Report on the Review of the Mental Health (Scotland) Act 1984

Chapter 8

DURATION, REVIEWS AND APPEALS

Current legislative position

1. There are three types of detention under the Mental Health (Scotland) Act: emergency, short term and long term.

2. Section 24 of the 1984 Act permits the emergency detention of a mentally disordered person in hospital for a period of up to 72 hours. Section 25 of the Act allows for the same type of emergency detention, applied to a person who is already in hospital (for example, a patient in a psychiatric hospital on a voluntary basis, or a person presenting to Accident and Emergency) who decides to leave the hospital but for whom it is considered that in the interests of his or her health or safety or for the protection of others it is necessary to prevent him or her doing so.

3. Section 26 of the Act allows a short-term detention, of up to 28 days in length. A detention under s.26 may only be undertaken if the person has previously been detained under s.24 or s.25, the entire 72 hours of that detention has elapsed, and the continuing detention is approved by a 's.20-approved' psychiatrist.

4. Section 18 of the Act deals with long term detention, of six months in the first instance, which may be renewed for a further six months, and then on a yearly basis³⁹. An application must be made to the sheriff for approval of initial admission under s18.

5. Section 25(2) of the Act gives a 'holding power' to nurses. A person already in hospital receiving treatment for mental disorder on a voluntary basis may be held there by a nurse, if the patient appears to require detention. The authority to hold the patient lasts for two hours, or until the earlier arrival of a doctor.

6. The Mental Health (Scotland) Act 1984 gives patients and their nearest relatives the ability to challenge their detention and imposes a duty on doctors to review detentions.

7. There is no appeal against an emergency detention, nor is there any judicial oversight of its imposition. The Mental Welfare Commission could discharge a patient detained on an emergency basis, but it is not practicable for them to review such cases within the 72 hour period.

8. A patient may appeal to the sheriff against short term (28 day) detention, or request that the Mental Welfare Commission exercise its power of discharge.

9. The patient or the nearest relative may oppose an application for long term detention, and it is for the sheriff to determine whether the application should be granted.

10. The patient or nearest relative can appeal to the sheriff against renewal of long term detention.

11. If, during the period of detention, the responsible medical officer (RMO) or the Mental Welfare Commission determine that the patient is no longer detainable, either may discharge the patient. With the consent of the responsible medical officer, an order for discharge may also be made by the nearest relative or the managers of the hospital.

Detention under current provisions

12. The Mental Welfare Commission Annual Report for 1999/2000 shows 4284 episodes of emergency detention. Of the total of 4284, 1784 (41%) patients were either discharged from hospital without further detention or remained on an informal basis (no breakdown is available between these two outcomes).

13. One thousand six hundred and fifty-eight (39%) patients were detained for up to a further 28 days under s26, and then either discharged or remained as informal patients. The remaining 842 (20%) patients were detained under s26 and went on to be detained on a long term basis under s18. In addition, 169 patients were detained under s18 without a prior use of emergency and short term detention.

14. The figures show that many episodes of detention are short, and would suggest that patients are not generally kept under compulsion longer than necessary. Only a relatively small minority (20%) of those detained on an emergency basis proceed to long term detention.

15. The evidence from the research into the operation of the courts and s18 detentions (See Annex 7) also suggests that large numbers of people detained under s18 are discharged well before the expiry of the initial six month duration of the order. The research analysed 936 cases of long term detention that were discharged between April 1998 and August 1999. Of these 264 (28%) were discharged at less than six months and a further 221 (24%) at the end of six months. 173 (18%) were discharged between seven and twelve months and a further 129 (14%) between thirteen and twenty four months. However, of the remaining 149 (16%) cases there were many where the detention had lasted for very long periods, including 35 between five and ten years and 13 longer than 10 years.

16. The analysis of these 936 cases also showed that 531 (57%) of the patients were on leave of absence at the time of discharge and of the other patients 230 (25%) remained in hospital informally. A comparatively small percentage of patients therefore were discharged directly from hospital.

17. In another analysis of 1548 patients whose orders were renewed during the year to 31 March 1999, the research showed that in 422 (27%) of cases detention started before 1996. Of these 105 (7%) started before 1990. In the remaining 317 (20%) cases, detention started between 1990 and 1995. These figures again show the existence of a significant number of patients who have been detained for long periods.

