SCIE Introduction to...adult mental health services

The legal and policy contexts

Care Programme Approach (CPA)

CPA is a UK-wide model for delivering community services to people with mental health problems. It is a key part of the mental health system. Health and social service professionals assess the service user’s need, provide a written care plan, allocate a care coordinator/lead professional, and regularly review the plan with the service user, their family and other professionals.

NHS and Community Care Act 1990 (CCA)

The Act requires health authorities – working with the local authority – to put in place set arrangements for the care and treatment in the community of people with mental health problems. It places a duty on local authorities to assess an individual’s needs and circumstances – in partnership with them – to decide whether or not they will offer social services. Local authorities can take into account their resources during the assessment process – each will have a threshold document, which sets out the eligibility criteria for the authority. The Fair Access to Care Services criteria will also form part of the assessment and eligibility process.

National Health Service and Community Care Act 1990

Mental Health Act 1983 (MHA)

Admission to a psychiatric inpatient unit can be voluntary. Compulsory admission under a section will only happen after all alternatives have been considered or if there is a risk to the individual or others.

The MHA sets out the required number and special expertise of mental health practitioners needed to enforce the Act, the role of the adult mental health professional (AMHP), the rights of relatives to be involved in decisions, and the rights of patients to appeal.

The most commonly used powers in the Act are:

Section 2: Admission for up to 28 days for assessment
Section 3: Admission for up to six months, in the first instance, for assessment and necessary treatment
Section 4: Admission in an emergency (only one doctor needs to agree initially)
Section 37: Hospital order by court
Section 37/41: Restriction order by court
Section 136: Police power in public places to remove person to a place of safety.

Section 117 of the MHA places a duty of care on a commissioner, trust or local authority to give aftercare to patients entitled to these services when they have been discharged. These responsibilities only affect those detained under certain sections of the MHA.

The rights of service users (Mind)
Mental Health Act 1983
Jones, Richard (2010) Mental Health Act Manual, thirteenth edn, UK: Sweet and Maxwell

Human Rights Act 1998

All health and social care needs to be conducted in a way that is mindful of the Human Rights Act.

Human Rights Act 1998

Mental Capacity Act 2005 (MCA)

The aim of the MCA is to promote and safeguard decision-making within a legal framework. It does this by empowering people to make decisions for themselves wherever possible, and by protecting people who do not have the capacity to protect themselved by setting out a flexible framework that puts individuals at the heart of the decision-making process. It is a key law for supporting people with mental health problems.

The MCA is a complex area of work but is based on five key principles:

It assumes that an individual has capacity unless it is established otherwise.
A person should not be treated as if they cannot make a decision unless all practicle steps to help them make decisions have been taken without success.
A person should not be treated as if they cannot make a decision just because they make an unwise decision.
Any action taken under this Act – for or on behalf of a person who lacks capacity – must be taken in their best interests.
Before any action is taken, you must make sure that there is no other effective way of achieving the outcome in a way that is less restrictive of the individual’s rights and freedom of action.

It is important to understand that – under the Act – decisions made on behalf of another person have to be time- and issue-specific. Each decision needs to be assessed separately.

Further reading on the MCA is recommended whenever working with adults who may lack the capacity to make a decision.