People who are subject to detention or community treatment orders under the Mental Health Act can ask for their case to be reviewed by the Hospital Managers for possible discharge. The Hospital Managers are classed as the Trust that is looking after the patient.
The power to review a case cannot be exercised by NELFT staff, so the Trust has a group of people it can call upon to act on its behalf; these are called Associate Hospital Managers.
To find out more about the Associate Hospital Managers (AHM) role, we spoke to Robert Keys (Mental Health Law Manager) and current AHM Spokesperson Clive Myers.
Firstly, we asked Robert:
What are Associate Hospital Managers?
They have a statutory role under the Mental Health Act 1983. The term is used to refer to the corporate body of the detaining authority, e.g. the NHS Trust, which has various statutory functions normally delegated to members of staff. It is also used to refer to lay members of the Trust appointed solely to hear appeals and other review hearings under the Act. This is also a statutory function and the Associate Hospital Managers have a power to discharge embodied in Section 23 of the Act. As such, detained patients and patients on a Community Treatment Order can appeal to the Associate Hospital Managers to discharge them from their section. There are also automatic review hearings whenever a Section 3 (a longer term treatment section) or a CTO is renewed for a further period. Associate Hospital Managers always meet as a panel of three, which is the minimum number needed to make a valid decision to discharge, and usually review both written and oral evidence before making a decision. The role is mainly limited to what are called Part 2 patients i.e. on a civil section, or if under Part 3, a criminal section, to those less serious cases where the patient is not subject to restrictions. In such cases only the Tribunal can discharge.
Why does NELFT use Associate Hospital Managers?
This is implicitly covered above. There is a statutory requirement to have a Hospital Managers service and eligible patients are considered to have a right to appeal to them, or have their section renewal reviewed by them. If it is further asked: why does the Act require this? The answer is that the Hospital Managers are a safeguard built into the Act to guard against wrongful or unnecessary detention or use of a CTO. Parliament, when it passed the Act, wanted to balance the very considerable powers of professionals, such as doctors and others e.g. social workers, against the judgment of the lay person. In other words, the Associate Hospital Manages fulfil a legal test: if this patient was presented to a panel of intelligent, well-selected, but non-expert members of the local community, would they agree that the coercive powers of the Act were necessary in this case and at this time?
How many appeals have they seen at NELFT?
Over the past two years, 2016 and 2017, there have been almost 250 hearings and five discharges. This is a low discharge figure, but it should be remembered that: tribunals often review patients at an earlier time and discharge the patient; the patients on longer term section 3s and CTOs are always less likely to be discharged; where there is a case for discharge the Responsible Clinician will sometimes discharge the patient in the run-up to hearing, something that is very much part of the safeguarding process. It is also the case that the threshold for use of the Act is arguably higher now as bed-numbers have reduced so that, at least for the detained patient group, the Hospital Managers are likely to be reviewing very unwell patients.
How long does the appeals process take?
This varies as hearings are arranged so as to leave a gap between the tribunal hearing, if the patient has appealed to the Mental Health Tribunal, and the Associate Hospital Managers one. Normally, if a patient appeals on a Section 3 or CTO - the hearing will take place at seven/eight weeks. Renewal hearings take place within a few weeks of the section being renewed. If the patient appeals against the shorter term Section 2 order, it will only be allowed if there is not also a tribunal, but if that is the case there will be a hearing within about seven days.
We also spoke to Clive Myers to ask what his experiences have been of being an Associate Hospital Manager:
I have been a Associate Hospital Manager now since 2014 and regard it as a privilege to be able to volunteer to help individuals who have been unfortunate enough to suffer mental health problems. Having Chaired, or been on the Panel of around 300 or so hearings, it will be no surprise if I say that each one is as different as each patient is from another.
As Robert has implied, our role is similar to that of a jury where 12 ‘lay’ people evaluate the evidence to reach a decision on an ‘accused’. In our case, like a jury, we start with the assumption that the patient is ‘innocent’ (i.e. should be discharged) unless the Trust can demonstrate otherwise. This means the doctors, nurses or social workers have to convince the panel (who must be unanimous) that their decision to continue to detain in hospital or to remain on a Community Treatment Order is justified.
Panels are usually sent written reports from the doctor, named nurse and care co-ordinator a few days before the hearing to enable them to prepare some of the questions which will be raised in advance. We meet half an hour before the designated start to discuss the case before the professionals, the patient and, often, the patient’s solicitor arrives. The hearing then takes from one to two hours before the panel discusses the outcome (amongst ourselves) and reaches a decision which is then explained to the patient. This decision is then formally written up by the Chair of the Panel and placed on the patient’s file.
As Robert has said we have rarely discharged a patient because, although we consider each case independently and, on its merits, it has to be recognised that patients who are detained in hospital are, or have been, acutely unwell. Community Treatment Orders are a way for such patients to be treated under the least restrictive option and are likely only to be lifted if there is evidence that the patient will remain well for the foreseeable future.
Thanks to Robert and Clive for their help explaining the role.
(Pictured above at Goodmayes Hospital before an Associate Hospital Managers meeting are (Left-Right) Clive Myers, Iain Burns and Margaret Lathbridge)