XXII tal-2012

(1)

The short title of this Act is the Mental Health Act, Short title and

commencement.

2012. (2)

This Act shall come into force on such date as the

Minister responsible for health may by notice in the Gazette establish,

and different dates may be so established for different provisions and

for different purposes of this Act.

PART I

PRELIMINARY

[Article 3(1)]

Mental Health Act This application shall be submitted to the Commissioner.

RFC Ref No

APPLICATION

TO RESTRICT FREEDOM OF COMMUNICATION

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders.

(1) Please approve my request to restrict freedom of communication in

respect of

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) .....................................................................................................

who was admitted at ............................ (ward) on ............................ (date) as

a voluntary patient

an involuntary patient under an Involuntary Admission for Observation,

an involuntary patient under an Involuntary Admission for Treatment

Order,

an involuntary patient under a Continuing Detention Order.

(2)

Give details of communication to be restricted

(3)

Give reasons for such restriction

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Application received on (date) .................................. at (time) .......................

Comments

Request approved

Request not approved

My decision was communicated in writing to the responsible specialist on

(date) ................................

(Signature)

(Date)

(Time)

In this Act unless the context otherwise requires

Interpretation.

"chief executive officer" means the person responsible for the

management of a licensed facility;

"clinical director" means the specialist responsible for the

clinical care provided by a licensed facility;

"the Commissioner" means the Commissioner established by

article 5;

"custodial care" means non-medical care that helps a person

with his or her activities of daily living and not requiring constant

attention of healthcare professionals;

"healthcare professional" means a professional registered with

the relevant Council under the Health Care Professions Act or under

any other Act regulating the professions of social work and, or

psychology, and "healthcare staff" shall be construed accordingly;

"incapacitation" means incapacitation as interpreted for the

purposes of the Civil Code and the Code of Organization and Civil

Procedure;

“informed consent” means that decision taken by the patient or

the carer as applicable after being informed of his rights under article

3;

"interdiction" means interdiction as interpreted for the purposes

of the Civil Code and the Code of Organisation and Civil Procedure;

"involuntary patient" means a patient who is in the licensed

facility or in the community receiving treatment and care against his

will;

"leave" means temporary absence of a person from a licensed

facility on the approval of the responsible specialist but in the case of

involuntary admission, the person still remains under the Order issued

under this Act and liable to be taken back for involuntary inpatient

care;

"medical practitioner" means any person whose name is entered

in the Medical Registers kept by the Medical Council and "medical

personnel" shall be construed accordingly;

"mental capacity" means the patient’s ability and competence to

make different categories and types of decisions and to be considered

responsible for his actions;

"mental disorder" means a significant mental or behavioural

dysfunction, exhibited by signs and, or symptoms indicating a

disruption of mental functioning, including disturbance in one or

more of the areas of thought, mood, volition, perception, cognition,

orientation or memory which are present to such a degree as to be

considered pathological in accordance with internationally accepted

medical and diagnostic standards and "mental illness" shall be

construed accordingly, and for the purpose of any matter related to

criminal proceedings, it shall include "insanity" as understood for the

purpose of the Criminal Code;

"mental health licensed facility" means a healthcare setting,

whether private or public, duly licensed to provide mental health care

and "licensed facility" shall be construed accordingly;

"mental welfare officer" means a healthcare professional with

experience in mental health appointed by the Minister on the

recommendation of the clinical director for the purposes of this Act;

"Minister" means the Minister responsible for health;

"minor" means a person under the age of eighteen years;

"multidisciplinary care" means the care and treatment given to

the patient by different healthcare professionals working as a team;

"multidisciplinary care plan" means the plan setting out the

relevant medical, nursing, social, psychological and rehabilitative

interventions that may be necessary to holistically address the needs

of the person, expected outcomes, responsibilities and timeframes to

be respected when giving the care and treatment to the patient and

"care plan" shall be construed accordingly;

"multidisciplinary team" means a group of different healthcare

professionals working together as a team in giving treatment and care

to the patient and "team" shall be construed accordingly;

"patient" means a person including minors, who is under

voluntary or involuntary treatment, care or rehabilitation and

"person" shall be construed accordingly;

"responsible carer" means the person appointed by virtue of

article 4 and "carer" shall be construed accordingly;

"responsible specialist" means the specialist in psychiatry under

whose care the patient is admitted or receiving treatment or care;

"restrictive care" includes seclusion and restraint;

"specialist in mental health" means a specialist whose name is

entered in the Specialist Register for Psychiatry held by the Medical

Council under the provisions of the Healthcare Professions Act and

"specialist" shall be construed accordingly;

"special treatment" means those types of invasive or irreversible

therapeutic interventions listed in the Special Treatment List in Part I

of the Fourteenth Schedule;

"treatment" includes voluntary and involuntary treatment of a

medical, nursing, social and psychological nature and "care" shall be

construed accordingly.

PART II

RIGHTS OF USERS AND CARERS

[Article 9(1) and 10(2)]

Mental Health Act This application is only valid for 120 hours from the date of the first medical

recommendation. The Clinical Director shall forward this application to the

Commissioner within 48 hours of the person being admitted.

IAO Ref No

APPLICATION

FOR A PERSON TO BE ADMITTED INVOLUNTARILY FOR OBSERVATION IN A

LICENSED MENTAL HEALTH FACILITY

To the Clinical Director Employed by the Licensed Mental Health Facility

PART (A) - MEDICAL RECOMMENDATION

Please make an Involuntary Admission for Observation for

M / F

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................................................

I am a medical practitioner and have personally examined the above person.

It is my opinion that the criteria for Involuntary Admission for Observation of

the Mental Health Act (delete as applicable) apply/do not apply to the person.

