Mental Health (Amendment) Act 1982

PART I — Definition of Mental Disorder

Replacement of " subnormality " by " mental impairment"

1

Other amendments of definition of mental disorder

2

• (1) For subsection (4) of section 4 of the principal Act (definition of " psychopathic disorder ") there shall be substituted—

(4) In this Act' psychopathic disorder' means a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned.

• (2) In subsection (5) of that section (person not to be treated as suffering from mental disorder by reason only of promiscuity or other immoral conduct) after the words " or other immoral conduct " there shall be inserted the words " , sexual deviancy or dependence on alcohol or drugs. "

PART II — Compulsory Admission to Hospital and Guardianship

Admission to hospital

Admission for assessment

3

• (1) In section 25 of the principal Act (under which a person may be detained in a hospital under observation if an application for admission for observation is made in accordance with that section)—

• (a) for the words " application for admission for observation ", wherever they occur, there shall be substituted the words " application for admission for assessment "; and

• (b) in subsection (2)(a) for the words "detention of the patient in a hospital under observation (with or without other medical treatment) " there shall be substituted the words " detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) ".

• (2) In section 27 of the principal Act (general provisions as to applications) after subsection (1) there shall be inserted—

(1A) Before or within a reasonable time after an application for the admission of a patient for assessment is made by a mental welfare officer, that officer shall take such steps as are practicable to inform the person (if any) appearing to be the nearest relative of the patient that the application is to be or has been made and of the power of the nearest relative under section 47 of this Act to discharge the patient.

• (3) In section 29 of the principal Act (emergency application for admission for assessment)—

• (a) in subsection (2) (persons by whom emergency application may be made) for the words " any relative of the patient" there shall be substituted the words " the nearest relative of the patient ";

• (b) for subsection (4) there shall be substituted—

(4) In relation to an emergency application, section 27 of this Act shall have effect as if in subsection (3) of that section for the words " the period of fourteen days ending with the date of the application " there were substituted the words "the previous twenty-four hours.

• (4) In section 31 of the principal Act—

• (a) for subsection (1)(b) (time limit for acting on emergency application for admission for assessment) there shall be substituted—

(b) in the case of an emergency application, the period of twenty-four hours beginning at the time when the patient was examined by the practitioner giving the medical recommendation first referred to in subsection (3) of section 29 of this Act, or at the time when the application is made, whichever is the earlier

;

• (b) after subsection (3) there shall be inserted—

(3A) A patient who is admitted to a hospital in pursuance of an application for admission for assessment may apply to a Mental Health Review Tribunal within the period of fourteen days beginning with the day on which he is so admitted.

Admission for treatment

4

• (1) Section 26 of the principal Act (admission for treatment) shall be amended as follows.

• (2) For subsection (2) (a) and (b) (grounds for application for admission of patient) there shall be substituted—

(a) that he is suffering from mental illness, severe mental impairment, psychopathic disorder or mental impairment, being a mental disorder of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital; and (b) in the case of psychopathic disorder or mental impairment, that such treatment is likely to alleviate or prevent a deterioration of his condition ; and (c) that it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and that it cannot be provided unless he is detained under this section.

• (3) In subsection (3) (contents of medical recommendations) for the words " paragraphs (a) and (b)", " the said paragraph (a)" and "the said paragraph (b)" there shall be substituted respectively the words " paragraphs (a), (b) and (c) " , " the said paragraphs (a) and (b) " and " the said paragraph (c) ".

Medical recommendations

5

• (1) Section 28 of the principal Act (general provisions as to medical recommendations) shall be amended as follows.

• (2) In subsection (1) (which requires the two practitioners making the recommendations to have examined the patient either together or at an interval of not more than seven days) for the words from " either together " onwards there shall be substituted the words " either together or separately but where they have examined the patient separately not more than five days must have elapsed between the days on which the separate examinations took place. "

• (3) At the beginning of subsection (3) (which provides that only one of the recommendations may be given by a practitioner on the staff of the hospital to which the patient is to be admitted) there shall be inserted the words " Subject to subsection (3A) of this section " and after that subsection there shall be inserted—

(3A) Subsection (3) of this section shall not preclude both the medical recommendations being given by practitioners on the staff of the hospital in question if— (a) compliance with that subsection would result in delay involving serious risk to the health or safety of the patient; and (b) one of the practitioners giving the recommendations works at the hospital for less than half of the time which he is bound by contract to devote to work in the health service; and (c) where one of those practitioners is a consultant, the other does not work (whether at the hospital or elsewhere) in a grade in which he is under that consultant's directions.

• (4) In subsection (4)(e) after the words " subsection (3)" there shall be inserted the words " or (3A) ".

• (5) After subsection (4) there shall be inserted—

(5) A general practitioner who is employed part-time in a hospital shall not for the purposes of this section be regarded as a practitioner on its staff.

Patients already in hospital

6

• (1) Section 30 of the principal Act (applications in respect of patients already in hospital) shall be amended as follows.

• (2) In subsection (2) (detention for three days on report by medical practitioner in charge of the treatment of the patient) for the words " a period of three days beginning with the day on which the report is so furnished " there shall be substituted the words " a period of seventy-two hours from the time when the report is so furnished. "

• (3) After subsection (2) there shall be inserted—

(3) The medical practitioner in charge of the treatment of a patient in a hospital may nominate one (but not more than one) other medical practitioner on the staff of that hospital to act for him under subsection (2) of this section in his absence. (4) If, in the case of a patient who is receiving treatment for mental disorder as an in-patient in a hospital and who is not liable to be detained therein under this Part of this Act, it appears to a nurse of the prescribed class— (a) that the patient is suffering from mental disorder to such a degree that it is necessary for his health or safety or for the protection of others for him to be immediately restrained from leaving the hospital ; and (b) that it is not practicable to secure the immediate at tendance of a practitioner for the purpose of furnishing a report under subsection (2) of this section, the nurse may record that fact in writing; and in that event the patient may be detained in the hospital for a period of six hours from the time when that fact is so recorded or until the earlier arrival at the place where the patient is detained of a practitioner having power to furnish a report under that subsection. (5) A record made under subsection (4) of this section shall be delivered by the nurse (or by a person authorised by the nurse in that behalf) to the managers of the hospital as soon as possible after it is made; and where a record is made under that subsection the period mentioned in subsection (2) of this section shall begin at the time when it is made. (6) In subsection (4) of this section " prescribed " means prescribed by an order made by the Secretary of State.

