Rights of psychiatric patients

The Mental Health Act 2001 sets out the rules about how a person is admitted to a psychiatric hospital and the rights of psychiatric patients.

If you are receiving treatment or involuntarily admitted to an approved psychiatric centre (psychiatric hospitals or inpatient service), you are entitled to:

• Be treated with dignity and respect
• Take part in decisions affecting your health
• Have your views considered carefully
• Be listened to by all those working on your care team
• Have all decisions made in your best interest
• Be examined by a psychiatrist in the centre
• Be provided with information about your legal rights, admission and 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.

Admission to an approved psychiatric centre

When you arrive at the centre, you will be examined by a consultant psychiatrist. You may be kept in the centre for a maximum of 24 hours for this examination.

If the psychiatrist believes you are suffering from a mental disorder, they must sign 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.

Your rights to information when admitted

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

Renewal order

A renewal order may extend your admission 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.

You can read more about the admission process in this guide from the Mental Health Commission.

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

The mental health tribunal process protects your rights as a patient if you are detained involuntarily (without your consent).

The Mental Health Commission refers your admission or renewal order to a mental health tribunal for review.

Members of the tribunal

A mental health tribunal is appointed by the Mental Health Commission. It must consist of a lawyer as chairperson, a consultant psychiatrist and a lay person (a person who is not a lawyer or doctor or nurse). Tribunal members are selected and trained by the Mental Health Commission.

Read more about mental health tribunals.

Review of admission by a mental health tribunal

When the Mental Health Commission receives a copy of an order for your admission or renewal order, for your detention in a psychiatric hospital, 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's decision

The tribunal must review your detention and make a decision within 21 days of the making of the order (this time limit can be extended).

If the tribunal believes that you are suffering from a mental disorder and that the proper procedures have been followed in your detention then it approves the order for your continued detention.

If the tribunal 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 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.

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

There are certain restrictions on taking civil actions in court arising from actions taken under the Mental Health Act.

You must 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.

In general, medical and surgical treatment may be administered only with the informed consent of the patient. You can read about consent to medical treatment for all other types of patients.

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

Psycho-surgery is a medical operation for the purposes of improving a mental illness.

You cannot get psycho-surgery unless you give your consent and it is authorised by a mental health tribunal.

Electro-convulsive therapy

Electro-convulsive therapy is a medical procedure to treat specific types of major mental illness. It involves an electric current being passed briefly through your brain.

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. The therapy must be given to the patient following the rules set by the Mental Health Commission (pdf.) .

Consent to take medication 

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

As a psychiatric patient, you may not be restrained or placed in seclusion unless this is necessary for your treatment or to prevent you from injuring yourself.

The Mental Health Commission has made rules for the use of seclusion and mechanical means of bodily restraint (pdf).

There is a Code of Practice on the use of Physical Restraint in Approved Centres (pdf).

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.

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