I base my opinion on the following facts

Facts communicated to me by another person to support my opinion

(Name and Surname)

(Signature)

(Reg. No)

(Date)

(Time)

I am a specialist in mental health and have personally examined the above

mentioned person. It is my opinion that the criteria for Involuntary Admission

for Observation of the Mental Health Act (delete as applicable) apply/do not

apply to the person.

I base my opinion on the following facts

Facts communicated to me by another person to support my opinion

(Name and Surname)

(Signature)

(Reg. No)

(Date)

(Time)

I am a specialist in mental health and have personally examined the above

mentioned person. It is my opinion that the criteria for Involuntary Admission

for Observation of the Mental Health Act (delete as applicable) apply/do not

apply to the person.

I base my opinion on the following facts

Facts communicated to me by another person to support my opinion

(Name and Surname)

(Signature)

(Reg. No)

(Date)

(Time)

PART (B) - APPLICATION BY RESPONSIBLE CARER

Please make an Involuntary Admission for Observation for

To be filled by I .................................................................. ID No ..................................... of

responsible carer (address) .......................................................................................................

over the age of 18

years.

Request that ............................................... ID No ......................... be

Application

is

involuntarily admitted for observation in a licensed mental health facility.

valid if Part [A]

Do not request that ............................................. ID No .......................... be

has been filled.

involuntarily admitted for observation in a licensed mental health facility.

I am the responsible carer for the above person by virtue of being

a relative [state relationship] ......................................

appointed by above person to be his responsible carer [submit evidence]

others, I am his ...................................... [submit evidence]

(Signature)

(Date)

(Time)

PART (C) - APPLICATION BY MENTAL WELFARE OFFICER

Please make an Involuntary Admission for Observation for

To be filled by I .................................................................. ID No ...................... am a mental

approved mental welfare officer appointed by the Minister in terms of the Mental Health Act

welfare officer if request that ....................................... ID No .......................... be involuntarily

responsible carer admitted for observation in a licensed mental health facility.

does not agree

that person needs I certify that

an

involuntary

the responsible carer has not agreed to such an admission

admission

or

responsible carer

the responsible carer can not be found

is absent.

I have reviewed the above named person

there are valid reasons for an involuntary admission for observation

in my opinion it is not safe to give the required care in the community

OR

I ............................................... ID No ............................ am a mental welfare

officer appointed by the Minister in terms of the Mental Health Act have

reviewed .................................................... ID No ........................... and in my

opinion the named person does not need an involuntary admission for

observation in a licensed mental health facility because (specify)

(Signature)

(Date)

(Time)

PART (D) - To be filled by the Clinical Director of the Mental Health Facility after the person has

been admitted

The person for whom this application refers

(a)

has been admitted on ward ......................... on (date) ....................... at (time) ..................

(b)

is under the care of (responsible specialist) .................................................

(Signature)

(Official Stamp)

(Date)

(Time)

To be filled by Notification received on (date) ......................... at (time) .......................

Comments

(Signature)

(Date)

(Time)

(1) Without prejudice to anything provided in this Act

and unless prevented by law, persons with a mental disorder shall

have the right to

(a)

exercise all civil, political, economic, social,

religious, educational and cultural rights respecting individual

qualities, abilities and diverse backgrounds and without any

discrimination on grounds of physical disability, age, gender,

sexual orientation, race, colour, language, religion or national or

ethnic or social origin;

(b) receive treatment of the same quality and standard

as other individuals;

(c)

receive treatment which addresses holistically their

needs through a multidisciplinary care plan approach;

(d) receive treatment in the least restrictive environment

and in the least restrictive manner;

(e)

receive care primarily in the community;

(f)

aftercare and rehabilitation when possible in the

community so as to facilitate their social inclusion;

(g) be adequately informed about the disorder and the

multidisciplinary services available to cater for their needs and

the treatment options available;

(h) actively participate in the formulation of the

multidisciplinary treatment plan;

(i)

give free and informed consent before any treatment

or care is provided and such consent shall be recorded in the

patient’s clinical record. This is without prejudice to the

patient’s right to withdraw consent;

(j)

have a responsible carer of their choice whenever

possible;

(k) confidentiality of all information about themselves,

their illness and treatment in whatever form stored, which

information shall not be revealed to third parties without their

consent unless

(i) there is a life threatening emergency when

information is urgently required to save lives; or

(ii) it is in the interest of public safety; or

(iii) ordered by court to do so; or

(iv) whosoever is requesting such information is

entitled by law to receive it;

(l)

access to their clinical records unless, in the opinion

of the responsible specialist revealing such information may

cause harm to the person’s health or put at risk the safety of

others. When any information is withheld, the patient or the

responsible carer, may contest such decision with the

Commissioner;

(m) be informed within twenty-four hours of admission

to a licensed facility or on receiving a Community Treatment

Order, of their rights in a form and language which the patient

understands, which information shall include an explanation of

those rights and how to exercise them;

(n)

full respect for their dignity;

(o) protection from cruel, inhuman and degrading

treatment;

(p) privacy unless there is a serious risk to the person’s

health or the safety of others;

(q)

a safe and hygienic environment;

(r)

free and unrestricted communication with the

outside world when receiving treatment in a licensed facility,

unless such freedom is detrimental to the patient’s health or it

impinges on the rights and freedoms of other people. In such

circumstances application to the Commissioner for approval to

restrict such freedom shall be sought by the responsible

specialist on the relevant form in accordance with the First

Schedule;

(s)

receive visitors in private within all reasonable times

unless such visiting is detrimental to the patient’s health or it

impinges on the rights and freedoms of other people. In such

circumstances application to the Commissioner for approval to

restrict such visiting shall be sought by the responsible

specialist on the relevant form in accordance with the First

Schedule.

(2)

If and for as long as the patient lacks the mental capacity

to understand any information regarding his rights, then such

information shall be communicated within 24 hours to the responsible

carer.

