7.6 Assessments in Mental Health

1. Introduction

There are two assessments relating to mental health that sound quite similar and can which cause some confusion to patients, carers, and professionals. They are:

• Mental Health Act Assessment (using Mental Health Act 1983)
• Mental Health Assessment

This chapter explains the process for the different assessments and when each is used.

2. Mental Health Act Assessment

A Mental Health Act assessment is when a person is assessed under the Mental Health Act 1983 (as amended 2007). The Mental Health Act (MHA) provides the legal framework to admit, detain and treat people with a mental disorder in hospital without their consent. It can also provide a legal framework for the supervision and treatment for people when in the community who have been subjected to certain sections of the Mental Health Act which also provides the legal framework to recall a patient back into hospital if required.

The Mental Health Act is underpinned by the Mental Health Act Code of Practice which provides guidance for best practice which all professions who are acting under the MHA have a duty to follow. The Code of Practice contains five guiding principles which all professional must adhere to when acting under the Mental Health Act.

There is no age limit for a person who can be assessed under the Mental Health Act, and the assessment can take place in almost any settings  including the community, hospitals, care homes or prisons.

Section 13 Mental Health Act states that a local authority is required to make arrangements for an approved mental health professional (AMHP) to consider the case if it has reason to think that an application for a admission to hospital may need to be made in respect of a patient who is in its area.

The Mental health Act assessment is undertaken by an approved mental health professional (AMHP) whose is responsible for arranging the assessment and making a admission to hospital if required.

Any applications made to hospital must be founded on two medical recommendations which are provided by two doctors one of which must have specialist knowledge of people with a mental disorder and who is approved under Section 12 Mental health act.

2.1 Nearest relative

A patient who is assessed under the Mental Health Act will usually have a person who would be classed as the nearest relative. The nearest relative is not the same as the ‘next of kin’ and is set out in a strict hierarchy in Section 26 Mental Health Act. It can be very complicated to determine who is a patient’s nearest relative.

The nearest relative should act as a safeguard for the patient, and they have certain  rights under the Mental Health Act including the right to object to a hospital detention, apply for the patient to be admitted to hospital, discharge a patient from hospital and ask for a patients case to referred for a Mental Health Tribunal.

When an AMHP is looking to detain a patient in hospital under the Mental Health Act, they must where possible establish who is the patient’s nearest relative. They must  then try to consult with the nearest relative before they make the application to hospital.

2.2 Possible outcomes of the Mental Health Act Assessment

2.2.1 Section 1 Mental Health Act

Section 1 Mental Health Act outlines provisions with respect to the reception, care, and treatment of patients with mental disorder, as well as the management of their property and other related matters. Mental disorder is defined for the purposes of the Act as ‘any disorder or disability of the mind’.

Depending on where the Mental Health Act assessment is being carried out determines who will be present at the assessment. The objective of the assessment is to determine whether the criteria for a hospital detention are met and, if so, whether an application for detention should be made.

Medical professionals (‘Section 12 doctor;) should determine whether a patient has a disorder or disability of the mind in accordance with good clinical practice and accepted standards of what constitutes such a disorder or disability. This means the person must be suffering from a mental disorder for the criteria for a hospital admission to he met.

Where it is possible to treat a patient safely and lawfully without detaining them under the MHA, the patient should not be detained. The AMHP and the doctors involved in the assessment must explore all of the options available to them before they look to detain a patient in hospital under the MHA. The Mental Health Act Code of Practice refers to this as the ‘least restrictive’ option.

When a patient needs to be in hospital, informal admission is usually appropriate when a patient who has the mental capacity to give or to refuse consent is consenting to admission.

2.2.2 Section 2 Mental Health Act

A person can be detained in hospital under Section 2 of the Mental Health Act if the relevant criteria are met. The patient must be suffering from a mental disorder of a nature or a degree which warrants their detention in hospital for assessment or for assessment followed by treatment, and the detention is in the interest of their own health or safety or for the protection of other persons. The Section 2 last for 28 days however this does not mean the patient needs to be in hospital for 28 days and can be discharged at any time if appropriate.

