MHA terminology - help! Registered medical practitioner, AC and RC

Law and practice Mental Health Act
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I don’t often have to wrestle this much with terminology in the MHA 1983(Amended 2007). However, I’m writing up something for patients and relatives to help them understand a few things. So I’m trying to be as accurate as possible and not confuse anybody!

I need to clarify the terms RC, AC, and RMP. This is my current understanding - and help out if I’ve gotten it wrong. :frowning_with_open_mouth:

Registered Medical Practitioner (RMP)

  • Any doctor registered with the General Medical Council
  • The basic qualification needed to practice medicine in the UK
  • Doesn’t require mental health specialisation or MHA training

Approved Clinician (AC)

  • A clinician who has been specially approved for MHA purposes
  • Could be a psychiatrist, psychologist, nurse, social worker, or occupational therapist
  • Has received specific training in the MHA
  • Has been approved by the Secretary of State (in practice, by the local approving body)
  • Can take certain roles under the Act that RMPs cannot

Responsible Clinician (RC)

  • Always an Approved Clinician
  • Has been specifically assigned responsibility for a particular patient’s case
  • Only exists for patients detained under application-based sections (S2, S3) or community patients
  • Has specific powers including granting leave under S17 but only under certain sections.

An Approved Clinician becomes the Responsible Clinician when:

  1. They’re assigned overall responsibility for a specific patient’s case, AND
  2. That patient is detained under an application-based section (S2, S3) or is a community patient

An Approved Clinician is NOT the Responsible Clinician when:

  1. They haven’t been assigned to that specific patient, OR
  2. The patient is held under a report-based section like S5(2), not an application-based section

It seems to become more complex because a consultant psychiatrist might be:

  • An RMP (always)
  • An AC (if approved)
  • An RC (if approved AND assigned to a specific patient under the right sections)

And when a patient moves from S2 to informal or S5(2) implemented subsequently, they go from having an RC to not having one, but may still have an AC or an RMP, despite potentially being under the care of the same consultant throughout!

Under S5(2), the patient:

  • May have an RMP (Registered Medical Practitioner) who created the report for the holding power
  • May have an AC (Approved Clinician) who’s involved in their care
  • But definitely does NOT have an RC (Responsible Clinician) as defined by the Act

This creates the peculiar situation where:

  • The same consultant psychiatrist could be simultaneously:
    • An RMP (by virtue of medical registration)
    • An AC (by virtue of approval under the Act)
    • The RC for some patients (under S2 or S3)
    • But NOT the RC for a patient under S5(2), even if they’re that patient’s consultant

The clinical reality (same doctor providing continuous care) completely diverges from the legal reality (patient’s status under the Act changes, along with the doctor’s legal powers).

And since S17 leave requires an RC to grant it, and S5(2) patients don’t have an RC by definition… no leave can be granted during that period regardless of the clinical appropriateness.

An Approved Clinician (AC) is a qualification - a status that a clinician has after receiving approval. This status exists independently of any specific patient.

Under S5(2), a patient may be under the care of a doctor who:

  • Holds AC status (has the qualification)
  • Is responsible for their clinical care
  • Made the S5(2) report (which is neither an application nor a recommendation).

But the Act doesn’t create the legal role of “Responsible Clinician” for that patient, because:

  • The RC designation is explicitly tied to patients detained under application-based sections
  • S5(2) uses a report mechanism, not an application

So while the patient is being treated by someone who has AC status, that person is not functioning in the legal capacity of an RC for that specific patient during the S5(2) period.

headache
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I need paracetamols - no worries - no overdose today. :rofl::joy:

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With one exception, I broadly agree with your description of the legal position, but not with the conclusion you draw from it.

Being pedantic:

  • RMP means someone on the medical register who also has a licence to practise;

  • the Act also specifies functions for RCs in respect of patients detained under hospital orders, transfer directions and hospital directions as well as applications under s2 & 3 (and CTOs and guardianship).

More substantively, whether an AC is a patient’s RC is a matter of fact. Do they, in fact, have overall responsibility for the patient’s case ? If so, they are the RC, regardless of whether anyone has formally assigned them that role.

You’re the RC if you are in charge, not in charge because you’re the RC.

RC is really just shorthand to avoid the legislation having to keep spelling out the phrase “the approved clinician with overall responsibility for the patient’s case”.

AC and RC are legal concepts that only have a meaning within the MHA context. They are used where the legislation confers powers or duties which are only to be exercised by appropriately trained, qualified and experienced professionals. They don’t have any significance outside that context.