[Article 12(1)]

Mental Health Act This application shall be submitted to the Commissioner within 240 hours

that a person is admitted to a licensed mental health facility as an involuntary

patient for observation.

IATO Ref No

APPLICATION

FOR A PERSON TO BE ADMITTED INVOLUNTARILY FOR TREATMENT ORDER

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders

Please grant an Involuntary Admission for Treatment Order for

M / F

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................................................

who was admitted at (ward) .............................. on (date) ........................... at (time) ......................

under an Involuntary Admission for Observation (IAO Ref No) ..........................

I am the responsible specialist of the above mentioned person in terms of the

Mental Health Act. It is my opinion that

(a) the criteria for Involuntary Admission under the Mental Health Act apply

to the person. I base my opinion on the following facts

(b) the person requires to be detained in this mental health facility beyond the

period of observation laid down in the said Act for treatment. I base my

opinion on the following facts

A multidisciplinary care plan is submitted with this application.

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Application received on (date) .......................... at (time) ................................

Multidisciplinary care plan submitted

(Signature)

(Date)

(Time)

Case reviewed on (date) ........................

DECISION

Involuntary Admission for Treatment Order granted for a period of

................... (weeks) and shall expire on (date) .............................

Involuntary Admission for Treatment Order not granted because

My decision was communicated in writing to the responsible specialist on

(date) ............................. .

(Signature)

(Date)

(Time)

(1) The responsible carer shall be a person who is

ordinarily resident in Malta and who maintains a close personal

relationship with the patient and manifests concern for his welfare.

(2)

The responsible carer shall be a person appointed in

writing by the patient to act on his behalf

Provided that when the patient lacks mental capacity, or

otherwise fails to appoint a responsible carer in writing, the

responsible carer shall without prejudice to the provisions of sub-

article (3) hereunder, be taken to be in the following order

(a)

the husband or the wife, if any, unless permanently

separated from the patient, either by a judgment or by mutual

consent authorised by a decree, in either case given by the

competent court, or has deserted or has been deserted by the

patient for any period which has not come to an end; or

(b)

sons and daughters over the age of eighteen years; or

(c)

either parent by mutual consent; or

(d)

a close friend or other relative of the patient; or

(e)

in those instances where a responsible carer under

paragraphs (a) to (d) above cannot be identified, traced or

refuses to give his consent, a healthcare professional shall be

appointed by the Commissioner to assume the role of

responsible carer, in so far as the giving or withholding of

consent to treatment is concerned

Provided further that notwithstanding the provisions of

this subarticle, the responsible specialist may request the

Commissioner in writing to substitute the responsible carer by any

other person, giving reasons for his request and the Commissioner

shall on receipt of the request review the case and give his decision in

writing within 120 hours to the responsible specialist and the patient.

(3)

Where any person is appointed by a decree of a Court to

represent the patient, the person so appointed shall be deemed to be

the responsible carer of the patient.

(4)

The responsible carer shall

(a)

be informed by the responsible specialist or his

delegated member of the multidisciplinary team of the rights of

the patient and on the services and support available to him in

looking after the person;

(b)

have access to such services and support;

(c)

participate

in

the

formulation

of

the

multidisciplinary care plan;

(d) be promptly informed and given adequate guidance

on how to better support and look after the patient.

PART III

COMMISSIONER

[Article 13(2)]

Mental Health Act This application shall be submitted to the Commissioner at least 168 hours

before the termination of the initial Involuntary Admission for Treatment

Order.

EIATO Ref No

APPLICATION

FOR EXTENSION OF INVOLUNTARY ADMISSION FOR TREATMENT ORDER

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders

Please extend the Involuntary Admission for Treatment Order for

M / F

(Name)

(ID No)

(D.O.B.)

(Sex)

(Ward)

granted on (date) ....................... IATO Ref No ....................... and due to expire on ...................

I am the responsible specialist of the above mentioned person in terms of the

Mental Health Act. It is my opinion that

(a) the criteria of the Mental Health Act for Involuntary Admission still apply

to the person. I base my opinion on the following facts

(b) the person requires to be further detained in this licensed facility for

treatment. I base my opinion on the following facts

(c) the objectives and timeframes of the original multidisciplinary care plan

were not attained because (give reasons and indicate which objectives were

not attained)

A modified multidisciplinary care plan is submitted with this application.

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Application received on (date) ......................... at (time) ................

Modified care plan submitted

Yes

Modified care plan not submitted

No

Dr ......................................... requested to submit modified care plan

(Signature)

(Date)

(Time)

Case reviewed on (date) ........................

DECISION

Extension of Involuntary Admission for Treatment Order granted for a

period of ................... (weeks) and shall expire on (date) .................

Extension of Involuntary Admission for Treatment Order not granted

because

My decision was communicated in writing to the responsible specialist on

(date) ............................. .

(Signature)

(Date)

(Time)

(1) There shall be established a Commissioner for the Commissioner

Promotion of Rights of Persons with Mental Disorders, hereinafter for

Promotion of

referred to as "the Commissioner", to be appointed by the Prime Rights

Persons with

Minister after consulting the Leader of the Opposition under such Mental

Disorders.

terms as he deems appropriate.

(2)

The Commissioner shall exercise his functions under this

Act in relation to particular cases in his own individual judgement but

he shall nevertheless be accountable for his performance to the

Minister.

(3)

In the performance of his functions, the Commissioner

shall be assisted by and shall consult with -

(a)

healthcare professionals; and

(b)

any other person including users and carers.

[Article 13(4)]

Mental Health Act This application shall be submitted to the Commissioner at least 168 hours

before the termination of the Extended Involuntary Admission for Treatment

Order or a Continuing Detention Order.

CDO Ref No

APPLICATION

FOR A CONTINUING DETENTION ORDER

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders

Please grant/renew a Continuing Detention Order for Involuntary Admission for Treatment

M / F

(Name)

(ID No)

(D.O.B.)

