Consulting nearest relative against patient's wishes

Law and practice Mental Health Act
1

If an AMHP has the contact details of the Nearest Relative of someone being assessed for a section 3, would/should they always consult the NR even if the patient says he does not want his family to be involved?

I am trying to help NRs and carers understand how confidentiality rules are applied by our local mental health services.

2

The case law turns on what ā€œreasonably practicableā€ means in s.11(4) MHA.

In R (E) v Bristol City Council [2005] EWHC 74 (Admin), Bennett J accepted that there may be cases where the AMHP does not have to consult the NR. In this case, the patient did not want the NR contacted and there was clinical evidence that doing so would be positively harmful to the patientā€™s mental health.

But a patient cannot veto consultation. In TW v Enfield LBC [2014] EWCA Civ 362, the patient demanded full confidentiality and had made allegations against the NR but the Court didnā€™t agree this meant it wasnā€™t reasonably practicable to consult them. The AMHP had to show a balancing exercise had been conducted between Arts 5 & 8. On one side is the importance of the NR safeguard before a person is detained under s.3. On the other is the patientā€™s confidentiality, wishes, and any real risk that contacting the NR would harm their health or safety.

3

Thanks Zac. " a patient cannot veto consultation" is a helpful and clear statement. In the case Iā€™m thinking of, the patient has along history of forbidding staff to contact his parents which has been v distressing for them. No one seems to know why the patient does this except that he is autistic as well as mentally ill and thinks in a v rigid way. It would definitely be practicable to co0ntact the NR and would not put them at risk so I think the NR consultatios should take place.

4

Hi, I donā€™t think it as straightforward as ā€˜a patient cannot veto consultationā€™. Itā€™s more that if a patient wants to veto consultation, that is the starting point for considerations about practicability. Itā€™s only if the AMHP thinks that consultation would not harm the patient (this includes psychological harm) that they should override the veto.

5

Thanks Nick, I take your point. I spend my time nowadays supporting the families of people with mental health conditions and we are always tempted to make things simpler than they really are!