Appendix: Scrutiny and Rectification of Documents

The Forms used in the assessment, detention, consent to treatment and guardianship processes under the Mental Health (Northern Ireland) Order 1986 provide legal justification for those actions taken under the Order.

The errors or defects in an application for assessment, the medical recommendation on which it is based, or in one of the medical reports may mean that the authority for the detention of the person is open to challenge and could be found to be invalid.

Those who complete and sign applications, medical recommendations and reports should therefore take care that they are accurate and fully comply with the requirements of the Order. In addition, those with responsibility for receiving and taking action on the basis of these forms should also ensure that they have been properly completed.

Trusts should make arrangements, usually through their Medical Records departments, to ensure that all documents are carefully scrutinized as soon as they are received, and before they are issued to RQIA.

As part of their role in safeguarding the rights of individuals subject to the Order, RQIA receives copies of all documents and has a duty to ensure that no patient is improperly detained. It will therefore draw immediate attention to any defects observed in documentation and will require appropriate action to be taken. Can the Mental Health (Northern Ireland) Order 1986 forms be amended? Yes, Article 11 of the Order details circumstances under which documents found to be inaccurate or defective can be rectified after they have been acted on.

Faults fall under 3 categories:

• Those which invalidate the application completely and cannot be rectified
• Those which may be capable of amendment under Article 11.
• Those which make a medical recommendation or report insufficient to detain the patient, but which may be capable of rectification by the substitution of a fresh medical recommendation or report under Article 11.

Which faults would completely invalidate an application? Documents that are left incomplete, not signed or signed by a person, who is not empowered to do so, can invalidate an application. Therefore in relation to an admission for assessment under the Order:

• The application must have been signed by the person's nearest relative or acting nearest relative, or by an approved social worker
• A practitioner who is not excluded under Schedule 1 of the Order must sign the medical recommendation
• The medical reports must be signed by practitioners who are empowered to do so.

If a fault of this kind is discovered in the documents there is no proper authority for the person's detention unless steps are taken for a new application to be made. Under what circumstances may documents be amended? If, within a period of 14 days from the date of admission, the application for assessment, medical recommendation or any of the medical reports is found to be incorrect, they may be amended by the person who originally signed them within the same 14-day period and with the consent of the Trust.

Faults that may be amended include the leaving of blank spaces on the form (other than the signature), or failure to delete one or more alternatives in places where only one can be correct.

The person's forenames and surname should agree in all places where they appear in the application, the supporting medical recommendation and subsequent medical reports.

Any amendment carried out as stated is considered to have always had effect. How are medical recommendations or reports amended? In addition to the scrutiny of Forms for errors of a technical nature, medical recommendations and reports will be checked to ensure that clinical details and reasons given to support expressed opinions, meet the requirements of the Order. If during the same 14-day period it appears that the medical recommendation or any of the medical reports are insufficient to warrant the detention of the person they will be disregarded and RQIA will inform the Trust immediately.

The applicant (nearest relative or approved social worker) must be notified of this fact in writing by the Responsible Trust, which will delegate the role to a Medical Records staff member. The application for assessment will, however, be considered sufficient if a fresh recommendation or report that complies with the provisions of the Order is supplied to the responsible Trust within 14 days of the patient's admission. In some cases it may be acceptable for the fresh medical recommendation (Form 3) to be made by another doctor on the staff of the hospital, provided he did not complete the Form 7.

Time Limits - Why are they important ? As soon as documents are received by Medical Records staff compliance with stipulated time limits will be checked. RQIA will also perform compliance checks on the time limits once the forms are forwarded to them.

These include:

1. The date on which the applicant last saw the person must not be more than 2 days before the date on which the application is made
2. The date of the medical examination of the person by the doctor giving the medical recommendation must not be more than 2 days before the date on which the recommendation is signed
3. The person's admission to hospital must take place within 2 days of the medical recommendation being signed
4. The person must be examined immediately after admission to hospital and a Form 7 completed
5. The Form 8 must be signed no more than 48 hours after the Form 7 is signed
6. The Form 9 must be signed no more than 7 days after the Form 7 is signed

If the dates on the application, medical recommendation or medical report do not conform to these time limits, the persons signing them will be asked to clarify whether dates or times entered are correct.

If they are not correct, and the correct dates or times do conform to the time limits, they can be amended as per Article 11 (see above). If the time limits have not been complied with the application is invalid.

Similar processes of scrutiny are in place in relation to the forms used in Consent to Treatment (Part IV) and Guardianship.