Hospital directions under s45A apply to any mental disorder

This change is as a consequence of the abolition by the MHA 2007, from 3/11/08, of the four different classifications of mental disorder. Previously the hospital direction under s45A was only available for patients suffering from psychopathic disorder. The hospital direction has been rare but is likely to become more commonly used.

Related changes

• Mental disorder no longer split into separate classifications
• Abnormally aggressive or seriously irresponsible conduct is only a consideration for learning disability (not personality disorder)

Commencement

Date in force	Commencement order	MHA 2007 section	MHA 1983 sections affected
3/11/08	Mental Health Act 2007 (Commencement No.7 and Transitional Provisions) Order 2008	s1, sch1	s45A

Summary of effect of amendments in Chapter 1 of Part 1

Table from Explanatory Notes, page 9.

Provision	Currently applies to	Will apply in future to	Learning disability provision to apply in future	"Treatability" test applies now	Appropriate medical treatment test to apply in future
Civil Patients (Part 2 of the Act)
Admission for assessment for up to 28 days (section 2)	Mental disorder	Mental disorder	No	No	No
Admission for treatment (s3)	MI, MM, PD, SMM	Mental disorder	Yes	Yes	Yes
"Holding power" for patients already in hospital (s5)	Mental disorder	Mental disorder	No	No	No
Guardianship (s7)	MI, MM, PD, SMM	Mental disorder	Yes	No	No
Patients concerned in criminal proceedings (Part 3 of the Act)
Remand to hospital for report (s35)	MI, MM, PD, SMM	Mental disorder	Yes	No	Yes
Remand to hospital for treatment (s36)	MI, SMM	Mental disorder	Yes	No	Yes
Hospital order (s37)	MI, MM, PD, SMM	Mental disorder	Yes	Yes	Yes
Hospital order without conviction (s37(3) and 51(5))	MI, SMM	Mental disorder	Yes	No	Yes
Interim hospital order (s38)	MI, MM, PD, SMM	Mental disorder	Yes	No	Yes
Hospital and limitation directions (s45A)	PD	Mental disorder	Yes	Yes	Yes
Transfer direction - sentenced prisoner (s47)	MI, MM, PD, SMM	Mental disorder	Yes	Yes	Yes
Transfer direction - other (s48)	MI, SMM	Mental disorder	Yes	No	Yes

Key: MI = mental illness, MM = mental impairment, PD = psychopathic disorder, SMM = severe mental impairment

INFORMATION

Changes made by MHA 2007 category:

• New procedure for renewal of detention
• Responsible Clinician/Approved Clinician replaces Responsible Medical Officer
• Approved Mental Health Professional replaces Approved Social Worker
• Supervised Community Treatment replaces Supervised Discharge
• Mental disorder no longer split into separate classifications
• Some exclusions to definition of mental disorder have been removed
• Hospital directions under s45A apply to any mental disorder
• New definition of medical treatment
• Civil partners are treated as if married when determining nearest relative
• Additional safeguards for ECT introduced in new s58A
• Treatment while under SCT is covered by new Part 4A
• NHS Foundation Trusts discharge power problem remedied
• Patients can be transferred between places of safety under s135 and s136
• 16- or 17-year-old with capacity cannot be detained on basis of parental consent
• Restriction orders can no longer be time-limited
• Legal status of Code of Practice set out in Act
• New Independent Mental Health Advocate scheme
• New requirements for age-appropriate accommodation for children
• Fundamental principles set out in Act and included in Code of Practice
• Automatic reference scheme under s68 changed
• Minor drafting error in MCA 2005 corrected
• Bournewood gap bridged by Deprivation of Liberty Safeguards inserted into MCA 2005
• Limitation to the exceptions to the duty to instruct IMCA
• Reference to Local Health Boards inserted into Act
• Procedure for making of instruments by Welsh Ministers set out
• Organisation of Mental Health Review Tribunal changed
• Transitional provisions until full implementation of MHA 2007
• New cross-border arrangements for leave and transfer
• New regulations on conflicts of interest
• SOAD certificate becomes invalid when patient loses or gains capacity
• Domestic Violence Crime and Victims Act 2004 applies to unrestricted criminal patients
• Higher penalties for offences under Act
• Hospital direction patients can no longer apply to Tribunal during first six months
• Abnormally aggressive or seriously irresponsible conduct is only a consideration for learning disability (not personality disorder)
• Conditionally-discharged hospital direction patients can be absolutely discharged by MHRT
• Patient can apply to displace nearest relative, who can now be displaced on grounds of unsuitability
• Appropriate treatment test replaces treatability test and applies to all patients under long-term detention

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Other information pages:

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What links here:

• 16- or 17-year-old with capacity cannot be detained on basis of parental consent
• Additional safeguards for ECT introduced in new s58A
• Approved Mental Health Professional replaces Approved Social Worker
• Automatic reference scheme under s68 changed
• Bournewood gap bridged by Deprivation of Liberty Safeguards inserted into MCA 2005
• Civil partners are treated as if married when determining nearest relative
• Conditionally-discharged hospital direction patients can be absolutely discharged by MHRT
• Domestic Violence Crime and Victims Act 2004 applies to unrestricted criminal patients
• Fundamental principles set out in Act and included in Code of Practice
• Higher penalties for offences under Act
• Hospital direction
• Hospital direction patients can no longer apply to Tribunal during first six months
• Limitation direction
• Mental Health Act 2007 Overview