(Sex)

(Ward)

EIATO Ref No........................ / CDO Ref No: ................... due to expire on ................. .

I am the responsible specialist of the above mentioned person in terms of the

Mental Health Act. It is my opinion that

(a) the criteria of the Mental Health Act for Involuntary Admission still apply

to the person. I base my opinion on the following facts

(b) the person requires to be further detained in this licensed facility for

treatment. I base my opinion on the following facts

(c) the objectives and timeframes of the multidisciplinary care plan submitted

with the Application for Extension of Involuntary Admission for Treatment

Order/Continuing Detention Order were not attained because (give reasons

and indicate which objectives were not attained)

A modified multidisciplinary care plan is submitted with this application.

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Application received on (date) ............................... at (time) ........................

Modified care plan submitted

Yes

Modified care plan not submitted

No

Dr ......................................... requested to submit modified care plan

(Signature)

(Date)

(Time)

Dr ......................................... an independent specialist was appointed

and notified to review person in terms of the Mental Health Act and to submit

his opinion by (date) ....................... .

(Signature)

(Date)

(Time)

I the undersigned, a specialist in mental health appointed by the

Commissioner to review ............................... ID No ................... certify that

(a) I am not the responsible specialist for the named person

(b) I have reviewed the person for whom this application is being made and in

my opinion the criteria for involuntary admission in the said Act are

satisfied

not satisfied

I base my opinion on the following facts

I recommend that a Continuing Detention Order be granted / renewed. I base

my opinion on the following facts

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Independent specialist opinion received on (date) .............................

Person reviewed by independent specialist on (date) ......................

DECISION

Continuing Detention Order granted / renewed for a further period of

.................. (months) and shall expire on (date) ........................

Continuing Detention Order not granted / renewed because

My decision was communicated in writing to the responsible specialist on

(date) .......................... .

(Signature)

(Date)

(Time)

(1)

The Commissioner shall

(a)

promote and safeguard the rights of persons

suffering from a mental disorder and their carers;

(b) review

any

policies

and

make

such

recommendations to any competent authority to safeguard or to

enhance the rights of such persons and to facilitate their social

inclusion and wellbeing;

(c)

review, grant and extend any Order issued in terms

of this Act and for this purpose it shall be the duty of any person

to appear before the Commissioner when so requested;

(d) ensure that patients are not held in the licensed

facility for longer than is necessary;

(e)

monitor any person duly certified as lacking mental

capacity and is under curatorship or tutorship;

(f)

authorise or prohibit special treatments, clinical

trials or other medical or scientific research on persons under

the provisions of this Act;

(g) review all patient incident reports and death records

received from licensed mental health facilities;

(h) ensure that guidelines and protocols for minimising

restrictive care are established;

(i)

investigate any complaint alleging breach of

patient’s rights and take any subsequent action or make

recommendations which may be required to protect the welfare

of that person;

(j)

investigate any complaint about any aspect of care

and treatment provided by a licensed facility or a healthcare

professional and take any decisions or make any

recommendations that are required;

(k) conduct regular inspections, at least annually, of all

licensed facilities to ascertain that the rights of patients and all

the provisions of this Act are being upheld. During such visits

he shall have unrestricted access to all parts of the licensed

facility and patient medical records as well as the right to

interview any patient in such facility in private;

(l)

report any case amounting to a breach of human

rights within a licensed facility to the appropriate competent

authority recommending the rectification of such a breach and

take any other proportional action he deems appropriate;

(m) report to the appropriate competent authority any

healthcare professional for breach of human rights or for

contravening any provision of this Act and this without

prejudice to any other proportional action that he may deem

necessary to take;

(n) present to the Minister an annual report of his

activity which shall be placed on the Table of the House of

Representatives by the Minister and shall be discussed in the

Permanent Committee for Social Affairs within two months of

receipt; and

(o) any other function which the Minister may prescribe

by regulations under this Act.

(2)

The Commissioner may delegate any of his functions to

any officer of his office or to any other person appointed to assist the

Commissioner in the execution of his functions.

PART IV

ADMISSION TO A LICENSED FACILITY

AND COMMUNITY TREATMENT

[Article 15(1)]

Mental Health Act This application shall be submitted to the Commissioner

RTO Ref No

APPLICATION FOR RELEASE FROM INVOLUNTARY ADMISSION

FOR TREATMENT ORDER / CONTINUING DETENTION ORDER

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders

To be filled by (1) Please withdraw the

Involuntary Admission for Treatment Order, IATO Ref No: ...................

Extension of Involuntary Admission for Treatment Order, EIATO Ref

No: .................. or

Continuing Detention Order, CDO Ref No: ................ granted on (date)

................... in respect of

M / F

(Surname)

(Name)

(ID No)

(D.O.B.) (Sex)

Ward

This release is being recommended because

the person’s mental health status has improved and the criteria for

involuntary admission are not fulfilled any more; OR

the Involuntary Admission for Treatment Order/Continuing Detention

Order has expired and there is no need to seek an extension.

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Application received on (date) .................................. at (time) .......................

Comments

Request approved and my decision was communicated in writing to the

responsible specialist on (date) ..................................... .

(Signature)

(Date)

(Time)

(1) A person shall be admitted voluntarily to a licensed Voluntary

facility when he needs inpatient treatment and is willing to receive it. admission

mental health

licensed facility.

