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Why we visited people on short-term detention certificates

Prior to the implementation of the Code of Practice to the Act the most common route into hospital detention was under an emergency order. This involved assessment by a single doctor, not necessarily with any specialist training, often supported by a mental health officer. Emergency orders lasted for 72 hours and could then be followed by a 28 day short term order. There was no facility under the 1984 Act to admit someone directly on a 28 day order. Evidence from our monitoring programme, prior to 2005, found that just over half of emergency detentions led to 28 day orders under the 1984 Act.

We believed, along with other organisations and user groups, that a better planned and more multi-disciplinary community assessment would help to avoid unnecessary hospital admissions.

Where hospital admission is the most appropriate way to safeguard an individual's mental health and welfare, STDCs should be used in preference to emergency orders. The Code of Practice to the Act highlights the advantages of this new procedure:

"A short-term detention certificate is the preferred "gateway order" because, as compared with an emergency detention certificate, it can only be granted by an approved medical practitioner; the consent of an MHO to the granting of a short-term detention certificate is mandatory; and it confers on the patient and the patient's named person a more extensive set of rights, including the right to make an application to the Tribunal to revoke the certificate" Volume 2, Chapter 1, Paragraph 16.

The Code of Practice says it is essential for a mental health officer (MHO) to consider whether alternative forms of community based care and support are appropriate and available to be used as an alternative to hospital admission. It makes it clear that emergency orders should only be used in cases of genuine urgency. Assessment in the community should build on best practice and the principles of the 2003 Act.The process should be planned and multi-disciplinary as far as possible and should engage individuals, their carers and relatives in identifying alternatives to admission.One of the areas we routinely examine in the operation of the 2003 Act is whether this change of emphasis is leading to changes in admission rates. Our monitoring confirms that individual admission on a STDC is now the most common route into compulsory treatment as envisaged by the Millan committee.

The intention of the 2003 Act was that EDCs should only be used where hospital detention is needed as a matter of urgency, and where there are significant risks which preclude the use of a STDC.There are a number of factors other than the availability of doctors and mental health officers which can impact on the use of EDCs prior to a STDC in an area:

  • geographical factors, such as lengthy travel times to access community mental health services in remote rural locations;
  • the range and availability of community mental health services;
  • availability of adequate social care resources to support people in the community; availability of resources out of hours.