32.18 As responsible clinicians have the power to discharge patients, they must keep under review the appropriateness of using that power. If, at any time, responsible clinicians conclude that the criteria which would justify renewing a patient’s detention or extending the patient’s CTO (as the case may be) are not met, they should exercise their power of discharge. They should not wait until the patient’s detention or CTO is due to expire.
In the situation where the subject has been detained under section 2 I presume 32.18 requires that the criteria for section 3 should be present to continue the section 2. So during section 2 detention the signs and symptoms of mental disorder would be continued or added to and the mental disorder would continue to be such that risk still arises from it and in addition appropriate medical treatment is available and it can only be provided in hospital. If any of these is judged to not be present the responsible clinician should release the subject.
I would take the view that the first sentence applies to Section 2. The second sentence is applicable to Section 3 and a CTO as it is concerned with renewing a Section 3 or extending a CTO. As Section 3 includes the additional ‘appropriate treatment test’, you would not apply the Section 3 framework to a Section 2 patient, not unless you were thinking of ‘regrading’ the Section 2 to a 3.
That’s interesting, the way I have heard it presented was that section 2 could be extended by section 3, but if I read you correctly section 2 can be followed by another section 2, is that correct?
Typically, a Section 2 cannot be followed by another Section 2.
Where this can happen is the RC discharges the Section, the patient remains on the ward as a consenting patient, Section 131 of the MHA, but then it later (few days) transpires that the patient can no longer provide that consent. This scenario tends to occur on older person’s units where a UTI or dehydration could bring on a sudden delirium like state, or the patient presents with a new set of behaviours not previously manifested at admission.
The terminology relied upon in mental health work can be very specific, so you would not use the term renewal or extended to describe a transition from Section 2 to Section 3, the term typically used is regrade, regrading.
Even the word regrading is, in my view, unhelpful.
A section 3 comes into force following a brand new assessment; recommendations by two doctors and an application by an AMHP, with different grounds (some of the grounds overlap).
The section 2 ends and the section 3 detention begins.
Ah, it is a bit more complicated than I thought, so redrafting my original question it turns out like this.
In the situation where the subject has been detained under section 2 I presume 32.18 requires that the criteria for section 2 should be present to initiate a new or extend the section 2 for another 28 days ( if that is allowed). So during section 2 detention the signs and symptoms of mental disorder would be continued or added to and the mental disorder would continue to be such that risk still arises from it. If either of these is judged to not be present the responsible clinician should release the subject.
Sorry if this is a bit simplistic, but my understanding is that s.2 can only be ‘stretched’ pending a court hearing re: NR displacement - it can’t be renewed. Rather, surely this means if the criteria for s.2 are no longer met it should be discharged. S.3 has nothing to do with it.
Yes, I think this gets to the heart of it. If the relevant criteria – for whatever section is relevant – are no longer met at any point then the RC must discharge. This what the first sentence quoted from the Code is getting at:
As responsible clinicians have the power to discharge patients, they must keep under review the appropriateness of using that power.
The second and third sentences are looking at the period towards the end of a period of detention or CTO when the RC is considering renewal:
If, at any time, responsible clinicians conclude that the criteria which would justify renewing a patient’s detention or extending the patient’s CTO (as the case may be) are not met, they should exercise their power of discharge. They should not wait until the patient’s detention or CTO is due to expire.
The renewal criteria are the same as the original s3 or CTO criteria (see s3/s20 and s17A/s20A) so in a sense this is just repetition of the first sentence. The relevant difference here is that there is no renewal process for s2.
Am I missing something? The CoP 32:18 has nothing to do with S2. It appears to be about the power (duty) of the RC to discharge a person from CTO and in the same breath, a S3. Where does a S2 feature in that except to suggest that the same principle exists to discharge where criteria are not met.
So many ways to interpret things, but the last comments seem to fit with my possible misapprehension that the sequence described by the RC in this case is section 2 for 28 days then a further period of 6 months if necessary which I took to mean section 3. So back to my original comments the RC during section 2 has to confirm continued presence of mental disorder out of which risk arises at least and depending on the section 3 option as being a next stage that treatment that can only be provide in hospital. But in this case the lack of mental disorder seems recognised and later the lack of risk if released seems recognised so the treatment part is not clearly involved. So release should have taken place probably 10 days and certainly 5 days before it was.