(2)

Without prejudice to any other rights under this Act, a

voluntary patient

(a)

shall not be admitted unless he consents in writing to

the required care and treatment;

(b)

shall not be secluded unless he consents in writing;

(c)

can discharge himself at any time unless the criteria

for involuntary admission are met;

(d) shall be informed on admission that medical

personnel may exercise the authority to prevent his discharge

should he meet involuntary admission criteria, unless the

responsible specialist decides that it is not in the interest of the

patient to be informed of such authority in which case such

information shall be passed to the responsible carer;

(e)

shall have a multidisciplinary care plan formulated

in consultation with the patient and, or the responsible carer and

finalised within 168 hours of admission; and

(f)

shall give written informed consent prior to any

significant changes in the care plan

Provided that in cases where a patient lacks mental

capacity or is legally prevented from giving consent to treatment, the

responsible carer shall give such consent

Provided further that if the responsible carer cannot be

identified, traced or otherwise refuses to give his consent, emergency

treatment can be given to prevent physical harm to self or others, or to

prevent mental deterioration and a note to this effect is entered in the

person’s clinical records.

(3)

In cases of voluntary admissions the nurse in charge of

the patient may prevent self discharge for up to four hours to allow

review by a medical practitioner if it is perceived that there are

grounds for involuntary admission.

[Articles 17, 18(2)]

Mental Health Act This application is only valid for 120 hours from the date of the first medical

recommendation and shall be submitted to the Commissioner

CTO Ref No

APPLICATION

FOR A PERSON TO BE PLACED ON A COMMUNITY TREATMENT ORDER

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders

Please grant/renew a Community Treatment Order for

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................................................

Is person detained in a mental health facility under an Involuntary Admission for Treatment

Order?

NO

YES

IATO Ref No

YES

EIATO Ref No

YES

CDO Ref No

Is person already under a Community Treatment Order?

NO

YES

CTO Ref No

PART (A) - MEDICAL RECOMMENDATION BY RESPONSIBLE SPECIALIST

To be filled by

I am a specialist in mental health and am the responsible specialist of the

responsible

above named person. It is my opinion that the criteria for Community

specialist in

Treatment Order of the Mental Health Act apply to the person.

mental health

I base my opinion on the following facts

Facts communicated to me by another person to support my opinion

The multidisciplinary care plan required in terms of the Mental Health Act

is attached with this application.

Key healthcare professional in terms of Article 18(3)(a) is .......................

Attach care plan

Eighth Schedule is enclosed (only if required)

and Eighth

Schedule if

required

(Name and Surname)

(Signature)

(Reg. No)

(Date)

(Time)

PART (B) - MEDICAL RECOMMENDATION BY MEDICAL PRACTITIONER

I am a medical practitioner and have personally examined the above named

person. It is my opinion that the criteria for a Community Treatment Order of

the Mental Health Act apply to the person.

I base my opinion on the following facts

Facts communicated to me by another person to support my opinion

(Name and Surname)

(Signature)

(Reg. No)

(Date)

(Time)

PART (C) - APPLICATION BY RESPONSIBLE CARER

I ................................. ID No ........................... of (address) ............................

responsible carer ..........................................................................................................................

Request that ..................................... ID No ....................... be placed on a

Community Treatment Order

Do not request that ............................................ ID No ........................ be

placed on a Community Treatment Order.

I am the responsible carer for the above person by virtue of being

a relative [state relationship] .............................

appointed by above person to be his responsible carer [submit evidence]

others. I am his .................................. [submit evidence]

(Signature)

(Date)

(Time)

PART (D) - APPLICATION BY MENTAL WELFARE OFFICER

I .................................................... ID No ......................... am a mental

welfare officer appointed by the Minister in terms of the Mental Health Act

request that ........................................ ID No .................................... be placed

responsible carer on a Community Treatment Order.

that person needs I certify that

the responsible carer has not agreed to such an Order

the responsible carer can not be found

I have reviewed the above named person

there are valid reasons for a Community Treatment Order

OR

I .................................................... ID No ......................... am a mental

welfare officer appointed by the Minister in terms of the Mental Health Act

have reviewed ........................................ ID No .................................... and in

my opinion the named person does not need a Community Treatment Order

because (specify)

(Signature)

(Date)

(Time)

Application received on (date) ................................ at (time) .........................

Care Plan submitted

Key Healthcare Professional identified

Medical Treatment is not to be provided by responsible specialist

Medical Treatment is not to be provided by medical practitioner signing

Part B of this Schedule

Eighth Schedule submitted

Comments

Decision

Community Treatment Order granted/renewed for a period of

........................ (months) and shall expire on (date) .......................

Community Treatment Order not granted/renewed because

My decision was communicated in writing to the

Responsible Specialist on (date) ...............................

Medical Practitioner on (date) ...................................

Person and / or Responsible Carer on (date) ............................

(Signature)

(Date)

(Time)

(1) A person may only be admitted involuntarily to a

licensed facility or, having already been admitted voluntarily, be

detained as an involuntary patient in such facility if a specialist

certifies that such person

(a)

has a severe mental disorder, and

(b) due to the mental disorder, there is a serious risk of

physical harm to that person or to other persons, and

(c)

failure to admit or detain that person is likely to lead

to a serious deterioration in his condition or will prevent the

administration of appropriate treatment that can not be given in

the community

Provided that in case of emergency when there is a

serious likelihood of immediate physical harm to the person or to

third parties, a reasonable suspicion of severe mental disorder shall

suffice.

(2)

A person requiring custodial care only shall not be kept

in a licensed facility as an involuntary patient.

(3)

A person shall not be admitted to a licensed facility if

other less restrictive alternatives such as community care can be

utilised.

[Article 19(1)]

Mental Health Act This notification shall be submitted to the Commissioner together with the

Seventh Schedule if the medical practitioner giving community treatment to a

person is different from the responsible specialist or the medical practitioner

signing the recommendation.

CTO Ref No

NOTIFICATION

OF AGREEMENT TO GIVE MEDICAL CARE IN THE COMMUNITY

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders

I the undersigned, a medical practitioner, agree to provide the medical

treatment as indicated in the care plan submitted with the application for a

Community Treatment Order in respect of

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Notification received on (date) ........................ at (time) ........................