18. The lack of a breakdown of the statistics for patients 'discharged to informal status' between those discharged from hospital and those remaining on an informal basis is a serious gap in the statistics.

19. While the fact that so many patients do not remain subject to compulsion beyond the 72 hour stage may be a positive feature, it might also suggest that in some cases perhaps not enough effort was made to secure the patient's admission on a voluntary basis.

Nurse's holding power

20. Section 25(2) of the Act gives nurses of a prescribed grade the power to prevent a mentally disordered person, who is already receiving treatment on a voluntary basis, from leaving hospital. It must appear to the nurse that the patient requires to be restrained from leaving for his or her health or safety or for the protection of other persons, and there must be no doctor immediately available to undertake emergency detention procedures. The power lasts until such time as a doctor may be obtained to assess the person for an emergency detention, or for two hours, whichever is shorter. We are in favour of the retention of this power.

21. However, the holding power appears to run out as soon as a doctor arrives on the scene⁴⁰. In cases which then proceed to emergency detention, there is some question as to what the patient's legal status is between the moment of the doctor's arrival and the completion of the emergency detention procedure. It may be argued that the patient is not lawfully detained during this period.

22. The ending of the holding power as soon as the doctor arrives also militates against obtaining a mental health officer (MHO) to give approval to an emergency detention, which we view as an important safeguard.

23. We therefore believe that the section should be amended to make it clear that a nurse's holding power continues until such time as the doctor is able to complete his or her assessment and, if appropriate, undertake the detention procedure. This should include time to make all efforts possible to contact and involve a MHO in the detention procedure.

24. The nurse's holding power in England and Wales lasts for a maximum of six, rather than two hours. We considered whether there was a case for extending the duration of the power. However, no evidence was put forward to suggest there were major practical problems with the current time limits other than those we have mentioned above.

25. In oral evidence, nursing bodies opposed any extension of the time period, and we therefore recommend that the current two hour limit be retained subject to modifications to deal with the practical problems that have been identified .

Emergency detentions

26. Emergency detentions currently last for 72 hours. In order to minimise the period that a person would be subject to an emergency detention, we considered whether this should be reduced, perhaps to 24 hours. However, several consultees pointed to the practical problems that this would pose, particularly in remote areas, or if a person is detained at the weekend when it might be difficult to get hold of a consultant psychiatrist to pursue a short term detention. We accept, therefore, that a maximum detention of 72 hours is a necessary compromise between the rights of the patient and the need for practicality. As at present, this should not be immediately renewable. However, a person should never be held for the whole 72 hours if this is not necessary.

27. We considered whether the distinction the Act makes between emergency detention of a patient already in hospital (under s25) and detention from the community (under s24) should be maintained. Although the procedure and outcome are the same, we consider there is merit in maintaining the distinction, if only in providing information on the use of the Act for statistical purposes.

28. There is currently no appeal to the sheriff available against emergency detentions. That would be desirable in principle, but given the practical problems with arranging an appeal within a 72-hour time frame, we believe that the introduction of such an appeal would offer little effective protection for the patient. We have therefore come to the view that there should be no appeal to the tribunal against a 72-hour detention. However, we recommend below a number of measures designed to reduce the reliance on emergency detentions.

29. Some respondents have suggested to us that detention without appeal runs the risk of breaching the European Convention on Human Rights. The Convention does state that an appeal should exist⁴¹, but it is our understanding that ECHR allows some leeway for emergency situations⁴².

Short term detention

30. A number of possible amendments to the length of short term detentions were suggested to us. These included replacing the short term detention with a seven-day assessment order, or maintaining the order at 28 days but having a review of the detention at seven days.

31. An argument in favour of shortening the order is that a short order would avoid a patient being detained for as long as 28 days if he or she simply required a few days admission for a period of crisis to pass. However, we are not aware of evidence to suggest that detentions of undue length under s.26 are a major problem at present, although we note the lack of statistics on the average length of such detentions.

32. There may also be advantages in, if necessary, detaining a person for a full four weeks in appropriate cases before applying for long term detention. Psychiatric evidence to the Committee has indicated that it may take some weeks for the efficacy of a treatment regime to be evaluated. In these circumstances, if the decision is made to apply for a long term detention order, the proposed plan of care put to the tribunal will be based on better evidence than if the person had only been detained for, say, one or two weeks.

