The Mental Health Act is to regulate the provision of mental health services, care and rehabilitation whilst promoting and upholding the rights of persons suffering from mental disorders.

The law enlists 19 rights.

You are to be informed of your rights and how you can exercise them in a form and language which is easy to understand within 24 hours of admission to a licensed facility or on receiving a Community Treatment Order. This information, together with information about available services and support should also be provided to your responsible carer.

As a user of mental health services, you have the right to exercise all civil, political, economic, social, religious, educational and cultural rights without any discrimination on grounds of physical disability, age, gender, sexual orientation, race, colour, language, religion or national or ethnic or social origin. The law gives you the right of full respect for your dignity and protection from cruel, inhuman and degrading treatment. You also have the right for a safe and hygienic environment, and privacy. The right to privacy may only be limited if there is a serious risk to your health or the safety of others.

You have the right to be adequately informed about your disorder and the multidisciplinary services available to cater for your needs and the treatment options available. You also have the right to actively participate in the formulation of your own multidisciplinary treatment plan. You have every right to discuss, question, express your opinion, and receive adequate answers for any questions you may have. It is however important that you follow the agreed care plan.

The Mental Health Act ensures your right to receive treatment of the same quality and standard as other individuals. You have the right to receive treatment which addresses your needs holistically through a multidisciplinary care plan approach in the least restrictive environment and manner, and primarily in the community. You also have the right to receive aftercare and rehabilitation in the community whenever possible, so as to facilitate social inclusion.

You have the right to appoint a person of your own choice as your responsible carer whenever possible. It is highly recommended that you choose a person with whom you have a close personal relationship, and who has your best interests at heart. You should appoint this person in writing. The responsible carer should also preferably confirm acceptance of this role in writing.

One of your fundamental rights as a patient is that of free and informed consent for care and treatment. It is very important that you understand what consent is being given, and can freely ask the pertinent questions where clarifications are necessary. Such consent is recorded in your clinical records. This is without prejudice to your right to withdraw consent. As a voluntary patient, you have the right to withdraw or refuse consent, so long as you are fully aware of the possible negative effects that such withdrawal, or refusal, may have on your overall condition.

The patient seeks, or consents to, admission into a hospital and to receive the necessary care and treatment. This consent to necessary treatment in writing, is given after receiving adequate and essential explanation and information regarding one’s condition and the care plan proposed in a manner that can be easily understood. The care plan may include medicines or other therapies as required. It may also include certain patient obligations, such as attending therapy sessions, co-operating with the multidisciplinary team and a commitment to involve oneself and one’s responsible carer in the care plan. The patient is entitled to any further clarification, including information regarding hospital protocols which one is bound to follow as required.

A voluntary patient has the right to refuse any form of treatment and also to request to be discharged. In order to be able to discharge himself, a patient needs to inform the nursing officer in charge and sign the relevant declaration. In those instances where the nurse in charge is of the opinion that the mental condition of the patient is not such as to warrant discharge, a doctor will be called to examine the patient. Within four (4) hours from patient’s request the doctor has to decide whether patient can be safely discharged. When there are strong indications that the patient’s condition may deteriorate if discharged and treatment is not followed, the patient may be detained as an involuntary patient. If you are a voluntary patient and refuse treatment or request to be discharged but in the opinion of the caring team you still require inpatient treatment, your legal status may be changed to involuntary if your condition meets the criteria for involuntary admission stipulated in the Mental Health Act.

You may only be admitted or kept in hospital against your will if a specialist in psychiatry certifies that

1. you have a severe mental disorder, and
2. due to the mental disorder, you are at serious risk of physical self harm or harm to others, and
3. if you are not admitted or kept in hospital your condition will likely get much worse or you may not be able to get the treatment that you need

When it results from a medical examination that all the above conditions concur, an application for an involuntary admission for observation is made.

Every involuntary admission commences with a period of observation not exceeding 10 days.  During the 10 day involuntary period of observation in a mental health licensed facility, the medical team responsible for you shall prepare a care plan. If the responsible specialist is of the opinion that you require further care in the facility and the criteria have not changed, but you refuse, then the specialist together with the caring team, shall submit an application for involuntary treatment to the Commissioner for Mental Health. As required by law, this application shall be accompanied by a Multidisciplinary care plan. After evaluating the application with the advice and assistance of an independent specialist if necessary, the Commissioner will issue a decision regarding the submitted application. A copy of this decision is sent to the patient, to the responsible carer, the specialist and Mental Health Services Management. The period of involuntary treatment shall be of not more than 10 weeks, but if necessary, this period may be extended by a further period of 5 weeks. In this case a revised care plan together with an application by the responsible specialist shall be sent to the Commissioner for Mental Health who, after evaluating them, shall issue a decision on the application received. In those instances where the period of detention required to treat a patient is longer, the Responsible Specialist needs to submit another application together with an updated multidisciplinary care plan.