Comments

(Signature)

(Date)

(Time)

(1) Prior to an involuntary admission for observation, Involuntary

an initial medical assessment shall be made by two medical admission

observation -

practitioners, one of whom shall be a specialist, within a maximum of medical

recommen-

seventy-two hours from each other and who shall fill the dation.

recommendation in Part (A) of the application form for involuntary

admission in accordance with the Second Schedule. In the case of a

discrepancy between the two assessments, a third independent

assessment by a specialist in mental health shall be carried out and

then the majority recommendation shall prevail.

(2)

In case of emergency, when there is a serious likelihood Emergency

of immediate physical harm to the person or to third parties, an initial admission

observation -

single medical assessment shall suffice for the purpose of application medical

recommenda-

for involuntary admission for observation. The second medical tion.

assessment by a specialist in mental health shall be carried out within

twenty-four hours of admission to the licensed facility.

(3)

No involuntary treatment shall be given before the Urgent

second assessment has been carried out unless it is emergency treatment

emergency.

treatment meant solely to prevent physical harm to the patient or

others or to prevent mental deterioration.

[Articles 21(1)(b) and 37(1)(b)]

Part I

Mental Health Act This notification shall be submitted to the Commissioner of Police or his

representative.

CO (I) Ref No

CONVEYANCE ORDER BY THE RESPONSIBLE SPECIALIST

TO TAKE A PATIENT FOR ASSESSMENT AND/OR TREATMENT

To the Commissioner of Police.

I, the undersigned, a specialist in mental health, request that

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................

who is an involuntary patient under the Mental Health Act and is subject to

an involuntary admission for observation;

an involuntary admission for treatment order;

an extension of involuntary admission for treatment order;

a continuing detention order;

a community treatment order;

be sought, detained and taken to (indicate facility) ........................... on (date)

.......................... at (time) .......................... for assessment and/or treatment.

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

(1) No application for involuntary admission for Application for

observation can be made unless the medical assessment has been involuntary

admission for

carried out and the medical recommendation for admission filled in. observation.

(2)

An application for involuntary admission for observation

shall be made by the responsible carer who shall fill Part (B) of the

application form for involuntary admission in accordance with the

Second Schedule, failing which or when the responsible carer

explicitly refuses consent for such involuntary admission, a mental

welfare officer may make such an application certifying on Part (C)

of the application form that he is satisfied that such an application

ought to be made and is of the opinion that there are valid reasons for

involuntary admission to a licensed facility and that care can not be

safely given in the community. If the mental welfare officer is of the

opinion that such involuntary admission is not justified, he shall fill

the relevant part of the application form giving reasons for his

disagreement, provided that such disagreement shall not prevent or

delay the involuntary admission for observation.

(3)

The application form shall be forwarded to the

Commissioner by the clinical director within forty-eight hours from

the person being admitted.

[Articles 21(1)(b) and 37(1)(b)]

Part II

Mental Health Act This notification shall be submitted to the Commissioner of Police or his

representative.

CO (II) Ref No

CONVEYANCE ORDER BY THE MINISTER RESPONSIBLE FOR JUSTICE

TO TAKE A PATIENT FOR ASSESSMENT AND/OR TREATMENT

To the Commissioner of Police.

I the undersigned, the Minister responsible for justice, request that

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................

who is an involuntary patient under the Mental Health Act and is subject to

a court order

be sought, detained and taken to (indicate facility) ........................... on (date)

.......................... at (time) .......................... for assessment and/or treatment.

(Official Stamp)

(Signature)

(Date)

(Time)

(1) When a person is admitted and detained in a Involuntary

licensed facility as an involuntary patient he shall be initially detained admission

observation.

therein for a period of observation not exceeding two hundred and

forty hours from the time of admission in the licensed facility within

which urgent treatment may be given

Provided that an assessment by a specialist in mental

health shall be carried out within twenty-four hours from the time of

admission to the licensed facility and that any issues of immediate

concern are dealt with promptly and expediently.

(2)

After the lapse of the observation period the patient shall

either be discharged or detained as a voluntary patient unless articles

12 or 17 have been applied in which case the patient can be detained

involuntarily until a decision of the Commissioner is taken.

(Article 23)

Mental Health Act This application shall be submitted to the Commissioner.

RCTO Ref No

APPLICATION

FOR REVOCATION OF A COMMUNITY TREATMENT ORDER

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders.

(1) Please withdraw the Community Treatment Order, CTO Ref No ................

granted on (date) ....................... in respect of

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................

This is being recommended because

the person’s mental health status has improved and the criteria for

community treatment are not fulfilled any more; OR

the Community Treatment Order has expired and there is no need to seek

an extension; OR

the person requires involuntary admission for therapeutic reasons.

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Notification received on (date) ........................ at (time) ........................

Comments

Request approved and my decision was communicated in writing to

(a) the responsible specialist on (date) ...........................

(b) the person / responsible carer on (date) .....................

(Signature)

(Date)

(Time)

(1) If within the period of observation it becomes

evident to the multidisciplinary team that the patient requires

involuntary admission beyond the observation period for therapeutic

reasons, an application for an Involuntary Admission for Treatment

Order shall be made to the Commissioner by the responsible

specialist on the specified form in accordance with the Third

Schedule, supported by a multidisciplinary care plan outlining the

patient’s needs, how and by whom these will be addressed, specifying

expected outcomes and timeframes

Provided that healthcare professionals making treatment

or care decisions as part of the multidisciplinary care plan shall only

do this within their professional scope of practice.

(2)

The Commissioner shall within one hundred and twenty

hours of receipt of the application referred to in subarticle (1)

(a)

interview the person, and if required and as

necessary, interview also, together or separately, any or all of

the members of the multidisciplinary team and the responsible

carer, in order to verify that the involuntary admission is

appropriate and that a care plan has been submitted;

(b)

approve or otherwise the application.