Reception into guardianship

Guardianship applications

7

• (1) Section 33 of the principal Act (application for guardianship) shall be amended as follows.

• (2) In subsection (1) for the words " A patient may be received into guardianship" there shall be substituted the words " A patient who has attained the age of sixteen years may be received into guardianship ".

• (3) In subsection (2)(a) (guardianship application on grounds of mental disorder, being, in the case of a patient of any age, mental illness or severe subnormality or, in the case of a patient under the age of twenty-one years, psychopathic disorder or sub-normality) for sub-paragraphs (i) and (ii) there shall be substituted the words " mental illness, severe mental impairment, psychopathic disorder or mental impairment ".

• (4) In subsection (2)(b) (guardianship necessary in the interests of the patient) for the words " the interests of the patient" there shall be substituted the words " the interests of the welfare of the patient ".

Effect of guardianship applications

8

In section 34(1) of the principal Act (under which the effect of a guardianship application when duly accepted is to confer on the guardian all such powers as would be exercisable if the guardian were the father of the patient and the patient were under the age of fourteen years) for the words from " all such powers " onwards there shall be substituted the words " the following powers, that is to say—

• (a) power to require the patient to reside at a place specified by the authority or person named as guardian ;

• (b) power to require the patient to attend at places and times so specified for the purpose of medical treatment, occupation, education or training ;

• (c) power to require access to the patient to be given, at any place where the patient is residing, to any registered medical practitioner, mental welfare officer or other person so specified."

Care and treatment of detained patients

Visiting and examination of patients

9

• (1) Section 37 of the principal Act (visiting and examination of patients) shall be amended as follows.

• (2) After subsection (1) there shall be inserted—

(1A) Any medical practitioner authorised for the purposes of subsection (1) of this section to visit and examine a patient may require the production of and inspect any records relating to the detention or treatment of the patient in any hospital.

• (3) In subsection (2) (examination of patients in mental nursing homes) for the words "a registration authority" there shall be substituted the words " the Secretary of State " and for the words " that authority " there shall be substituted the words " the Secretary of State or, as the case may be, that authority ".

• (4) In subsection (3) (production and inspection of medical records of patients in mental nursing homes) for the words " medical records" there shall be substituted the word " records ".

Re-classification of patients

10

After section 38(1) of the principal Act (re-classification of patients) there shall be inserted—

(1A) Where a report under subsection (1) of this section in respect of a patient detained in a hospital is to the effect that he is suffering from psychopathic disorder or mental impairment but not from mental illness or severe mental impairment the responsible medical officer shall include in the report a statement of his opinion whether further medical treatment in hospital is likely to alleviate or prevent a deterioration of the patient's condition; and if he states that in his opinion such treatment is not likely to have that effect the authority of the managers to detain the patient shall cease. (1B) Before furnishing a report under subsection (1) of this section the responsible medical officer shall consult one or more other persons who have been professionally concerned with the patient's medical treatment.

Leave of absence and patients absent without leave

11

• (1) Sections 39 and 40 of the principal Act (1eave of absence and patients absent without leave) shall be amended as follows.

• (2) At the end of subsection (3) of section 39 (persons who may have custody of patient during leave of absence) there shall be inserted the words " or, if the patient is required in accordance with conditions imposed on the grant of leave of absence to reside in another hospital, of any officer on the staff of that other hospital. "

• (3) After subsection (1) of section 40 (persons who may take into custody and return a patient absent without leave) there shall be inserted—

(1A) Where the place referred to in paragraph (c) of subsection (1) of this section is a hospital other than the one in which the patient is for the time being liable to be detained, the references in that subsection to an officer on the staff of the hospital and the managers of the hospital shall respectively include references to an officer on the staff of the first-mentioned hospital and the managers of that hospital.

• (4) In subsection (3) of section 40 (period within which patient may be taken into custody) for the words from " after the expiration of the following period " to " twenty-eight days " there shall be substituted the words " after the expiration of the period of twenty-eight days beginning with the first day of his absence without leave ".

• (5) After subsection (3) of section 40 there shall be inserted—

(3A) A patient shall not be taken into custody under this section if the period for which he is liable to be detained is that specified in section 25(4), 29(3) or 30(2) or (4) of this Act and that period has expired.

Duration of detention or guardianship and discharge of patients

Duration of authority for detention and guardianship

12

• (1) Section 43 of the principal Act (duration of authority for detention and guardianship) shall be amended as follows.

• (2) In subsections (1) and (2)(a) (initial period of detention or guardianship and period of first renewal) for the words "one year " there shall be substituted the words " six months ".

• (3) In subsection (2) (subsequent periods of renewal) for the words " two years", in both places where they occur, there shall be substituted the words " one year ".

• (4) In subsection (3) (renewal report by responsible medical officer) for the words from " if it appears to him " onwards there shall be substituted the words " if it appears to him that the conditions set out in subsection (3A) of this section are satisfied he shall furnish to the managers of the hospital where the patient is detained a report to that effect in the prescribed form. "

• (5) After subsection (3) there shall be inserted—

(3A) The conditions referred to in subsection (3) of this section are— (a) that the patient is suffering from mental illness, severe mental impairment, psychopathic disorder or mental impairment, being a mental disorder of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital; and (b) that such treatment is likely to alleviate or prevent a deterioration of his condition ; and (c) that it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and that it cannot be provided unless he continues to be detained ; but, in the case of mental illness or severe mental impairment, it shall be an alternative to the condition specified in paragraph (b) of this subsection that the patient, if discharged, is unlikely to be able to care for himself, to obtain the care which he needs or to guard himself against serious exploitation. (3B) Before furnishing a report under subsection (3) of this section the responsible medical officer shall consult one or more other persons who have been professionally concerned with the patient's medical treatment.

• (6) In subsection (4) (renewal report in case of guardianship) for the words from " if it appears to him" onwards there shall be substituted the words

if it appears to him— (i) that the patient is suffering from mental illness, severe mental impairment, psychopathic disorder or mental impairment, being a mental disorder of a nature or degree which warrants his reception into guardianship, and (ii) that it is necessary in the interests of the welfare of the patient or for the protection of other persons that the patient should remain under guardianship, he shall furnish to the guardian and, where the guardian is a person other than a local social services authority, the responsible local social services authority a report to that effect in the prescribed form.

• (7) After subsection (5) there shall be inserted—

(5A) Where the form of mental disorder specified in a report furnished under subsection (3) or (4) of this section is a form of disorder other than that specified in the application for admission for treatment or, as the case may be, in the guardianship application, that application shall have effect as if that other form of mental disorder were specified in it; and where on any occasion a report specifying such a form of mental disorder is furnished under either of those subsections by the responsible medical officer or the patient's nominated medical attendant he need not on that occasion furnish a report under section 38 of this Act.

