Rights of psychiatric patients

Introduction

The Mental Health Act 2001 provides for, among other things, rules about admission to psychiatric hospitals and rules about the rights of psychiatric patients.

If you are involuntarily admitted to an approved psychiatric centre, you are entitled to:

  • Have all decisions made in your best interests
  • Be examined by a psychiatrist in the centre
  • Be provided with information about your rights and the proposed treatment
  • Have your retention reviewed by a tribunal
  • Appeal to the Courts in certain circumstances

There are specific rules about psychiatric patients and their consent to treatment.

Rules

Your best interests

Under the Mental Health Act 2001, if you are admitted to or are receiving treatment in approved centres (that is, psychiatric hospitals or inpatient services), your best interests should be considered before any decision about your care and treatment is made. You have the right to be treated with dignity and respect and the right to be listened to by all those working on your care team. You are entitled to take part in decisions that affect your health and your care team should consider your views carefully. You have the right to be fully informed about your legal rights, your admission and treatment.

Admission to an approved psychiatric centre

When you arrive at the centre, you will be examined by a consultant psychiatrist. You may be detained for a maximum of 24 hours in the centre for this examination. If the psychiatrist believes you are suffering from a mental disorder, they make an admission order to make you a patient of the centre. If they do not, you will be free to leave the centre. The admission order lasts for 21 days and you can be kept in the centre for treatment for this time.

A renewal order may extend this period by a further 3 months. This must be made by the consultant psychiatrist responsible and they must have examined you in the week before making the order. A further renewal order may be made by the same psychiatrist for a period of up to 6 months and subsequently for up to 12 months at a time.

A mental health tribunal will review your case every time a renewal order is made. If you have a renewal order of between 3 and 6 months, you can request an additional review after 3 months.

Your right to information

Each time an admission order or a renewal order is made, a copy must be given to the Mental Health Commission and a notice in writing must be given to the patient. The notice to you, the patient, must include the following information:

  • You are being detained under the Mental Health Act and the relevant section
  • You are entitled to legal representation
  • You will be given a general description of the treatment recommended for you during the detention
  • You are entitled to communicate with the Inspector of Mental Health Services
  • You will have the detention reviewed by a mental health tribunal
  • You are entitled to appeal to the Circuit Court against a decision of a tribunal
  • You may be admitted as a voluntary patient if you wish.

Review of admission by a mental health tribunal

When the Mental Health Commission receives a copy of an admission or renewal order, it must

  • Refer the matter to a mental health tribunal
  • Assign a legal representative to represent you unless you personally engage one
  • Arrange for another consultant psychiatrist to examine you, interview the consultant responsible for your treatment and care and review your records in order to decide whether you are suffering from a mental disorder. The tribunal's report must be given within 14 days to the Commission and to your legal representative.

The tribunal is appointed by the Mental Health Commission. It must consist of a lawyer as chairman, a consultant psychiatrist and a lay person (a person who is not a lawyer or doctor). Tribunal members have been selected and trained by the Mental Health Commission.

The tribunal must review your detention and make a decision within 21 days of the making of the order (there are provisions for extending this time limit). If it is satisfied that you are suffering from a mental disorder and that the proper procedures have been followed (or, if they have not, the failure does not affect the substance of the order and does not cause an injustice) then it affirms the order. If it is not satisfied, it revokes the order and directs that you be discharged.

The tribunal has similar powers to a court, including the power to require the attendance of the relevant people and the production of documents. The tribunal is, of course, obliged to respect the usual requirements of natural justice, for example, it must ensure that you have copies of the reports that are being considered by the tribunal.

The tribunal must notify its decision, in writing, to

  • The Mental Health Commission
  • The psychiatrist responsible for your care and treatment
  • You and your legal representative
  • Any other person the tribunal considers should be notified.

Mental health tribunals during COVID-19 (coronavirus) pandemic

On 30 March 2020, temporary changes were made to how mental health tribunals work, in response to the coronavirus pandemic.

Meetings with your solicitor, or with the independent psychiatrist reviewing your case, may take place by phone or video link. The tribunal will take place by phone and your solicitor will represent you on that call. You can make a written submission if you wish. If your treating consultant is not able to take part they will give a report to the tribunal.

If it is not possible to gather a three-person tribunal due to the coronavirus pandemic, the lawyer can be appointed as a one-person tribunal with access to an independent psychiatrist if required.

The tribunal can extend the time for a hearing or decision if necessary due to the public health emergency.

The law making these changes in response to coronavirus (pdf) will continue to apply until 9 November 2020.

Appeal to the Circuit Court

You may appeal to the Circuit Court (within 14 days) against a decision to affirm an order. At this stage, it is up to you, the patient, to prove your case that you are not suffering from a mental disorder.

Civil proceedings generally

There are certain restrictions on taking civil actions in court arising from actions taken under the Mental Health Act. You need to get the permission of the High Court before taking civil proceedings in respect of any act done in carrying out the functions of the Mental Health Act. The High Court must not refuse such permission unless it is satisfied that the proceedings are either frivolous or vexatious or that there are no reasonable grounds for contending that the person against whom the proceedings are brought acted in bad faith or without reasonable care. The court is not allowed to determine the proceedings in favour of the patient unless it is satisfied that the person against whom the proceedings are brought acted in bad faith or without reasonable care.

Consent to psychiatric treatment

In general, medical and surgical treatment may be administered only with the informed consent of the patient. The law is different in the case of psychiatric patients.

For the purposes of the Mental Health Act 2001, consent means consent in writing, obtained freely without threats or inducements, where:

  • The consultant psychiatrist who is caring for you certifies that you are capable of understanding the nature, purpose and likely effects of the proposed treatment and
  • The psychiatrist has given you adequate information, in a form and a language that you can understand, on the nature, purpose and likely effects of the proposed treatment.

Under the Act, your consent to treatment is required except where the consultant psychiatrist considers that the treatment is necessary to safeguard your life, to restore your health, to alleviate your condition or to relieve your suffering, and you are incapable of giving such consent because of your mental disorder.

Psycho-surgery may not be performed unless you consent and it is authorised by a mental health tribunal. Psycho-surgery will not be carried out while temporary measures for mental health tribunals (above) are in place to deal with coronavirus.

Electro-convulsive therapy may not be performed unless you give consent or where you are unable to give consent and the therapy is authorised by the consultant psychiatrist responsible for you and by another consultant psychiatrist.

If you have been on medication for 3 months, your consultant must ask for you to consent to continue taking it. If you do not consent and your consultant believes you fully understand your decision, you do not have to take the medicine. If the consultant believes you do not understand the decision and a second consultant psychiatrist agrees, you can be given the medication for up to 3 months. Your medication will be reviewed in the same way every 3 months.

Restraint

Patients may not be restrained or placed in seclusion unless this is necessary for treatment or to prevent the patients from injuring themselves. The Commission has made rules for the use of seclusion and mechanical means of bodily restraint. There is a Code of Practice on the use of Physical Restraint in Approved Centres.

Clinical trials

People who are suffering from a mental disorder and who have been admitted to an approved centre may not take part in clinical trials.

Further information

The Mental Health Commission has published a guide to the Mental Health Act 2001 that explains your rights under mental health law.

Page edited: 1 April 2020