportunity to make representations orally or in writing and of leading or producing evidence.

• Regulations under Section 191 will require a report from the designated MHO to accompany all applications under Section 191.

Conditional Discharge of Person on Compulsion Order and Restriction Order

• Where a patient has been conditionally discharged by the Tribunal under Section 193 and the Tribunal imposes conditions on that discharge, Scottish Ministers have the authority under Section 200, if satisfied that it is necessary, to vary any of the conditions imposed by the Tribunal and must in such cases notify the MHO as soon as practicable of that variation.

Appeal to Tribunal by patient/named person against variation of conditions imposed on conditional discharge where patient was subject to Compulsion Order and Restriction Order

• When Scottish Ministers do vary conditions as stated above, Section 201 states that the patient and/or their named person may appeal this decision to the Tribunal within 28 days. Before making a decision on this appeal, the Tribunal must afford the MHO the opportunity to make representations orally or in writing and of leading or producing evidence.

Appeal to Tribunal against recall from Conditional Discharge where persons were subject to Compulsion Order and Restriction Order

• Where an appeal is made to the Tribunal under Section 204 by the patient or their named person, before deciding on the appeal the Tribunal must afford the MHO the opportunity to make representation orally or in writing and of leading or producing evidence.

Hospital Directions and Transfers for Treatment Directions

• Under Section 59B of the Criminal Procedure (Scotland) Act 1995 a report by an MHO is required for the court when a Hospital Direction is being considered.

• Section 205 requires the MHO as soon as practicable after the direction is made to take such steps as are reasonably practicable to ascertain the name and address of the patient's named person.

• Hospital Directions and Transfer for Treatment Directions are both 'relevant events' under Section 232 and as such require both the appointment of a designated Mental Health Officer (under S.229) and the provision of an SCR by that MHO (under S.231) unless, in the latter, the MHO states in writing to the RMO and the MWC why the provision of an SCR would serve little, or no, practical purpose.

Review of Hospital Direction and Transfer for Treatment Direction

• Section 206 places a duty on RMOs to consult with the MHO as part of the review of Hospital Directions or Transfer for Treatment Directions.

Reference to Tribunal by Scottish Ministers or the MWC re Hospital Directions and/or Transfer for Treatment Directions

• Section 210 requires Scottish Ministers to give notice to MHOs as soon as practicable where, upon receipt of a report by the RMO following a review of a Hospital Direction or a Transfer for Treatment Direction the decision is taken not to revoke the direction and a reference is

• Section 211 outlines the process to take effect when a notice is given by the MWC to Scottish Ministers under Section 209. Scottish Ministers must make a reference to the Tribunal as a result and must give notice to the MHO as soon as practicable after receiving notice from the MWC.

Reference to Tribunal by Scottish Ministers re Hospital Direction or a Transfer for Treatment Direction

• When no reference or application to the Tribunal has been made during a period of two years, Section 213 requires Scottish Ministers to make reference to the Tribunal. In doing so they must as soon as practicable give notice to the MHO that a reference is to be made.

Application by patient/named person to Tribunal to revoke Hospital Direction or Transfer for Treatment Direction

• Section 214 gives patients and /or their named person the right to apply to the Tribunal to revoke a Hospital Direction or Transfer for Treatment Direction. Before making a decision the Tribunal must afford the MHO the opportunity to make representation orally or in writing and of leading or producing evidence.

Assessment Order: Suspension of measure authorising detention

• Under Section 221 the RMO may suspend the detention requirement of a patient on an Assessment Order and may include conditions seen as necessary in the interests of the patient. These conditions may involve the MHO, e.g. a condition that the patient grants access to an MHO. If an MHO is authorised under this section, the RMO then has a duty under Section 222 to give them notice when the order is revoked. Similarly, when Scottish Ministers revoke the order under Section 223, they must also notify the MHO if they had been authorised under Section 221.

Suspension of measures authorising detention after other relevant events

• Section 224 relates to situations in respect of; Treatment Orders; Interim Compulsion Orders; Compulsion Order and a Restriction Orders; Hospital Directions; and, Transfer for Treatment Directions where the RMO grants a certificate specifying the suspension of the detention requirement for up to three months. When the period for which detention is to be suspended would exceed 28 days, the RMO must give notice of the proposal to the MHO. When the certificate is revoked under Section 225, the RMO must also give notice to the MHO. Similarly, where Scottish Ministers revoke this certificate, Section 226 requires that they give notice to the MHO.

1. As with previous material in this sequence, we advise you that we have been unable to work to the final versions of the Civil and Criminal Procedures Codes of Practice. However, care has been taken to work to the most currently available drafts.

2. The conditions are- the existence of mental disorder; the availability of treatment likely to alleviate or prevent deterioration of the condition; the risks to health, safety and welfare; the impairment of ability to make treatment decisions because of mental disorder and the necessity of the Order.

3. These include the patient, his or her named person and main carer, the MHO applicant, the authors of the mental health reports, any welfare proxy, any curator ad litem appointed by the Tribunal and (the catch-all category) any other person appearing to the Tribunal to have an interest in the application.

4. New Directions, Report on the Review of the Mental Health (Scotland) Act 1984, Scottish Executive, January 2001.

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