33. The Richardson Committee put forward a proposal for a 'paper review' of the continued need for detention at seven days. We are not convinced, though, that such a review would have any appreciable effect.

34. We therefore take the view that four weeks is an appropriate maximum duration for a short term detention. As at present, this should not be immediately renewable.

35. Section 26A of the 1984 Act is intended to cover situations where it has been expected that a short term detention will be allowed to lapse, but the patient worsens towards the end of the 28-day period, without leaving sufficient time for a s.18 application to be made. It permits a three-day extension of the period of short term detention, during which time it is expected an application for long-term detention will be made. Detention under s.26A is not immediately renewable, nor can a person so detained be further detained except under s.18.

36. Sections 21 (3B) and 21 (3C) permit extensions to detentions under ss.26 or 26 (A) to allow, respectively, the court five working days within which to hold a hearing or approve the application, or to allow for continued detention during a court adjournment.

37. We have not received any evidence that the extensions to detentions permitted by s26 (A) and ss21 (3B) and (3C) are misused to the detriment of patients. We understand there are very few episodes of detention under s26A. We accept that, in some situations, a brief continuation of short term detention might be reasonable, to allow proper consideration of the need for long term compulsory measures. We therefore recommend that these provisions be retained.

38. We are concerned however that the authority under s21 (3C) to detain a patient because of an adjournment of the court hearing is potentially for an indefinite period. Except, perhaps, where the patient has sought an adjournment to obtain further evidence, we believe that there should be a maximum period for such an adjournment.

39. Short term detentions (ss26 and 26A) may be appealed to the sheriff, although this currently only happens in a very few cases. We favour the retention of this protection, subject to replacement of the sheriff by our proposed tribunal. We recommend in Chapter 23 that the Mental Welfare Commission should retain the power to review and, where appropriate, discharge patients subject to short term detention.

40. We take the view that any appeal against a short term detention should be made within the first 14 days of such a detention and should be heard by the tribunal within seven working days of the appeal having been initiated.

Long term compulsory measures

41. We received little evidence to suggest that the current limits of long term detentions lasting six months in the first instance, then renewable for a further six months and yearly afterwards, are inappropriate. Most respondents appeared to accept these as a reasonable framework for long term compulsory measures. We therefore recommend that the time-limits are not changed, and we have indicated in Chapter 6 that they should apply to community orders as well as to hospital based orders. We regard the approval by an independent judicial body of long term compulsory measures before their imposition as an important safeguard, which should be retained. This should apply both to hospital based and community orders.

42. Section 30 (6) of the 1984 Act permits the patient an appeal to the sheriff against his or her detention after the first renewal of a long term detention (i.e. after six months have elapsed). We believe this right should be retained though at the moment very few patients take the opportunity to appeal to the sheriff.

43. However, there is no provision in the Act for an appeal to the sheriff during the first six months of detention. Although the issue has, in a legal sense, been determined by the granting of the order, much can change in six months -both in the patient's condition, and the surrounding circumstances. Under our proposals, the tribunal would consider and approve the plan of care, not simply whether the criteria for compulsion have been met. We therefore feel that the patient should have the opportunity, after a reasonable period, to seek a variation in terms of the order.

44. It appears from the Act that there is no limit upon how many times during the period of renewed detention a person might appeal. Whilst we would not wish to see the tribunal's business being occupied by persons persistently appealing compulsory orders where there has been no change of circumstances, we are not aware of any particular difficulties being caused by this. We therefore do not recommend any change.

45. The relevant provisions would of course apply to a community order as well as a hospital based order.

46. There is currently no automatic review of detentions by the sheriff. This differs markedly from the situation in England and Wales, where Mental Health Review Tribunals automatically review detentions every three years, if no appeal has taken place during that time.

47. The effect in Scotland, for some patients, is that they may be continuously detained for long periods without any formal review of their detention. Patients who do not wish or feel able to appeal against compulsory measures, for whatever reason, and who are being held under compulsion for lengthy periods, are a vulnerable group. We believe they are not adequately protected by the law as it stands, and that there should be an automatic review of compulsory measures by the tribunal.

48. We considered whether the review should coincide with the annual renewal of long term compulsion. However, to consider the merits of every case every year would place too great a burden on the tribunal. Furthermore, given the continuous informal review that takes place in a treatment setting, and the oversight of the Mental Welfare Commission, we believe this would be a disproportionate response to the problem.