Discharge of patients

13

• (1) For paragraphs (a) and (b) of section 47(2) of the principal Act (under which the patient's nearest relative may make an order of discharge if the patient is liable to be detained in pursuance of an application for admission for treatment but not if he is liable to be detained in pursuance of an application for admission for assessment) there shall be substituted—

(a) where the patient is liable to be detained in a hospital in pursuance of an application for admission for assessment or for treatment, by the responsible medical officer, by the managers or by the nearest relative of the patient;

.

• (2) In subsection (3) of section 48 of the principal Act (right of nearest relative to apply to Mental Health Review Tribunal if his order for discharge is nullified under subsection (2) of that section) after the words " in respect of a patient " there shall be inserted the words " who is liable to be detained in pursuance of an application for admission for treatment ".

Functions of relatives of patients

Definition of relative and nearest relative

14

• (1) Section 49 of the principal Act (definition of relative and nearest relative) shall be amended as follows.

• (2) In subsection (1) for paragraphs (c) and (d) there shall be substituted—

(c) father or mother ;

.

• (3) After subsection (3) there shall be inserted—

(3A) Subject to the provisions of this section and to the following provisions of this Part of this Act, where the patient ordinarily resides with or is cared for by one or more of his relatives (or, if he is for the time being an inpatient in a hospital, he last ordinarily resided with or was cared for by one or more of his relatives) his nearest relative shall be determined— (a) by giving preference to that relative or those relatives over the other or others ; and (b) as between two or more such relatives, in accordance with subsection (3) of this section.

• (4) In subsection (4) after the words " subsection (3)" there shall be inserted the words " or (3A) " and for paragraph (a) there shall be substituted—

(a) in the case of a patient ordinarily resident in the United Kingdom, the Channel Islands or the Isle of Man, is not so resident; or

.

• (5) After subsection (6) there shall be inserted—

(7) A person, other than a relative, with whom the patient ordinarily resides (or, if the patient is for the time being an in-patient in a hospital, last ordinarily resided before he was admitted), and with whom he has or had been ordinarily residing for a period of not less than five years, shall be treated for the purposes of this Part of this Act as if he were a relative but— (a) shall be treated for the purposes of subsection (3) of this section as if mentioned last in subsection (1) of this section ; and (b) shall not be treated by virtue of this subsection as the nearest relative of a married patient unless the husband or wife of the patient is disregarded by virtue of paragraph (b) of subsection (4) of this section.

Appointment by court of acting nearest relative

15

• (1) Sections 52 and 53 of the principal Act (appointment by court of acting nearest relative) shall be amended as follows.

• (2) After section 52(4) there shall be inserted—

(4A) An order made on the ground specified in subsection (3) (a) or (b) of this section may specify a period for which it is to continue in force unless previously discharged under section 53 of this Act.

• (3) In section 53(4) after the words " cease to have effect" there shall be inserted the words " at the expiration of the period, if any, specified under subsection (4A) of that section or, where no period is so specified ".

Applications and references

Applications by mental welfare officers

16

• (1) Section 54 of the principal Act (duty of mental welfare officer to make applications) shall be amended as follows.

• (2) In subsection (1) for the words " the local authority " there shall be substituted the words " the local social services authority ".

• (3) After subsection (1) there shall be inserted—

(1A) Before making an application for the admission of a patient to hospital a mental welfare officer shall interview the patient in a suitable manner and satisfy himself that detention in a hospital is in all the circumstances of the case the most appropriate way of providing the care and medical treatment of which the patient stands in need. (1B) An application under this section by a mental welfare officer may be made outside the area of the local social services authority by whom he is appointed. (1C) It shall be the duty of a local social services authority, if so required by the nearest relative of a patient residing in their area, to direct a mental welfare officer as soon as practicable to take the patient's case into consideration under subsection (1) of this section with a view to making an application for his admission to hospital; and if in any such case that officer decides not to make an application he shall inform the nearest relative of his reasons in writing.

Social reports

17

Where a patient is admitted to a hospital in pursuance of an application (other than an emergency application) made under Part IV of the principal Act by his nearest relative, the managers of the hospital shall as soon as practicable give notice of that fact to the local social services authority for the area in which the patient resided immediately before his admission; and that authority shall as soon as practicable arrange for a social worker of their social services department to interview the patient and provide the managers with a report on his social circumstances.

Power of Secretary of State to refer cases to tribunal

18

The existing provisions of section 57 of the principal Act (power of Secretary of State to refer cases to tribunal) shall become subsection (1) and after those provisions there shall be inserted—

(2) For the purpose of furnishing information for the purposes of such a reference any medical practitioner authorised by or on behalf of the patient may, at any reasonable time, visit the patient and examine him in private and require the production of and inspect any records relating to the detention or treatment of the patient in any hospital.

Part III — Patients concerned in Criminal Proceedings etc.

Hospital orders

Power to make hospital order

19

Applications in respect of patient subject to hospital order

20

• (1) After subsection (3) of section 63 of the principal Act (effect of hospital orders and guardianship orders) there shall be inserted—

(3A) Without prejudice to any provision of Part IV of this Act as applied by this section, an application to a Mental Health Review Tribunal in respect of a patient admitted to a hospital in pursuance of a hospital order may be made by the nearest relative of the patient— (a) in the period between the expiration of six months and the expiration of twelve months beginning with the date of the order ; and (b) in any subsequent period of twelve months.

• (2) In subsection (4) of that section the words " admitted to a hospital in pursance of a hospital order, or " shall be omitted.

• (3) Where a person detained in a hospital or mental nursing home—

• (a) is treated as subject to a hospital order or transfer direction by virtue of section 37(2) below, section 65(5) or 87(2) of the principal Act, section 73(2) of the Mental Health (Scotland) Act 1960 or section 5(1) of the Criminal Procedure (Insanity) Act 1964 ; or

• (b) is subject to a direction having the same effect as a hospital order by virtue of section 71(4), 72(3) or 73(3) of the principal Act,

then, without prejudice to any provision of Part IV of the principal Act as applied by section 63 of that Act, that person may make an application to a Mental Health Review Tribunal in the period of six months beginning with the date of the order or direction mentioned in paragraph (a) above or, as the case may be, the date of the direction mentioned in paragraph (b) above.

