The part of the law that you are most likely to use is the Temporary Treatment Order (TTO). This allows you to admit someone with mental illness even if they do not agree. This is what you need to do to complete a TTO:
- The TTO requires a written application by a relative (e.g. a short letter or note requesting the admission). If this is not available. you must explain in the referral letter why you were not able to obtain it (e.g. there were no relatives present or contactable at the time)
- The application must be accompanied by your signed recommendation as a medical practitioner. This is the TTO form (see Part 7). You MUST examine the person and specify the date you did this. You need to decide whether all 3 of the following criteria are met:
- The person is “suffering from mental disorder or mental defect”.
- Either you have made a diagnosis, or you are clear that the person has a mental illness even if you are not certain of the exact diagnosis. AND
- The person is “likely to benefit by temporary treatment in a mental hospital”
- In other words, the person’s health and safety will be improved by admission to hospital for the treatment that can be provided there (e.g. medication, specialist nursing care). This benefit is likely if the person currently poses a risk of self-neglect, or harm to self or to other persons. E.g.
- Has attacked someone
- Has immediate plans of suicide
- Is not eating/drinking
- Is not taking care of himself/herself in the way that they would do normally when well. AND
- In other words, the person’s health and safety will be improved by admission to hospital for the treatment that can be provided there (e.g. medication, specialist nursing care). This benefit is likely if the person currently poses a risk of self-neglect, or harm to self or to other persons. E.g.
- The person is “for the time being incapable of expressing himself/herself as willing or unwilling to receive such treatment”
- This requires you to assess the person’s “capacity” to make their own decision about receiving treatment. You should assess the following 4 questions. If the answer to one or more of these questions is no, then the person likely lacks capacity.
- The person is “suffering from mental disorder or mental defect”.
1) Do they understand the information about their condition, and the treatment being suggested?
e.g. someone with acute psychosis may not believe mental illness exists nor accept that their actions carry risk.
2) Can they retain this information? (i.e. remember it for long enough to make a decision)
e.g. Someone with delirium may be too distracted or drowsy.
3) Can they weigh up the information?
e.g. someone with psychotic depression may understand the treatment but refuse because he thinks he is wicked and deserves to die. Someone may be too distracted by hearing voices to weigh up the information.
4) Can they communicate their decision?
If someone has communication difficulties (e.g. deafness, intellectual impairment) you must do all you can to help him/her understand and to communicate their decision e.g. writing it down, putting it in simple language.
C. Once you have signed the TTO form, the person must be admitted within 14 days, or another assessment will need to take place.
1. In the hospital, the TTO lasts up to 12 months but must be discharged by the clinician as soon as the person no longer meets the criteria for detention.