49. Instead, we believe that there should be a formal review by the tribunal every three years, if there has been no appeal during that time. The necessity of compulsion would be reappraised, and the plan of care would be approved or required to be amended.

50. When a plan of care is before the tribunal, it would be open to the named person as well as the patient to challenge or ask for clarification on one or more elements of the service user's plan of care. Either party might wish to challenge on a number of grounds: for example, whether the proposed care to be given in the community is sufficient or practical, or they might wish to propose that a person detained in hospital be given an opportunity to try living in the community.

51. The tribunal would have to take the views put forward into account in deciding whether or not to approve the plan of care.

The Mental Welfare Commission's power of discharge

52. The Mental Welfare Commission is a more frequently used method of seeking discharge than the sheriff court. Although discharges by the MWC are relatively uncommon following reviews, we recommend, in Chapter 23, the retention of the right for the Mental Welfare Commission to discharge non-restricted patients.

53. The Mental Welfare Commission also has a duty to visit patients subject to compulsion. It has a particular duty to visit, at least every two years, any patient subject to long term detention. We make recommendations relating to these powers in Chapter 23, which should of course encompass patients on community orders as well as hospital based orders.

Discharge by the responsible medical officer

54. Under the current law the RMO must discharge a patient from detention if the statutory grounds for detention are no longer applicable⁴³. This provision of the Act should serve to prevent a patient being detained for any longer than necessary.

55. We believe that no person should be detained until the completion of an order if it is possible to discharge him or her prior to that. As we have already indicated, there do not appear to be any statistics on the actual duration of episodes of short term detentions, but the evidence from the Mental Welfare Commission statistics for long term detentions, which we have quoted in paragraph 15 above, is that many orders for discharge are indeed made by RMOs prior to the completion of the term.

56. Despite this, we believe that there is a need for the Act to be clear in providing that the need for compulsion should be kept under constant review, and that no patient who does not continue to meet the criteria for compulsion should be subject to compulsory measures.

57. The power of the RMO to discharge the patient would apply to both hospital based orders and community orders. Where the consequence of a discharge of an order is likely to be that the person leaves hospital, or that plans of care change in other respects, we believe that the RMO should first consult with the MHO. This will allow any appropriate steps to be taken by community services on discharge.

58. There is a requirement in s22(4) of the Act that in the fourth week of a long term detention, the RMO should undertake a review of the case to see whether detention is still warranted. If the outcome is that the patient continues to be detained, the Mental Welfare Commission, the local authority and the nearest relative must be notified. This appears often to be treated as little more than a formality. We have received no information as to the number of patients who might be discharged as a result of such a review. We believe that the other recommendations we make, including the need to keep compulsion under continuing review, provide a more effective framework for protecting patients and keeping relatives informed, and propose that this requirement be abolished.

The hospital managers' powers of discharge

59. The Act currently gives hospital managers the right to make an order for discharge⁴⁴, which comes into effect within seven days, unless the RMO makes a report indicating that the grounds for detention continue to apply⁴⁵. The provision differs from the English and Welsh Act in that the managers cannot overrule the RMO, and there is no formal review procedure set down in the Code of Practice⁴⁶. In practice, we assume that hospital managers will normally rely on advice from the RMO, who of course possesses an independent power of discharge. Given the powers of the RMO, the Mental Welfare Commission and the tribunal to discharge patients, the power vested in hospital managers would seem to be unnecessary, and we recommend that it be removed.

The nearest relative's power of discharge

60. The nearest relative has the right to make an order for discharge⁴⁷, but only if he or she gives seven days' notice to the hospital managers⁴⁸. If, during that time, the RMO makes a report stating that the grounds for detention continue to apply to the patient, the patient is not discharged and the nearest relative cannot make another order for discharge for six months. This decision is then appealable to the sheriff by the nearest relative⁴⁹.

61. The nearest relative's power to initiate discharge does not apply in relation to patients detained in the State Hospital or to patients detained by order of a criminal court⁵⁰.

62. Our proposals in respect of the tribunal are intended to encourage the participation of carers and families at the initial hearing for long term compulsory measures. We also make proposals later which are intended to encourage relatives and carers to be involved in decisions about care on an ongoing basis. In particular, we recommend in Chapter 16 that relatives and carers should have the legal right to receive improved information and support from service providers.