2.2.2 Section 3 Mental Health Act

A person could be detained in hospital under a Section 3 of the Mental Health Act if the criteria are met. The patient must be suffering from a mental disorder of a nature or a degree which warrants their detention in hospital for treatment, and they ought to be detained in the interest of their own health or safety or with the view to the protection of other persons and the medical treatment is available. A detention under Section 3 is initially up to 6 months.

3. Mental Health Act Assessment – Process

If you have concerns about a person’s deteriorating mental health, and that they are putting themselves or other at risk:

• Make a referral for a Mental Health Act Assessment via:
  • General Practitioner (GP)
  • Other health practitioner / social worker
  • Referral to the Approved Mental Health Practitioner (AMHP) via the local authority. Bury AMHP Service can be contact by phone on 0161 253 7997 or out of hours on 0161 253 7356.
• Outcomes – Remember the least restrictive option will always be considered.
  • Back home with support from the Home Treatment Team and a referral to Access and Crisis for consideration of other services, including Talking Therapies, Out Patients’ Clinic, CMHT or other services available in Bury.
  • Informal admission to a mental health ward.
  • Detention under the Mental Health Act to a mental health ward (if available in the local area). All people who are detained will be able to appeal their section under a Mental Health Tribunal and will be eligible for an Independent Mental Capacity Advocate (see Independent Mental Capacity Advocate Service chapter).

4. Mental Health Assessment

A mental health assessment is needed in order to access mental health services and is a conversation between an individual and a mental health professional about symptoms and risk factors, to determine what kind of support is required. Access to mental health assessment is via Access and Crisis Team and individuals can self-refer or be referred in by their General Practitioner (GP) or other professional.

It is usually a nurse or a social worker in role of the mental health practitioner, who will complete an initial assessment, keeping the assessment patient focussed, providing discussion about any treatment options and or therapeutic assessments indicated.

A mental health assessment is not a test or an exam. It is about helping an individual to talk about what they want to talk about. The more open and honest they are, the easier it will be to get the right help and support.

People can bring a friend or relative to support them, although some prefer to bring an advocate who can represent their views and interests. Advocates can be volunteers, like mental health charity workers, or professionals, like lawyers.

4.1 What the mental health assessment will cover

During the assessment, professionals may talk with the person about the following areas:

• mental health symptoms and experiences
• feelings, thoughts, and actions
• physical health and wellbeing
• housing and financial circumstances
• employment and training needs
• social and family relationships
• culture and ethnic background
• gender and sexuality
• use of drugs or alcohol
• past experiences
• safety of the person and others
• whether there are any dependents, such as a child or elderly relative
• strengths and skills
• hopes and aspirations for the future.

4.2 At the end of the assessment

The professional will have the information they need to make their assessment and explain the next steps in clear language.

The adult should be asked if they have any questions about their condition, the diagnosis, possible causes, the treatments on offer, and how those might affect them.

5. Mental Health Assessment – Process

To access mental health services in Bury, the adult can request a referral through their General Practitioner (GP) or contact the Access and Crisis Team for adults and older people on 0161 716 1080 (8am to 9pm).

The Access and Crisis Team act as the single point of access for all referrals into mental health services; they screen an triage referrals received.

Once we a referral is received, the team will:

• Direct the referral to the relevant service;
• Provide a comprehensive mental health assessment; and
• Provide short-term follow-up interventions.

Adults will usually be seen within 14 days of the referral. If a referral is urgent, please contact the team on 0161 716 1080 to discuss the situation with the duty worker, as we may be able to offer an appointment quicker than this.

The Team have also developed the ‘consultant access’ service to provide GPs with quick access to consultant psychiatrist advice and rapid feedback for patients in primary care (Bury).