UK: Are You Ready For 3 November 2008?

Last Updated: 14 October 2008
Article by Karen Keogh

In preparation for 3 November 2008, every NHS Trust needs to have the following measures in place.

Code Of Practice

Trusts must have available for staff copies of the Code of Practice (revised by Parliament on 12 May 2008) which comes into force the same day.  If not, it can be downloaded from

Statutory Forms

Copies of all the new statutory forms must be available to all staff as they must be used from 3 November 2008.  It is not necessary to complete new forms for patients who are already subject to holding powers or where reports have already been furnished to hospital managers for renewal of detention.  It is only when new actions are taken from 3 November 2008 that the new forms must be used.  Note, however, that in an application for detention where two recommendations are required from practitioners, it is not possible to have a recommendation from one practitioner on an old form and another recommendation on a new form.  Both either have to be on the old forms and completed prior to 3 November 2008, or both have to be completed on new forms.

New Terminology

All staff must be aware of the new terminology.  For instance:

  1. An Approved Social Worker (ASW) will be referred to as an Approved Mental Health Professional (AMHP) recognising that the role has been opened up to a wider group of professionals.  Any decision made by an ASW will be treated as made by an AMHP.  ASWs will be treated as AMHPs for as long as their ASW approval lasts.
  2. A Responsible Medical Officer (RMO) will now be a Responsible Clinician (RC).  There will also be Approved Clinicians (AC).  An RC is the AC with overall responsibility for a patient's case.  Decisions made by a RMO will be treated as made by a RC and/or AC as appropriate.
  3. The Mental Health Review Tribunal (MHRT) will sit within the Health and Social Care Chamber of the new First-Tier Tribunal (the Tribunal). 

The New MHA Booklet

Trusts must have available for staff a copy of the Department of Health booklet entitled "Implementation of the Mental Health Act 2007: Transitional Arrangements" which was published on 31 July 2008.  If not, it can be downloaded from  The booklet sets out how the transition will occur between current and future practice from 3 November 2008.  It deals with many issues, the most important being:

  1. Patient detention - existing decisions using the old criteria will remain valid although when the Trust considers if the patient should remain detained after 3 November 2008 then the new provisions apply.  Doctors providing reports should address both criteria if it is not clear on what date a decision will be made.  A report furnished to hospital managers on an old form prior to 3 November 2008 remains valid for a renewal of detention if the actual renewal date is after 3 November 2008.
  2. Holding powers - patients already subject to the holding powers remain liable to be detained.
  3. Conflict of interest - the new rules apply to all applications for detention and guardianship made after 3 November 2008 even if the medical recommendations were made before that day.
  4. Consent to treatment - most certificates will remain valid but the transitional provisions should be checked in each individual case to ensure a new form does not have to be completed.
  5. Tribunal decisions - decisions made, but not yet implemented, by the MHRT will be treated as if made by the new Tribunal.  If it is not clear what date a decision will be made, reports submitted to the MHRT should deal with the old and new criteria.
  6. Automatic referrals to the Tribunal - if under the new rules the date for automatic referral has already passed on 3 November 2008, then the referral should be made as soon as possible.  Other applications to the Tribunal and to the County Court are dealt with in the booklet.
  7. Approved clinicians - for continuity of treatment there are three groups of section 12 doctors who will be approved as ACs from 3 November 2008.  These are doctors who have:

    • carried out the functions of a RMO in the immediate preceding 12 month period;
    • been in overall charge of medical  treatment for the mental disorder of a person in the immediate preceding 12 month period; and
    • been appointed to the post of consultant psychiatrist in the immediate preceding six month period and one year post-3 November 2008.

Each group is subject to further training and approval which is set out in the booklet.  All ACs must have had Section 12 approval before 3 November 2008.  Further guidance on approving and employing RCs and ACs is to be published.

Approved Clinician Directions

Managers at the Trust need to be aware of the Mental Health Act 1983 Approved Clinician (General) Directions made on 31 July 2008 which revoked the Directions made on 7 May 2008.  Please note that the Trust must have a list of ACs.  It must be established by 3 November 2008 and thereafter maintained.  Every Strategic Health Authority must also have a register of ACs.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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