(3)

An Involuntary Admission for Treatment Order shall not

exceed ten weeks after the lapse of the initial period of observation.

[Article 24(4) and (6)]

Mental Health Act This certificate shall be forwarded to the Commissioner within 24 hours of

certification.

CLMC Ref No

CERTIFICATION OF LACK OF MENTAL CAPACITY

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders.

(1) I the undersigned, a specialist in mental health have personally reviewed

M / F

(Surname) (Name)

(ID No)

(D.O.B.)

(Sex) (Ward)

of (address) ......................................................................................................

and certify that the above named person lacks mental capacity.

(2) The reasons for such decision are

(3) In my opinion, this person lacks mental capacity to take rational decisions

regarding

(4) Estimated duration of lack of mental capacity is

................................. (weeks) and an application for incapacitation or

interdiction is not recommended; OR

more than 26 weeks and an application for incapacitation is

recommended; OR

more than 26 weeks and an application for interdiction is recommended.

(5) If applicable, indicate if person is

a voluntary patient .............................

an involuntary patient under an Involuntary Admission for Observation

IAO Ref No ..............

an involuntary patient under an Involuntary Admission for Treatment

Order

IATO Ref No .............

an involuntary patient under an Extension of Involuntary Admission for

Treatment OrderEIATO Ref No .........

an involuntary patient under a Continuing Detention Order

CDO Ref No ..............

an involuntary patient under a Community Treatment Order

CTO Ref No ..............

(6) Is this a new application?

YES

NO

CLMC Ref No: .................... which should now be revoked

(7) The responsible carer is

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Certification received on (date) ........................... at (time) ........................

Dr ............................... an independent specialist is appointed and

notified to review person in terms of the Mental Health Act and is to submit

his opinion by (date) ............................ .

(Signature)

(Date)

(Time)

I the undersigned, a specialist in mental health appointed by the

Commissioner to review ........................................ ID No .......................

certify that

(a) I am not the responsible specialist for the named person

(b) I have reviewed the person for whom this certification is being made and

I agree with the certification of lack of mental capacity;

I disagree with the certification of lack of mental capacity for the

following reasons

I agree with the certification of lack of mental capacity but have the

following reservations (specify)

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Independent specialist opinion received on (date) ......................... at

(time) ........................

DECISION

Certification approved for a period of ......................... (weeks) and shall

expire on ....................

Certification approved for a period of ........................ (weeks) and shall

expire on ............................. with the following amendments

Certification for more than 26 weeks and a recommendation for an

application for incapacitation are approved

Certification for more than 26 weeks and a recommendation for an

application for interdiction are approved.

CLMC Ref No: ......................... is revoked (if applicable)

Certification not approved

CLMC Ref No: .............................. is not revoked (if applicable)

My decision was communicated in writing to the responsible specialist, the

person, and the responsible carer on (date) ..................... .

(Signature)

(Date)

(Time)

(1) An Involuntary Admission for Treatment Order

may be extended for a further period not exceeding five weeks as

approved by the Commissioner following an application by the

responsible specialist.

(2)

An application for extension of Involuntary Admission

for Treatment Order in accordance with the Fourth Schedule shall be

submitted by the responsible specialist to the Commissioner at least

one hundred and sixty-eight hours before the termination of the initial

period of involuntary admission for treatment giving specific reasons

for the extension and any modification of the care plan.

(3)

(a) Before granting any extension the Commissioner

shall investigate whether the criteria for involuntary admission are

still operative and whether there was any failure by any healthcare

professional in not attaining the desired outcomes as a result of not

abiding by established patient management protocols and, or the

multidisciplinary care plan submitted by the team.

(b) In those cases where the Commissioner is satisfied

that the necessity for the extension results from a failure from any

healthcare professional in not abiding to established patient

management protocols and, or to the submitted multidisciplinary care

plan, the Commissioner shall make any recommendations he deems

necessary and take such actions against any healthcare professional as

provided by or under this Act.

(4)

No further extension of involuntary admission and

treatment is allowed beyond the extension granted by the

Commissioner under subarticle (1)

Provided that upon the application of the responsible Continuing

specialist for a Continuing Detention Order on the prescribed form in Detention

Order.

accordance with the Fifth Schedule, if the Commissioner is satisfied,

after an independent review by a specialist, that the person still has a

mental disorder that requires treatment and should continue to be

detained for his own safety or that of others, and that no other less

restrictive way would achieve the best possible outcome for that

person and his safety and, or the protection of the public, the

Commissioner may grant a Continuing Detention Order for a

maximum period of six months which may be renewed for further

periods of up to six months after a new application accompanied by a

modified multidisciplinary care plan is submitted to the

Commissioner.

[Article 24(7) and (8)]

Mental Health Act This certificate shall be forwarded to the Commissioner within 24 hours.

RCLMC Ref No

APPLICATION FOR REVOCATION OF A CERTIFICATE

OF LACK OF MENTAL CAPACITY

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders.

(1) I the undersigned, a specialist in mental health have personally reviewed

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

Ward

of (address) ......................................................................................................

and certify that the above named person has mental capacity to make different

categories and types of decisions and is responsible for his actions.

(2) In my opinion, the Certificate of Lack of Mental Capacity CLMC Ref No

...................... approved on ............................ is to be revoked.

(3) If applicable, indicate if person is

a voluntary patient .............................

an involuntary patient under an Involuntary Admission for Observation

IAO Ref No ..............

an involuntary patient under an Involuntary Admission for Treatment

Order

IATO Ref No .............

an involuntary patient under an Extension of Involuntary Admission for

Treatment OrderEIATO Ref No ..........

an involuntary patient under a Continuing Detention Order

CDO Ref No ..............

an involuntary patient under a Community Treatment Order

CTO Ref No ..............