• (4) In sections 52(1) and (5) and 53 of the principal Act (appointment by court of acting nearest relative) references to Part IV of that Act shall include references to section 63 (3A) and (4) of that Act and in subsection (4)(a) of section 53 of that Act the reference to detention in pursuance of an application for admission for treatment and to guardianship under tot Part shall include a reference to detention and guardianship by virtue of an order or direction under Part V of that Act.

Committal for hospital order

21

• (1) Section 68 of the principal Act (admission to hospital of person committed by magistrates' court with a view to the making of a hospital order) shall be amended as follows.

• (2) In subsection (1) for the words " the magistrates" court by which he is committed is satisfied that arrangements have been made for the admission of "the offender to a hospital there shall be substituted the words " the magistrates' court by which he is committed is satisfied, on written or oral evidence, that arrangements have been made for the admission of the offender to a hospital ".

• (3) After subsection (1) there shall be inserted—

(1A) The evidence required by subsection (1) of this section shall be given by the medical practitioner who would be in charge of the offender's treatment or by some other person representing the managers of the hospital in question.

Transfer directions

Removal to hospital of persons serving sentences of imprisonment etc.

22

For section 72(1 )(b) of the principal Act (removal to hospital of persons serving sentences of imprisonment etc..) there shall be substituted—

(b) that the mental disorder from which that person is suffering is of a nature or degree which makes it appropriate for him to be detained in a hospital for medical treatment and, in the case of psychopathic disorder or mental impairment, that such treatment is likely to alleviate or prevent a deterioration of his condition;

.

Removal to hospital of other prisoners

23

• (1) Section 73 of the principal Act (removal to hospital of other prisoners) shall be amended as follows.

• (2) In subsection (1) for the words " which warrants the detention of the patient in a hospital for medical treatment" there shall be substituted the words " which makes it appropriate for him to be detained in a hospital for medical treatment and that the patient is in urgent need of such treatment ".

• (3) For paragraphs (a), (b) and (c) of subsection (2) there shall be substituted—

(a) persons detained in a prison or remand centre, not being persons serving a sentence of imprisonment or persons falling within the following paragraphs of this subsection;

.

• (4) For paragraph (f) of subsection (2) there shall be substituted—

(f) persons detained under the Immigration Act 1971.

Persons under sentence

24

• (1) Section 75 of the principal Act (provisions applying where person under sentence has been transferred to hospital) shall be amended as follows.

• (2) In subsection (1) for the words " and the Secretary of State is notified by the responsible medical officer at any time before the expiration of that person's sentence that that person no longer requires treatment for mental disorder " there shall be substituted the words " and before the expiration of that person's sentence the Secretary of State is notified by the responsible medical officer, any other medical practitioner or a Mental Health Review Tribunal that that person no longer requires treatment in hospital for mental disorder or that no effective treatment for his disorder can be given in the hospital to which he has been removed ".

• (3) At the end of subsection (3) there shall be inserted the words " and that period shall be treated as expiring on the date on which he could have been discharged if he had not forfeited remission of any part of the sentence after his removal pursuant to the direction ".

Persons committed for trial etc.

25

• (1) Section 76 of the principal Act (provisions applying where person committed for trial etc. has been transferred to hospital) shall be amended as follows.

• (2) In subsection (2)(a)—

• (a) for the words " the Secretary of State is notified by the responsible medical officer at any time before that person is brought before the court" there shall be substituted the words " the Secretary of State is notified by the responsible medical officer, any other medical practitioner or a Mental Health Review Tribunal at any time before that person's case is disposed of by the court ";

• (b) for the words " that he no longer requires treatment for mental disorder " there shall be substituted the words " that he no longer requires treatment in hospital for mental disorder or that no effective treatment for his disorder can be given at the hospital to which he has been removed ".

• (3) After subsection (2)(a) there shall be inserted—

(aa) if (no direction having been given under paragraph (a) of this subsection) that court is satisfied, on the written or oral evidence of the responsible medical officer, that that person no longer requires treatment in hospital for mental disorder or that no effective treatment for his disorder can be given at the hospital to which he has been removed, the court may order him to be remitted to any such place as aforesaid or released on bail and on his arrival at that place or, as the case may be, his release on bail the transfer direction shall cease to have effect;

.

• (4) In subsection (2) (b) for the words " (no direction having been given under paragraph (a) of this subsection) " there shall be substituted the words " (no direction or order having been given or made under paragraph (a) or (aa) of this subsection) ".

• (5) In subsection (3) for the words " on the oral evidence of at least two medical practitioners " there shall be substituted the words " on the written or oral evidence of at least two medical practitioners " and for the the words " which warrants the detention of the patient in a hospital for medical treatment" there shall be substituted the words " which makes it appropriate for the patient to be detained in a hospital for medical treatment ".

Persons remanded by magistrates' courts

26

• (1) This section has effect where a transfer direction has been given in respect of a person remanded in custody by a magistrates' court; and that person is in this section referred to as " the accused ".

• (2) Subject to subsection (5) below, the transfer direction shall cease to have effect on the expiration of the period of remand unless the accused is committed in custody to the Crown Court for trial or to be otherwise dealt with.

• (3) Subject to subsection (4) below, the power of further remanding the accused under section 128 of the Magistrates' Courts Act 1980 may be exercised by the court without his being brought before the court; and if the court further remands the accused in custody (whether or not he is brought before the court) the period of remand shall, for the purposes of this section, be deemed not to have expired.

• (4) The court shall not under subsection (3) above further remand the accused in his absence unless he has appeared before the court within the previous six months.

• (5) If the magistrates' court is satisfied, on the written or oral evidence of the responsible medical officer—

• (a) that the accused no longer requires treatment in hospital for mental disorder; or

• (b) that no effective treatment for his disorder can be given in the hospital to which he has been removed,

the court may direct that the transfer direction shall cease to have effect notwithstanding that the period of remand has not expired or that the accused is committed to the Crown Court as mentioned in subsection (2) above.

• (6) If the accused is committed to the Crown Court as mentioned in subsection (2) above and the transfer direction has not ceased to have effect under subsection (5) above, section 76 of the principal Act shall apply as if the transfer direction given in his case were a direction given in respect of a person falling within that section.

• (7) The magistrates' court may, in the absence of the accused, inquire as examining justices into an offence alleged to have been committed by him and commit him for trial in accordance with section 6 of the Magistrates' Courts Act 1980 if—

• (a) the court is satisfied, on the written or oral evidence of the responsible medical officer, that the accused is unfit to take part in the proceedings ; and

• (b) where the court proceeds under subsection (1) of that section, the accused is represented by counsel or a solicitor.

