CHAPTER TWELVE - ABSOLUTE DISCHARGE
12.1 The Mental Health Tribunal are empowered to discharge a restricted patient absolutely once they are fully satisfied that the patient is no longer suffering from mental disorder as defined in the 2003 Act, and thus no longer presents as a result of mental disorder a serious danger to the public. The exception being those restricted patients who are also life sentence prisoners. Please refer to Chapter 7 for guidance on these patients.
When it might be appropriate
12.2 In most cases, it will have been appropriate for the patient to have undergone a period of supervision in the community, on conditional discharge, before a decision about absolute discharge can be taken. It is not, however, unprecedented for a patient to be discharged absolutely direct from hospital. It may be helpful for the Responsible Medical Officer ( RMO) to discuss a recommendation for absolute discharge in the first instance with the Scottish Executive Health Department's ( SEHD) Psychiatric Adviser. When a formal recommendation is submitted to Scottish Ministers, it will automatically be referred for consideration by the Mental Health Tribunal.
12.3 To enable Ministers to take an early view on the recommendation and make their position clear to the Mental Health Tribunal, it would be helpful if the following information could be provided:
- the RMO's clear confirmation that in their view, the patient is no longer suffering from mental disorder which requires detention in hospital and no longer presents a risk to the public; and
- a report from the social work supervisor providing a full comprehensive community care assessment to support the viability, safety and effectiveness of any proposed absolute discharge.
For further details of the information required see Annex E.
How it is achieved?
12.4 Scottish Ministers will make a reference to the Mental Health Tribunal under the 2003 Act, following a recommendation from the RMO or the Mental Welfare Commission. Scottish Ministers can also make applications to the Tribunal following on from their ongoing duty to keep the compulsion order and the restriction order under review. Patients may also make an application to the Mental Health Tribunal for an order revoking the compulsion order and the restriction order. It will be for the Mental Health Tribunal to determine the sufficiency of evidence and to seek any additional information which they consider relevant to their deliberations.
How it is managed?
12.5 Once a patient is absolutely discharged, Scottish Ministers no longer have a formal role to play in the patient's care. In most cases, informal contact is maintained by the multi-disciplinary care team, including the social worker following absolute discharge.
Early Discharge Protocol for patients in secure hospital settings
12.6 In response to one of the recommendations in the Mental Welfare Commission's 'Report of the Inquiry into the care and treatment of Noel Ruddle', the Scottish Executive, together with local authorities and NHS Trusts, set up a working group with a remit to develop an Early Discharge Protocol. The Protocol complements the proper application of the established Care Programme Approach ( CPA), and applies to all patients in the State Hospital who no longer, or may no longer meet the criteria for compulsory intervention under the 2003 Act or the Criminal Procedure (Scotland) Act 1995, as amended, but who have complex needs and continue to pose a significant risk to public safety. See HDL (2002)85 for further guidance.