63. We have also recommended earlier in this Chapter that the 'named person' should have the same right as the patient to appeal against the imposition of short term detention, or the approval or renewal of long term compulsory measures. In view of the above, we take the view that the current right of the nearest relative to make an order for discharge, which is in effect subject to the approval of the RMO, is not necessary.

The relationship between emergency, short term and long term detention

64. We now go on to deal with a number of other issues relating to the detention of patients under the 1984 Act.

The use of emergency detentions

65. One of the understandings upon which the Mental Health (Scotland) Act 1960 was based was that long term detentions would be the normal route into detention for the majority of patients. This same belief underpins the 1984 Act⁵¹.

66. However, figures from the Mental Welfare Commission's Annual Reports in recent years have consistently shown that the vast majority of detentions are emergency detentions in the first instance, under ss.24 and 25. In the year 1999-2000, some 96% (4284 out of 4453) of all detentions were emergency detentions. By contrast, in England and Wales emergency detentions are not widely used. Instead, the 28 day assessment order is the main route into detention.

67. There are a number of reasons why emergency detentions are so frequently used in Scotland. The first is that it is not possible to proceed to the 28 day short term detention without it being preceded by an emergency detention. The only alternative to admission from the community is therefore a long term detention, which requires recommendations from two doctors and a RMO and approval by the sheriff. This takes time and is not practical in a situation of urgency. A delay can also be detrimental to the patient's best interests. It may also seem disproportionate to subject a person to potentially up to six months detention when they may require no more than assessment, or perhaps just a very short period of hospital treatment.

68. Furthermore, research⁵² has shown in samples of trainee psychiatrists and GPs that the majority did not view s.18 as the 'mainstay' of formal detention. It was particularly striking that only 16% of a one in four sample of general practitioners in Edinburgh said that it was. The commonly held view is that Sections 24/25 is the normal entry route into detention and, in practice, that is what it has turned out to be.

Short term detention from the community

69. In many cases a short term (28 day) compulsory order would be an appropriate alternative to an emergency detention or long term order. Most importantly, unlike in the case of an emergency detention, there would be an appeal available. We therefore recommend that it should be possible for a person to move directly from the community on to a short term detention.

70. We also recommend that it should be necessary to gain approval from both a 's20 approved' doctor and a MHO for a short-term order. We accept that in some situations this may be impracticable, in which case an emergency detention would be a reasonable alternative.

71. We considered whether short term detention should require the approval of two doctors, as well as the MHO. An application for long term detention requires two medical recommendations. However, we concluded that if both a doctor approved as having experience in the treatment of mental disorder and a MHO were required to be involved, the participation of a second doctor is unnecessary.

Monitoring the use of emergency detention

72. If short-term detention is available from the community as we propose, the use of emergency detention should lessen. In that case, and given the lack of safeguards surrounding emergency detention, we believe it would be desirable for written reasons for the use of an emergency detention rather than short-term detention to be given to the Mental Welfare Commission by the detaining doctor.

73. There was a lack of systematic research available to us on the reasons for the preponderant use of emergency detention. The provision of written reasons for the use of emergency detention would enable this to be monitored by the Mental Welfare Commission, and in due course might allow research to be undertaken with a view to issuing any necessary guidance.

Moving from emergency to short term detention

74. It is not currently possible to move a patient from emergency detention under s.24/s.25 onto short-term detention under s.26 until the 72 hours of the emergency detention have elapsed. If a person has been assessed during that period as requiring treatment, the law currently has the dual effect of keeping him or her detained without the possibility of an appeal, and confusing the position relating to his or her treatment.

75. We can see little value in insisting that the full 72 hours elapse before a person may be given treatment under the provisions of the Act, and be allowed to appeal against detention. We therefore suggest that it would be more appropriate, where a patient detained on an emergency basis needs to be moved onto a short term detention, for this to happen as soon as possible. The Act should therefore provide that the RMO should make every effort to assess the patient as early as possible in an emergency detention. In most cases, this would mean that a patient requiring continuing detention could move on to short term detention before the 72 hours is completed.

Treatment during emergency and short term detention

76. Currently, emergency detention confers no power to treat the patient compulsorily. Where treatment of patients is carried out without consent on a patient detained under s24 or 25, this is under common law, rather than the Mental Health Act. Patients detained under short term (28 day) detention can be treated compulsorily under the provisions of Part X of the 1984 Act.