Civil prisoners and persons detained under the Immigration Act 1971

27

• (1) Subject to subsection (2) below, a transfer direction given in respect of any such person as is described in paragraph (e) or (f) of section 73(2) of the principal Act (civil prisoners and persons detained under the Immigration Act 1971) shall cease to have effect on the expiration of the period during which he would, but for his removal to hospital, be liable to be detained in the place from which he was removed.

• (2) Where a transfer direction and a restriction direction have been given in respect of any such person as is mentioned in subsection (1) above, then, if the Secretary of State is notified by the responsible medical officer, any other medical practitioner or a Mental Health Review Tribunal at any time before the expiration of the period there mentioned—

• (a) that that person no longer requires treatment in hospital for mental disorder ; or

• (b) that no effective treatment for his disorder can be given in the hospital to which he has been removed,

the Secretary of State may by warrant direct that he be remitted to any place where he might have been detained if he had not been removed to hospital, and on his arrival at the place to which he is so remitted the transfer direction and the restriction direction shall cease to have effect.

Orders and directions restricting discharge

Restriction orders and restriction directions

28

• (1) In section 65(1) of the principal Act (power to make an order restricting an offender's discharge if necessary for the protection of the public) after the words " the protection of the public " there shall be inserted the words " from Serious harm "and the same amendment shall be made in section 66(1) of that Act (power to revoke order if no longer required for that purpose).

• (2) An order under section 65 of the principal Act shall be known as " a restriction order" instead of as " an order restricting discharge "; and a direction under section 74 of that Act (which has the same effect as such an order) shall be known as " a restriction direction " instead of as " a direction restricting discharge ".

• (3) While a person is subject to a restriction order or a restriction direction the responsible medical officer shall at such intervals (not exceeding one year) as the Secretary of State may direct examine and report to the Secretary of State on that person; and every report shall contain such particulars as the Secretary of State may require.

• (4) Schedule 1 to this Act shall have effect for enabling persons who are subject to restriction orders or restriction directions to be discharged by Mental Health Review Tribunals ; and section 66(6) to (8) of the principal Act (under which such a tribunal has only advisory powers in respect of such persons) shall cease to have effect.

Remands to hospital and interim hospital orders

Remand to hospital for report on accused's mental condition

29

• (1) Subject to the provisions of this section, the Crown Court or a magistrates' court may remand an accused person to a hospital specified by the court for a report on his mental condition.

• (2) For the purposes of this section an accused person is—

• (a) in relation to the Crown Court, any person who is awaiting trial before the court for an offence punishable with imprisonment or who has been arraigned before the court for such an offence and has not yet been sentenced or otherwise dealt with for the offence for which he has been arraigned ;

• (b) in relation to a magistrates' court, any person who has been convicted by the court of an offence punishable on summary conviction with imprisonment and any person charged with such an offence if the court is satisfied that he did the act or made the omission charged or he has consented to the exercise by the court of the powers conferred by this section.

• (3) Subject to subsection (4) below, the powers conferred by this section may be exercised if—

• (a) the court is satisfied, on the written or oral evidence of a medical practitioner approved for the purposes of section 28 of the principal Act, that there is reason to suspect that the accused person is suffering from mental illness, psychopathic disorder, mental impairment or severe mental impairment; and

• (b) the court is of opinion that it would be impracticable for a report on his mental condition to be made if he were remanded on bail ;

but those powers shall not be exercised by the Crown Court in respect of a person who has been convicted before the court if the sentence for the offence of which he has been convicted is fixed by law.

• (4) The court shall not remand an accused person to a hospital under this section unless satisfied, on the written or oral evidence of the medical practitioner who would be responsible for making the report or of some other person representing the managers of the hospital, that arrangements have been made for his admission to that hospital and for his admission to it within the period of seven days beginning with the date of the remand ; and if the court is so satisfied it may, pending his admission, give directions for his conveyance to and detention in a place of safety.

• (5) Where a court has remanded an accused person under this section it may further remand him if it appears to the court, on the written or oral evidence of the medical practitioner responsible for making the report, that a further remand is necessary for completing the assessment of the accused person's mental condition.

• (6) The power of further remanding an accused person under this section may be exercised by the court without his being brought before the court if he is represented by counsel or a solicitor and his counsel or solicitor is given an opportunity of being heard.

• (7) An accused person shall not be remanded or further remanded under this section for more than twenty-eight days at a time or for more than twelve weeks in all; and the court may at any time terminate the remand if it appears to the court that it is appropriate to do so.

• (8) An accused person remanded to hospital under this section shall be entitled to obtain at his own expense an independent report on his mental condition from a medical practitioner chosen by him and to apply to the court on the basis of it for his remand to be terminated under subsection (7) above.

• (9) Where an accused person is remanded under this section—

• (a) a constable or any other person directed to do so by the court shall convey the accused person to the hospital specified by the court within the period mentioned in subsection (4) above ; and

• (b) the managers of the hospital shall admit him within that period and thereafter detain him in accordance with the provisions of this section.

• (10) If an accused person absconds from a hospital to which he has been remanded under this section, or while being conveyed to or from that hospital, he may be arrested without warrant by any constable and shall, after being arrested, be brought as soon as practicable before the court that remanded him ; and the court may thereupon terminate the remand and deal with him in any way in which it could have dealt with him if he had not been remanded under this section.

Remand of accused person to hospital for treatment

30

• (1) Subject to the provisions of this section, the Crown Court may, instead of remanding an accused person in custody, remand him to a hospital specified by the court if satisfied, on the written or oral evidence of two medical practitioners, that he is suffering from mental illness or severe mental impairment of a nature or degree which makes it appropriate for him to be detained in a hospital for medical treatment.

• (2) For the purposes of this section an accused person is any person who is in custody awaiting trial before the Crown Court for an offence punishable with imprisonment (other than an offence the sentence for which is fixed by law) or who at any time before sentence is in custody in the course of a trial before that court for such an offence.

• (3) Of the medical practitioners whose evidence is taken into account under subsection (1) above at least one shall be a practitioner approved for the purposes of section 28 of the principal Act.

• (4) The court shall not remand an accused person under this section to a hospital unless it is satisfied, on the written or oral evidence of the medical practitioner who would be in charge of his treatment or of some other person representing the managers of the hospital, that arrangements have been made for his admission to that hospital and for his admission to it within the period of seven days beginning with the date of the remand ; and if the court is so satisfied it may, pending his admission, give directions for his conveyance to and detention in a place of safety.

