Response

Chapter/

paragraph number

Comment

Chapter 1 (Guiding Principles)

The College is concerned that the hierarchy of principles in the Code differs from those in section 118 of the amended Act. Given that the Act is about detention and forced treatment it seems right that the first principle be respect for patients’ past and present wishes, as in the Act, rather than risk reduction (minimising the importance of autonomy) as in the draft revised Code.

We also consider that the wording of the Welsh Code is preferable in that it presents risk reduction in terms of well being and safety of the patient or public safety. The words “minimising the harm of mental disorder” as the opening to the chapter seem to us unnecessary and unhelpful.

1.3

It is difficult to understand the point of the qualification (“having regard to the purpose for which they are imposed”) to this principle of least restriction. While it may be intended to bring in the legitimate concept of proportionality it is so broadly expressed it could be used in a quite different way, to negate the operation of the principle in some circumstances.

1.4

(Respect Principle)

We particularly welcome the inclusion of the respect principle in view of the good evidence to suggest that there is an over representation of patients belonging to Black and Minority Ethnic communities among patients who are detained under Mental Health Act.

However we consider it improper to state that “respect” should only be required when appropriate

1.5

(Participation Principle)

Although we welcome the inclusion of the participation principle, the application of this principle needs to be in the light of clinicians’ duties of confidentiality (e.g. General Medical Council guidelines), especially when involving carers and family members.