A gap in Jersey’s mental health law created “an increase in risk to vulnerable patients” who were able to leave hospitals before a consultant psychiatrist had authorised their detention, it has emerged.
The Health Minister has proposed changes to the Mental Health Law that would close this loophole and expand emergency detention powers.
Under the existing law, only an “approved practitioner” – typically a consultant psychiatrist – can authorise the emergency detention of a voluntary patient for up to 72 hours.
However, consultants are frequently not on-site, particularly out of hours.
Deputy Tom Binet explained: “This limitation in who may exercise the power has given rise to difficulties in practice and causes an increase in risk to vulnerable patients.
“Currently, where an approved practitioner is not available, it may then not be possible to prevent a patient from leaving hospital and thus to prevent them from coming to serious harm or from harming others.”
At St Saviour’s Hospital, there is usually no consultant present overnight. At the General Hospital, consultants may be working elsewhere or off-site, and although on-call cover exists, there can be a delay before they arrive.
Figures contained in the report show the emergency detention power was used 27 times at mental-health ward Clinique Pinel last year – 13 of those out of hours – and four times at the General Hospital.
In 22 of those 31 cases, the patient was later formally detained following a full assessment.
The Health Minister is now proposing that any registered doctor with at least three years’ post-foundation experience – including staff-grade doctors – will be able to authorise emergency detention.
The change is described as a “backstop that improves patient safety”, with consultants still expected to be sought first.
Deputy Binet explained: “The amendment will enable staff grade psychiatrists at St Saviour’s Hospital to authorise an emergency admission pending a full Mental Health Law assessment when a consultant is not available, with the full assessment then following during the day rather than (in some cases) having to take place at night.
“At the General Hospital, the amendment will enable staff grade or more senior doctors, who have been appropriately trained, in the Emergency Department and on the wards to take immediate action to prevent, from leaving, a patient likely to have a mental disorder who would present a significant risk to themselves or others, thereby avoiding the risk that the patient may leave before the on-call approved clinician arrives.”
Elsewhere in the proposition, the minister also proposes allowing senior nurses, psychologists, occupational therapists and social workers to become “approved clinicians” and act as the lead decision-maker for patients detailed under the mental health law. Currently, only doctors can hold that role.
The move is intended to modernise the workforce model and widen the pool of senior professionals able to take responsibility for care and discharge decisions.
If approved, the amendment would also correct what is described as a drafting error in the Capacity and Self-Determination Law.
Because the law used the word “and” instead of “or” in defining restraint, measures such as sedation or bed rails did not technically meet the legal definition of restraint – despite being treated as such in practice.
The proposition also tightens governance around court-appointed delegates who manage the affairs of people lacking capacity.
Delegates will no longer be able to resign with immediate effect. Instead, the court must oversee the process to ensure continuity of protection.