If a person requires further involuntary treatment after the period of 10 days, followed by 10 and an additional 5 weeks an application for a Continuing detention order may be filed. As required by law, this application shall be accompanied by a Multidisciplinary care plan. After evaluating the application with compulsory advice of an independent specialist, the Commissioner will issue a decision regarding the submitted application. The maximum period for a Detention Order is six months. An assessment by an independent Specialist on behalf of the Commissioner is required for all applications for a Detention Order, and every decision is taken on an individual basis. A copy of this decision is sent to the patient, to the responsible carer, the specialist and Mental Health Services Management. A detention order may be renewed if further involuntary in-patient care is needed.

A period of Involuntary Care may be transformed into Voluntary Care if the patient accepts and consents to treatment.

The law establishes that The multidisciplinary care plan is to clearly outline the patient’s needs, how and by whom these will be addressed, specifying expected outcomes and timeframes. Each professional within the multidisciplinary team is considered responsible for assessment and care within their professional scope of practice. For any desired change in any aspect of the plan, you should consult with your caring team to avoid any possible negative repercussions that such a decision may have on your mental health or condition.

Individuals under that age of 18yrs are covered by the mental health act as minors.

An order for involuntary treatment can only be issued for treatment in a mental health licensed facility for minors for patients under the age of 18years. The same criteria for involuntary admission and procedures which apply for adults apply also for minors. Minors may be detained for a 10 day period of observation in a mental health licensed facility under the care of the medical team responsible for the patient. A care plan is to be prepared for you during this time. If the responsible specialist is of the opinion that you require further involuntary in-patient care but you/your parents/guardians refuse, then the specialist together with the caring team, shall submit an application for involuntary treatment to the Commissioner. As required by law, this application shall be accompanied by a Multidisciplinary care plan. After evaluating the application with the advice and assistance of an independent specialist if necessary, the Commissioner will issue a decision regarding the submitted application. A copy of this decision is sent to you/parent/guardian, the responsible carer, the specialist and Mental Health Services Management.

Following the initial 10 days of involuntary observation period, the period of involuntary treatment shall be of not more than 4 weeks, but if necessary, this period may be extended by a further period of 4 weeks to a maximum of 12 weeks in total including the period of involuntary observation order. In the case of an extension, a revised care plan together with an application by the responsible specialist shall be sent to the Commissioner who, after evaluating them, shall issue a decision on the application received. In those instances where the period of detention required is longer, the Responsible Specialist needs to submit an application for detention together with an updated multidisciplinary care plan.

The maximum period for a Detention Order is three months. An assessment by an independent Specialist on behalf of the Commissioner is required for all applications for a Detention Order, and every decision is taken on an individual basis. A detention order may be renewed if further involuntary in-patient care is needed.

The Community Treatment Order is a form of supervised care which allows for treatment, care and management of a person with a mental health disorder to be provided in the community by healthcare professionals as nominated in the care plan.

An application for a Community Treatment Order may be made when it results during a medical assessment that you:

1. have a severe mental disorder which can be safely treated outside hospital under adequate supervision,

And

2. have previously refused or failed to cooperate in taking treatment,

and

3. are at serious risk of harm to self or to others if you do not take the treatment,

A Community Treatment Order shall be issued for a maximum period of six (6) months that can be extended further if considered necessary. For each renewal, a medical re-assessment is necessary and a fresh application must be submitted together with an updated care plan. The decision regarding a Community Treatment Order is issued by the Commissioner and a copy is sent to you, your responsible carer and caring team.

The Key Healthcare Professional is a specifically appointed professional within a Community Treatment Order.  Such professional will be responsible for the co-ordination of the care plan and also to explain to you your rights and responsibilities under the same care plan. This professional shall be the reference point for you and your responsible carer and shall ensure that you follow the care-plan as agreed.

The responsible carer will help and support you to follow your care plan and act on your behalf whenever necessary. The responsible carer can act instead of you when you lack the mental capacity to do so. A responsible carer appointed under the Mental Health Act is only responsible for the care aspect and is not responsible for management of finance and property. The responsible carer has the right to receive information regarding your care plan and should be actively involved in the drawing up and implementation of the care plan. He/she has the right to ask for clarifications of the care plan from the medical team. The responsible carer is there to encourage you to take the necessary medication as needed, to follow the advice of the team following you and to see that you do not miss out on appointments. The responsible carer can communicate with the caring team if he/she notices that you are not well.

If you do not appoint a responsible carer, the caring team shall identify one for you from amongst your nearest relatives or close friends. If the medical team is of the opinion that the responsible carer should be changed, the responsible specialist informs the Commissioner stating reasons. After evaluation the Commissioner may appoint another responsible carer. Where a responsible carer cannot be found, the Commissioner can be requested to appoint a responsible carer only in so far as the giving or withholding of consent to treatment is concerned.