77. We accept that it is appropriate that patients who are subject to short term detention should be able to be treated under the Act. Were this not the case, it could in some cases be necessary to delay treatment for a considerable period pending approval of long term detention. This could be highly detrimental to the patient's welfare. Our proposals to allow swifter transfer to short term detention should allow treatment to be commenced as quickly as is necessary in nearly all cases.

78. There could still be some situations of great urgency, perhaps where treatment cannot safely await the arrival of a MHO to approve short term detention. In such cases, we feel it is undesirable that an Act which is intended to provide a comprehensive statutory code should be silent, with treatment being carried out under common law. We therefore propose that such treatment should be governed by provisions similar to those in s102 of the 1984 Act, concerning urgent treatment for detained patients, and our recommendations are based on that.

Moving from emergency detention to long term detention

79. It is currently possible under the 1984 Act for a patient to move directly from an emergency to a long term detention. This is, however, rarely done. According to the Mental Welfare Commission's Annual Reports for the years 1992-99, the average number of such transfers has been two per year, and there were none at all in the year 1998-99 or 1999-00.

80. Despite its rarity, we accept that there may be circumstances where it would be appropriate to transfer a patient directly from an emergency to a long term detention. An example of this might be when an application for long term measures is already in train, but a crisis situation develops prior to the hearing.

81. We therefore recommend that this provision be retained. As at present, no power to extend the length of an emergency detention should exist⁵³: if the application is likely to require longer than the 72 hours to complete, the person should first be detained under short term detention procedures.

Information and support for the patient

82. When considering an appeal against detention, the service user needs to know his or her rights and how to exercise them. Our principle of Participation requires that service users should be provided with all the information necessary to enable them to participate fully. All such information should be provided in a way which renders it most likely to be understood.

83. Section 110 of the 1984 Act already contains provisions relating to information. It requires that "such steps as are practicable" are taken to ensure that a detained patient understands:

• which provision of the 1984 Act he or she is detained under, and the implications;
• what rights of appeal to the sheriff are available;
• that he or she may make representations or appeal to the Mental Welfare Commission;
• that an order for discharge may be made by the RMO, the MWC or the sheriff;
• the meanings of Part X (consent to treatment⁵⁴), sections 115 and 116 (withholding of mail⁵⁵) and section 119 (the Code of Practice⁵⁶).

The Act requires that the information be given both orally and in writing.

84. Section 110 is a key section of the Act. The Mental Welfare Commission investigated the operation of the section during their hospital visiting programme for 1998/9, and reported on their findings in its Annual Report.

85. The Commission was disturbed to find that half of the patients they interviewed did not know under what section of the Act they were detained and could not explain what their detention meant, and also that two informal patients interviewed by mistake were under the impression that they were detained. Even allowing for the fact that patients may not have remembered explanations which were given, the Commission points out that the lack of recording in some hospitals of what steps were taken to inform patients of their rights leaves the hospitals vulnerable to criticism.

86. It is of course the case that some patients experiencing an episode of mental illness may have difficulty in taking in and dealing with information regarding detention, and their rights in relation to this detention.

87. The Code of Practice might therefore specifically refer to the need to repeat information in a clear, comprehensible manner as often as necessary.

88. However, more proactive steps may be required to ensure that patients are fully aware of their legal rights. During interviews for the research into the operation of s.18 detentions most service users said that they had not taken legal advice even when aware of the need for legal representation or their right to challenge orders⁵⁷. Some had felt that to do so would mark them out as 'troublesome' and might increase their chances of continued hospitalisation.

89. We have no evidence to suggest that these views are being encouraged by hospital staff. Nonetheless, the Code of Practice should provide that steps should be taken to ensure that service users feel comfortable and unthreatened in exercising their legal rights.

90. The provision of an advocacy service, as we recommend in Chapter 14, will also assist service users to exercise their rights. An advocate can provide effective information and support to a service user, and, if the service user wishes to appeal, can help to make the appropriate arrangements, including contacting a solicitor.

91. Currently, the duty to provide information rests solely with hospital managers. If, as we recommend, community orders are introduced, mental health service managers will need to have arrangements in place to impart information to patients in the community

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