With that in mind, I don’t think there’s anything inherently peculiar about the same doctor being one person’s RC, but another person’s AC. Or being their AC at one time, then RC or plain old RMP at another. Even if, as you say, their clinical responsibilities to the patient remain the same.

In the case of s5, nothing there is limited only to the AC in overall charge of the patient’s case, so there is no need to invoke concept of an RC. Likewise, if you’re a doctor, it is immaterial whether you are also an AC. For other parts of the Act it matters, but not here.

If there is an anomaly, it is that there is no power to grant leave to someone detained under s5, whereas there is for other sections.

That really has nothing to do with distinctions between RMPs, ACs and RCs, except at the level of drafting. The way that RC is defined in s34 explains why s17 doesn’t apply to s5 patients as a matter of drafting, not as a matter of policy. If Parliament had wanted to allow leave to be granted to s5 patients it could have provided for that in various different ways. That might have involved calling someone an RC in respect of a s5 patient, but equally it might not.

That said, I’m not sure it really is an anomaly at all. s5 is designed as a short-term holding power for the sole purpose of getting an assessment done. It isn’t hard to see why it was not felt necessary to provide a mechanism for granting leave of absence.

s5 wasn’t designed as a stopgap between two other sections, even if that is sometimes - questionably - how it ends up being used. (s5 cannot lawfully be used to extend detention under s2 or 3, it can only be used for patients who are not already so detained - see s5(6)).

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I agree with all but with a couple of clarifications… RC is also required for forensic sections as well as a 2 or a 3 (along with CTOs but not for guardianships).
Also the RC is a formal agreement and trusts have on call procedures for who the designated RC is out of hours. When the RC takes leave then a named person must take over RC for those patients for duration of leave.
A ward can have more than one RC and when this occurs the RC is chosen for each patient under section (formally declared not just who is in charge as this creates confusion).
As a slight aside a patient under section can have both a RC and an AC in charge of treatment. This is particularly important to note when the RC is not a prescriber (eg a social worker). In cases like this the RC has legal responsibility for overall care and statutory forms/ duration of section etc but it is the AC who is in charge of the treatment (therefore only AC in charge of treatment can complete consent to treatment forms). This is also relevant for ECT where the RC does not have specific competences required to be the AC in charge of treatment. Unless specified the RC is also the AC In charge of treatment, this is only relevant where the RC cannot provide this function.
(I am a consultant nurse who is also an AC and holds RC responsibility for half of my ward and as I’m a prescriber I am also the AC in charge of treatment for my allocated patients. I work alongside a consultant psychiatrist who is RC for the other half of the patients).

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Hi Russell

Not sure if this will help but I generally refer people, their families and sometimes colleagues to the Rethink website. It has a host of well-written but easy non-jargon content. This link – Jargon Buster – Mental Health Research – might also be useful.

Thanks

Leona

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I love your pedantry (honestly no sarcasm intended). Keep in mind that I was trying to create something as simple as possible to explain the quoted concepts to relatives and patients.

Then I got tangled up in legal pedantry which then sliced up various roles into doctor and non-doctor on occasions and then ‘doctor’ according to which section.

On the S5(2) issue, I was abused today - TTFO by a patient because I have no power to grant them leave. I tried to explain the situation and got another round of abuse - door slammed on me and another nurse. Legal draftsmen and judges don’t see these sorts of things.They don’t have to care.

I’m looking at the whole thing from the patients’ and relatives’ perspective because it is them I want to serve/help.

These are ordinary people of simple means. All they come with is that the doctor is in charge - which of course is not the case.Then they’re even more confused that if a doctor is in charge of various legalities the doctor is not in charge of any services - and dare not direct anybody to do anything, lest they attract complaints of bullying staff.

All this confuses ordinatry people no end. So my effort to simplify things for the ordinary person is confounded by legal pedantry that serves its own ends. That’s the nature of law perhaps.

I’ll just have to man up and take more abuse.

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Nice. Keep in mind that I was trying to create some guidance for patients and relatives and ended up in a quagmire of tangled legalese written in law.

I don’t have a big issue dissecting roles and responsibilities across, sections and the terminology. I was trying to serve ordinary people who are confused - leading to me being abused when for example I can’t grant them S17 leave when on S5(2).

As of today I’ve been defamed and accused of “driving patients insane” - no joke or exaggeration. Complaints are flying. I guess I had better grant the patients S17 leave on S5(2) illegally to avoid trouble. Methinks perhaps I can get away with it - cuz nobody will care and nobody will know of my illegal actions, once I keep everybody nice. I’ll buy them pizzas on a Friday night - a tip I picked up from another consultant. It’s easier and I’ll be more popular than writing some guidance that nobody will read anyway.