• (5) Where a court has remanded an accused person under this section it may further remand him if it appears to the court, on the written or oral evidence of the responsible medical officer, that a further remand is warranted.

• (6) The power of further remanding an accused person under this section may be exercised by the court without his being brought before the court if he is represented by counsel or a solicitor and his counsel or solicitor is given an opportunity of being heard.

• (7) An accused person shall not be remanded or further remanded under this section for more than twenty-eight days at a time or for more than twelve weeks in all; and the court may at any time terminate the remand if it appears to the court that it is appropriate to do so.

• (8) An accused person remanded to hospital under this section shall be entitled to obtain at his own expense an independent report on his mental condition from a medical practitioner chosen by him and to apply to the court on the basis of it for his remand to be terminated under subsection (7) above.

• (9) Subsections (9) and (10) of section 29 above shall have effect in relation to a remand under this section as they have effect in relation to a remand under that section.

Interim hospital orders

31

• (1) Where a person is convicted before the Crown Court of an offence punishable with imprisonment (other than an offence the sentence for which is fixed by law) or is convicted by a magistrates' court of an offence punishable on summary conviction with imprisonment and the court before or by which he is convicted is satisfied, on the written or oral evidence of two medical practitioners—

• (a) that the offender is suffering from mental illness, psychopathic disorder, mental impairment or severe mental impairment; and

• (b) that there is reason to suppose that the mental disorder from which the offender is suffering is such that it may be appropriate for a hospital order to be made in his case,

the court may, before making a hospital order or dealing with him in some other way, make an order (" an interim hospital order ") authorising his admission to such hospital as may be specified in the order and his detention there in accordance with this section.

• (2) In the case of an offender who is subject to an interim hospital order the court may make a hospital order without his being brought before the court if he is represented by counsel or a solicitor and his counsel or solicitor is given an opportunity of being heard.

• (3) Of the medical practitioners whose evidence is taken into account under subsection (1) above at least one shall be a practitioner approved for the purposes of section 28 of the principal Act and at least one shall be employed at the hospital which is to be specified in the order.

• (4) An interim hospital order shall not be made for the admission of an offender to a hospital unless the court is satisfied, on the written or oral evidence of the medical practitioner who would be in charge of his treatment or of some other person representing the managers of the hospital, that arrangements have been made for his admission to that hospital and for his admission to it within the period of twenty-eight days beginning with the date of the order; and if the court is so satisfied the court may, pending his admission, give directions for his conveyance to and detention in a place of safety.

• (5) An interim hospital order—

• (a) shall be in force for such period, not exceeding twelve weeks, as the court may specify when making the order; but

• (b) may be renewed for further periods of not more than twenty-eight days at a time if it appears to the court, on the written or oral evidence of the responsible medical officer, that the continuation of the order is warranted;

but no such order shall continue in force for more than six months in all and the court shall terminate the order if it makes a hospital order in respect of the offender or decides, after considering the written or oral evidence of the responsible medical officer, to deal with the offender in some other way.

• (6) The power of renewing an interim hospital order may be exercised without the offender being brought before the court if he is represented by counsel or a solicitor and his counsel or solicitor is given an opportunity of being heard.

• (7) Where an interim hospital order is made in respect of an offender—

• (a) a constable or any other person directed to do so by the court shall convey the offender to the hospital specified in the order within the period mentioned in subsection (4) above ; and

• (b) the managers of the hospital shall admit him within that period and thereafter detain him in accordance with the provisions of this section.

• (8) If an offender absconds from a hospital in which he is detained in pursuance of an interim hospital order, or while being conveyed to or from such a hospital, he may be arrested without warrant by a constable and shall, after being arrested, be brought as soon as practicable before the court that made the order; and the court may thereupon terminate the order and deal with him in any way in which it could have dealt with him if no such order had been made.

Information and evidence

Information as to hospitals

32

• (1) Where a court is minded to make a hospital order (or interim hospital order in respect of any person it may request—

• (a) the Regional Health Authority for the region in which that person resides or last resided ; or

• (b) any other Regional Health Authority that appears to the court to be appropriate,

to furnish the court with such information as that Authority has or can reasonably obtain with respect to the hospital or hospitals (if any) in its region or elsewhere at which arrangements could be made for the admission of that person in pursuance of the order, and that Authority shall comply with any such request.

• (2) In its application to Wales, subsection (1) above shall have effect as if for any reference to any such Authority as is mentioned in paragraph (a) or (b) of that subsection there were substituted a reference to the Secretary of State, and as if for the words " in its region or elsewhere " there were substituted the words " in Wales ".

Reports by medical practitioners etc.

33

• (1) For the purposes of any provision of Part V of the principal Act or of this Part of this Act under which a court may act on the written evidence of—

• (a) a medical practitioner or a medical practitioner of any description; or

• (b) a person representing the managers of a hospital,

a report in writing purporting to be signed by a medical practitioner or a medical practitioner of such a description or by a person representing the managers of a hospital may, subject to the provisions of this section, be received in evidence without proof of the signature of the practitioner or that person and without proof that he has the requisite qualifications or authority or is of the requisite description; but the court may require the signatory of any such report to be called to give oral evidence.

• (2) Where, in pursuance of a direction of the court, any such report is tendered in evidence otherwise than by or on behalf of the person who is the subject of the report, then—

• (a) if that person is represented by counsel or a solicitor, a copy of the report shall be given to his counsel or solicitor;

• (b) if that person is not so represented, the substance of the report shall be disclosed to him or, where he is a child or young person, to his parent or guardian if present in court; and

• (c) except where the report relates only to arrangements for his admission to a hospital, that person may require the signatory of the report to be called to give oral evidence, and evidence to rebut the evidence contained in the report may be called by or on behalf of that person.

Mental condition of persons accused of murder

Amendments of Bail Act 1976 etc.

34

• (1) The Bail Act 1976 shall be amended in accordance with subsections (2) to (4) below.

• (2) After subsection (6) of section 3 (conditions of bail) there shall be inserted—

(6A) In the case of a person accused of murder the court granting bail shall, unless it considers that satisfactory reports on his mental condition have already been obtained, impose conditions of bail— (a) a requirement that the accused shall undergo examination by two medical practitioners for the purpose of enabling such reports to be prepared ; and (b) a requirement that he shall for that purpose attend such an institution or place as the court directs and comply with any other directions which may be given to him for that purpose by either of those practitioners. (6B) Of the medical pracititioners referred to in subsection (6A) above at lease ine shall be a pracititioner approved for the purpose of section 28 of the Mental Health Act 1959.

