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Mental Health

This section provides a summary of legislation on mental health and the responsibilities of hospital managers in relation to legislation.


Mental Health Act 1983

The Mental Health Act 1983 (the Act) is primarily concerned with the circumstances in which a person with a mental disorder can be detained for treatment for that disorder without his or her consent. It also sets out the processes that must be followed and the safeguards for patients, to ensure that they are not inappropriately detained.

The main purpose of the legislation is to ensure that people with serious mental disorders which threaten their health or safety or the safety of the public can be managed appropriately, where it is necessary to prevent them from harming themselves or others, as well as protect the rights of people with such disorders in such circumstances.

The Act was amended in 2007 and changes made to some definitions, roles, and safeguards. It also introduced Supervised Community Treatment and Independent Mental Health Advocacy services.

All those concerned with the provision of Mental Health Services will need to be familiar with the principles contained within the Code of Practice for Wales, published in 2008.

The Welsh Ministers have responsibility under the Act to monitor its use, which Health Inspectorate Wales (HIW) undertakes on their behalf. HIW have established the Review Service for Mental Health to carry out this work, which mainly involves:

  • visits to patients subject to the powers of the Mental Health Act and
  • the provision of a Second Opinion Appointed Doctor (SOAD) service which appoints independent doctors to give a second opinion as a safeguard for patients who either refuse to give consent for certain treatments or are incapable of giving such consent.

The focus of the Review Service for Mental Health will be that everyone receiving care and treatment in Wales who are subject to the provisions of the Mental Health Act 1983 should:

  • be treated with dignity and respect;
  • have the right to ethical and lawful treatment;
  • receive the care and treatment that is appropriate to his or her needs; and
  • be enabled to lead as fulfilling a life as possible

Further details are available at Mental Health Act 1983 - NHS Wales website


The Mental Capacity Act (2005)

The introduction of the Mental Capacity Act (MCA) in April and October 2007 put into law much of what had previously been seen as ‘good practice’. The Act provides a statutory framework for persons who do not have the capacity to make decisions for themselves and for those who wish to make preparations for a time when they may not have the capacity to make certain decisions.

Staff acting in a professional role for, or in relation to, a person who lacks capacity or  a person being paid for acts in relation to such a person are legally required to ‘have regard’ to the MCA Code of Practice.

All staff, including those working in for example care homes or from domiciliary care agencies, need to have a working knowledge of the Act and the Code of Practice so they can support people in their care who may lack the mental capacity to make some decisions. They also need to have the confidence and competence to challenge other people who may not be aware of the legislation, in support of their clients. 

The MCA also has relevance in the protection of vulnerable adults and guidance. A free learning resource will help them achieve a required level of understanding.


Mental Health (Wales) Measure 2010 

The Mental Health (Wales) Measure 2010 (‘The Measure’) is a piece of law made by the National Assembly for Wales. It has the same legal status in Wales as an Act of Parliament. The Measure was passed by the National Assembly for Wales in November 2010, and received Royal Assent in December 2010. 

It places new legal duties on Local Health Boards and Local Authorities about the assessment and treatment of mental health problems. The Measure also improves access to independent mental health advocacy for people with mental health problems.

The Measure has four main Parts:

Part 1 of the Measure will ensure more mental health services are available within primary care. This Part of the Measure requires Local Health Boards and Local Authorities to work together to establish Local Primary Mental Health Support Services across Wales.

This service will be delivered within and alongside GP settings. It aims to provide:

  • assessment,
  • short-term interventions,
  • information, advice and, where appropriate,
  • onward referral to other services.

Part 2 makes sure people of all ages receiving secondary mental health services receive an individual Care and Treatment Plan (CTP). Care co-ordinators, will be appointed, and will ensure that CTPs are informed by the service user and their carers. Mental health services will focus on the recovery model of care and treatment and the active involvement of service users in individually tailored C&T Plans.

A new Code of Practice for Parts 2 and 3 of the Measure has been produced and staff are legally required to ‘have regard to’ the relevant guidance.

The University of Lincoln has developed training resources to assist care coordinators and others understand the Care and Treatment planning process.

Part 3 enables eligible adults who have been discharged from secondary mental health services - but who subsequently believe their mental health is becoming worse - to self-refer directly back to secondary services. It will no longer be necessary to first see a GP or go elsewhere for a referral

Part 4 ensures all inpatients in Wales who are receiving assessment or treatment for a mental disorder are entitled to request support from an Independent Mental Health Advocate (IMHA).This extends the Independent Mental Health Advocacy scheme. It covers patients subject to compulsion under the Mental Health Act 1983, and those in hospital voluntarily.