• (3) In subsection (7) of that section (obligations of parent or guardian in respect of conditions of bail) for the words “subsection (6) above” there shall be substituted the words “ subsection (6) or (6A) above ”.

• (4) In paragraph 8(3) of Schedule 1 (exceptions from restriction of conditions of bail) after the words “shall not” there shall be inserted the words “ apply to the conditions required to be imposed under section 3(6A) of this Act or ”.

• (5) ...... the Crown Court may order the payment out of central funds of such sums as appear to it reasonably sufficient to compensate any medical practitioner for the expenses, trouble or loss of time properly incurred by him in preparing and making a report to the court on the mental condition of a person accused of murder.

PART IV — Removal of Patients to and from the United Kingdom

Removal of alien patients etc.

35

Removal of patients to Channel Islands or Isle of Man

36

If it appears to the Secretary of State, in the case of a patient who is for the time being liable to be detained or subject to guardianship under the principal Act, that it is in the interests of the patient to remove him to any of the Channel Islands or to the Isle of Man, and that arrangements have been made for admitting him to a hospital or, as the case may be, for receiving him into guardianship there, the Secretary of State may authorise his removal to the island in question and may give any necessary directions for his conveyance to his destination.

Patients removed from Channel Islands or Isle of Man

37

• (1) This section applies to any patient who is removed to England and Wales from any of the Channel Islands or the Isle of Man under a provision corresponding to section 36 above and who immediately before his removal was liable to be detained or subject to guardianship in the island in question under a provision corresponding to an enactment contained in the principal Act.

• (2) Where the patient is admitted to a hospital in England and Wales he shall be treated as if on the date of his admission he had been so admitted in pursuance of an application made, or an order or direction made or given, on that date under the corresponding enactment contained in the principal Act and, where he is subject to an order or direction restricting his discharge, as if he were subject to a restriction order or restriction direction.

• (3) Where the patient is received into guardianship in England and Wales, he shall be treated as if on the date on which he arrives at the place where he is to reside he had been so received in pursuance of an application, order or direction under the corresponding enactment contained in the principal Act and as if the application had been accepted or, as the case may be, the order or direction had been made or given on that date.

• (4) Where the patient was immediately before his removal liable to be detained by virtue of a transfer direction given while he was serving a sentence of imprisonment imposed by a court in the island in question, he shall be treated as if the sentence had been imposed by a court in England and Wales.

• (5) Where the patient was immediately before his removal subject to an order or direction restricting his discharge, being an order or direction of limited duration, the restriction order or restriction direction to which he is subject by virtue of subsection (2) above shall expire on the date on which the first-mentioned order or direction would have expired if he had not been removed.

• (6) While being conveyed to the hospital referred to in subsection (2) or, as the case may be, the place referred to in subsection (3) above, the patient shall be deemed to be in legal custody, and section 140 of the principal Act (retaking of patients escaping from custody) shall apply to him as if he were in legal custody by virtue of section 139 of that Act.

• (7) In the case of a patient removed from the Isle of Man the reference in subsection (4) above to a person serving a sentence of imprisonment includes a reference to a person detained as mentioned in section 60 (6) (a) of the Mental Health Act 1974 (an Act of Tynwald).

Patients absconding from hospital in Channel Islands or Isle of Man

38

Any person (other than a person subject to guardianship) who under any provision corresponding to section 40 or 140 of the principal Act may be taken into custody in any of the Channel Islands or the Isle of Man, may be taken into custody in, and returned to the island in question from, England and Wales by a mental welfare officer or constable.

PART V — Mental Health Review Tribunals

Powers and procedure of tribunals

39

• (1) At the end of section 122(2) of the principal Act (which provides that where a person is authorised to make an application within a specified period not more than one such application shall be made by him within that period) there shall be added the words " but for that purpose there shall be disregarded any application which is withdrawn in accordance with rules made under section 124 of this Act. "

• (2) In section 123(1) of the principal Act (cases in which tribunal is to direct discharge of patient) for the words from "and shall so direct" onwards there shall be substituted the words

and— (a) the tribunal shall direct the discharge of a patient liable to be detained under section 25 of this Act if they are satisfied— (i) that he is not then suffering from mental disorder or from mental disorder of a nature or degree which warrants his detention in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period ; or (ii) that his detention as aforesaid is not justified in the interests of his own health or safety or with a view to the protection of other persons ; (b) the tribunal shall direct the discharge of a patient liable to be detained otherwise than under section 25 of this Act if they are satisfied— (i) that he is not then suffering from mental illness, psychopathic disorder, mental impairment or severe mental impairment or from any of those forms of disorder of a nature or degree which makes it appropriate for him to be liable to be detained in a hospital for medical treatment; or (ii) that it is not necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment; or (iii) in the case of an application under section 48(3) of this Act, that the patient, if released, would not be likely to act in a manner dangerous to other persons or to himself.

• (3) After section 123(1) of the principal Act there shall be inserted—

(1A) In determining whether to direct the discharge of a patient detained otherwise than under section 25 of this Act in a case not falling within paragraph (b) of subsection (1) of this section, the tribunal shall have regard— (a) to the likelihood of medical treatment alleviating or preventing a deterioration of the patient's condition ; and (b) in the case of a patient suffering from mental illness or severe mental impairment, to the likelihood of the patient, if discharged, being able to care for himself, to obtain the care he needs or to guard himself against serious exploitation. (1B) A tribunal may under subsection (1) of this section direct the discharge of a patient on a future date specified in the direction; and where a tribunal do not direct the discharge of a patient under that subsection the tribunal may— (a) with a view to facilitating his discharge on a future date, recommend that he be granted leave of absence or transferred to another hospital or into guardianship; and (b) further consider his case in the event of any such recommendation not being complied with.

• (4) In section 123(2)(b) of the principal Act (discharge of patient subject to guardianship) for the words " the interests of the patient" there shall be substituted the words " the interests of the welfare of the patient ".

• (5) In section 124(2) of the principal Act (matters capable of being dealt with by rules) after paragraph (j) there shall be inserted—

(k) for enabling any functions of a tribunal which relate to matters preliminary or incidental to an application to be performed by the chairman of the tribunal.

• (6) Any functions conferred on the chairman of a Mental Health Review Tribunal by rules under section 124 of the principal Act may, if for any reason he is unable to act, be exercised by another member of that Tribunal appointed by him for the purpose.

• (7) A Mental Health Review Tribunal may pay allowances in respect of travelling expenses, subsistence and loss of earnings to any person attending the tribunal as an applicant or witness, to the patient who is the subject of the proceedings if he attends' otherwise than as the applicant or a witness and to any person (other than counsel or a solicitor) who attends as the representative of an applicant.

Duty of managers of hospitals to refer cases to tribunal

40

• (1) Where—

• (a) a patient who is admitted to a hospital in pursuance of an application for admission for treatment does not exercise his right to apply to a Mental Health Review Tribunal under section 31(4) of the principal Act; or

• (b) a patient who is transferred from guardianship to hospital does not exercise his right to apply to such a tribunal under section 41(5) of that Act,

the managers of the hospital shall at the expiration of the period for making such an application refer the patient's case to such a tribunal unless an application or reference in respect of the patient has then been made under section 38(2), 48(3), 52(6) or 57 of the principal Act.

• (2) If the authority for the detention of a patient in a hospital is renewed under section 43 of the principal Act and a period of three years (or, if the patient has not attained the age of sixteen years, one year) has elapsed since his case was last considered by a Mental Health Review Tribunal, whether on his own application or otherwise, the managers of the hospital shall refer his case to such a tribunal.

• (3) For the purpose of furnishing information for the purposes of any reference under this section, any medical practitioner authorised by or on behalf of the patient may at any reasonable time visit and examine the patient in private and require the production of and inspect any records relating to the detention or treatment of the patient in any hospital.

• (4) The Secretary of State may by order vary the length of the periods mentioned in subsection (2) above.

• (5) For the purposes of subsection (1) above a person who applies to a tribunal but subsequently withdraws his application shall be treated as not having exercised his right to apply, and where a person withdraws his application on a date after the expiration of the period mentioned in that subsection the managers shall refer his case as soon as possible after that date.

• (6) References in this section to a hospital shall be construed as references to a hospital within the meaning of Part IV of the principal Act.

Applications to tribunal by patients under the age of sixteen

41

• (1) A patient who has not attained the age of sixteen years shall have the same rights under the provisions of the principal Act mentioned in subsection (2) below (applications to Mental Health Review Tribunal) as a person who has attained that age.

• (2) The provisions referred to in subsection (1) above are sections 31(4), 38(2), 43(6) and 63(4)(a).

PART VI — Consent to Treatment

Preliminary

42

• (1) This Part of this Act applies to any patient liable to be detained under the principal Act or this Act except—

• (a) a patient who is liable to be detained by virtue of an emergency application and in respect of whom the second medical recommendation referred to in section 29 (3) (a) of the principal Act has not been given and received;

• (b) a patient who is liable to be detained by virtue of section 30(2) or (4), 64(1), 135 or 136 of that Act or by virtue of section 29 above ; and

• (c) a patient who has been conditionally discharged under section 66(2) of that Act or paragraph 5 or 6 of Schedule 1 to this Act and has not been recalled to hospital.

• (2) In this Part of this Act " the responsible medical officer " means the medical practitioner in charge of the treatment of the patient in question and " hospital " includes a mental nursing home.

• (3) Any certificate for the purposes of this Part of this Act shall be in such form as may be prescribed by regulations made by the Secretary of State.

Treatment requiring consent and a second opinion

43

• (1) This section applies to the following forms of medical treatment for mental disorder—

• (a) any surgical operation for destroying brain tissue or for destroying the functioning of brain tissue ; and

• (b) such other forms of treatment as may be specified for the purposes of this section by regulations made by the Secretary of State.

• (2) Subject to section 48 below, a patient shall not be given any form of treatment to which this section applies unless he has consented to it and—

• (a) a medical practitioner appointed for the purposes of this Part of this Act by the Secretary of State (not being the responsible medical officer) and two other persons appointed for the purposes of this paragraph by the Secretary of State (not being medical practitioners) have certified in writing that the patient is capable of understanding the nature, purpose and likely effects of the treatment in question and has consented to it; and

• (b) the medical practitioner referred to in paragraph (a) above has certified in writing that, having regard to the likelihood of the treatment alleviating or preventing a deterioration of the patient's condition, the treatment should be given.

• (3) Before giving a certificate under subsection (2)(b) above the medical practitioner concerned shall consult two other persons who have been professionally concerned with the patient's medical treatment, and of those persons one shall be a nurse and the other shall be neither a nurse nor a medical practitioner.

• (4) Before making any regulations for the purposes of this section the Secretary of State shall consult such bodies as appear to him to be concerned.

Treatment requiring consent or a second opinion

44

• (1) This section applies to the following forms of medical treatment for mental disorder—

• (a) such forms of treatment as may be specified for the purposes of this section by regulations made by the Secretary of State ; and

• (b) the administration of medicine to a patient by any means (not being a form of treatment specified under paragraph (a) above or section 43 above) at any time during a period for which he is liable to be detained as a patient to whom this Part of this Act applies if three months or more have elapsed since the first occasion in that period when medicine was administered to him by any means for his mental disorder.

• (2) The Secretary of State may by order vary the length of the period mentioned in subsection (1)(b) above.

• (3) Subject to section 48 below, a patient shall not be given any form of treatment to which this section applies unless—

• (a) he has consented to that treatment and either the responsible medical officer or a medical practitioner appointed for the purposes of this Part of this Act by the Secretary of State has certified in writing that the patient is capable of understanding its nature, purpose and likely effects and has consented to it; or

• (b) a medical practitioner appointed as aforesaid (not being the responsible medical officer) has certified in writing that the patient is not capable of understanding the nature, purpose and likely effects of that treatment or has not consented to it but that, having regard to the likelihood of its alleviating or preventing a deterioration of his condition, the treatment should be given.

• (4) Before giving a certificate under subsection (3)(b) above the medical practitioner concerned shall consult two other persons who have been professionally concerned with the patient's medical treatment, and of those persons one shall be a nurse and the other shall be neither a nurse nor a medical practitioner.

• (5) Before making any regulations for the purposes of this section the Secretary of State shall consult such bodies as appear to him to be concerned.

Plans of treatment

45

Any consent or certificate under section 43 or 44 above may relate to a plan of treatment under which the patient is to be given (whether within a specified period or otherwise) one or more of the forms of treatment to which that section applies.

Withdrawal of consent

46

• (1) Where the consent of a patient to any treatment has been given for the purposes of section 43 or 44 above, the patient may, subject to section 48 below, at any time before the completion of the treatment withdraw his consent, and those sections shall then apply as if the remainder of the treatment were a separate form of treatment.