(4) The responsible carer is

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Application received on (date) ........................... at (time) ........................

Dr ............................... an independent specialist is appointed and

notified to review person in terms of the Mental Health Act and is to submit

his opinion by (date) ............................ .

(Signature)

(Date)

(Time)

I the undersigned, a specialist in mental health appointed by the

Commissioner to review ........................................ ID No .......................

certify that

(a) I am not the responsible specialist for the named person

(b) I have reviewed the person for whom this application is being made and

I agree that the above named person has mental capacity to make

different categories and types of decisions and is responsible for his actions

and that Certificate of Lack of Mental Capacity CLMC Ref No

........................ approved on ................................. can be revoked.

I disagree with the application for the following reasons and facts

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Independent specialist opinion received on (date) ......................... at

(time) ........................

DECISION

Revocation of Certification approved

Revocation of Certification not approved

My decision was communicated in writing to the responsible specialist, the

person, and the responsible carer on (date) ..................... .

(Signature)

(Date)

(Time)

Prior to the administration of any treatment, informed Consent in the

consent shall be given by the patient and in those cases where the case

involuntary

patient lacks the mental capacity to give consent, such consent shall admission.

be obtained from the responsible carer

Provided that if the patient refuses to give consent,

treatment can be given to prevent physical harm to self or others or to

prevent mental deterioration and notes to this effect shall be entered

in the person’s clinical records

Provided further that if the responsible carer cannot be

traced or refuses to give consent, treatment can be given to prevent

physical harm to self or others or to prevent mental deterioration and

notes to this effect shall be entered in the person’s clinical records and

in such cases measures to replace the responsible carer in terms of

article 4 may be taken.

[Article 30(1)]

Mental Health Act This notification shall be submitted to the Clinical Director who shall forward

this application to the Commissioner within 48 hours of the person being

admitted together with the Second Schedule.

IAO Ref No

NOTIFICATION

BY SPECIALIST WITH CLINICAL EXPERIENCE OF WORKING WITH MINORS

WITH MENTAL HEALTH PROBLEMS FOR AN INVOLUNTARY ADMISSION

FOR OBSERVATION OF A MINOR

To the Clinical Director Employed by the Licensed Mental Health Facility

I the undersigned, a specialist with clinical experience of working with

specialist who has minors with mental health problems, and having been so appointed by the

Minister in terms of the Mental Health Act certify that

(a) I have personally reviewed the minor

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

by the Minister in of (address) ......................................................................................................

(b) The criteria for involuntary admission to a licensed mental health facility

of the said Act apply to this minor

(c) Treatment can not be safely given in the community.

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Notification received on (date) ........................... at (time) ........................

Comments

(Signature)

(Date)

(Time)

(1) If the patient’s mental health status improves and

the criteria for involuntary admission and treatment cease to exist

either during the period of involuntary admission, or at the end of the

approved involuntary treatment period, as the case may be, the

responsible specialist shall immediately request the Commissioner on

the prescribed form in accordance with the Sixth Schedule to release

the patient from the Involuntary Admission for Treatment Order or

the Continuing Detention Order.

(2)

On release from the Involuntary Admission for

Treatment Order or the Continuing Detention Order the patient shall

attain all the rights related to a voluntary admission.

[Article 33(1)]

Part I

Mental Health Act

SPECIAL TREATMENT LIST

(1) Persons with a mental disorder who do not require

treatment in a licensed facility but meet the criteria for compulsory

treatment in the community, shall, following the granting of a

Community Treatment Order, be compulsorily treated in the

community under a care plan that helps the person to live and

integrate in the community.

(2)

The Community Treatment Order shall allow for

treatment, care and management of a person with a mental disorder to

be provided in the community by healthcare professionals as

nominated in the care plan.

(3)

A person who is subject to a Community Treatment

Order shall be required to undergo the authorised treatment, failing

which, he may be liable to the issue of a Conveyance Order as

provided under article 21 of this Act.

(4)

A Community Treatment Order shall be granted by the

Commissioner in respect of a person living in the community or a

patient receiving voluntary or involuntary treatment in a licensed

facility, if after receiving the relevant application in accordance with

the Seventh Schedule he is satisfied that

(a)

the person has a severe mental disorder that is

amenable to treatment in the community; and

(b) the responsible specialist has previously authorised

treatment for the illness but the person has refused or failed to

consistently cooperate with the treatment to an extent that has

resulted or may result in relapse of the mental disorder or

inadequate response which has previously led or may lead to

involuntary admission to a licensed facility; and

(c)

the person should be given treatment for the illness

in the interest of his own safety or for the protection of others;

and

(d) the treatment required for the person can be safely

provided in the community.

(5)

After granting a Community Treatment Order, the

Commissioner shall inform in writing the person and his responsible

carer about the Order.

(6)

Upon request from a person who is receiving treatment

under a Community Treatment Order in the private healthcare sector

or his responsible carer, the Commissioner may direct the clinical

director responsible for psychiatric care in the public sector to arrange

for such treatment to be provided in the public sector under the same

conditions under which treatment is provided in the said sector, if in

the opinion of the Commissioner the person lacks the financial means

for private treatment, provided that such treatment is available in the

public sector.

(7)

There shall be a public officer duly authorised by the Supervision

clinical director responsible for psychiatric care in the public sector Register.

who shall keep an updated supervision register listing all patients who

are on a Community Treatment Order and indicating their respective

level of risk. A copy of this information shall be sent to the

Commissioner every six months.

[Article 33(2)(b)]

Part II

Mental Health Act This application shall be submitted to the Commissioner.

IIT Ref No

APPLICATION

FOR INVASIVE OR IRREVERSIBLE TREATMENT

To the Commissioner for the Promotion of Rights of Persons with Mental Disorders.

(1) Please approve my request in respect of

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

(Ward)

of (address) ......................................................................................................

to undergo invasive or irreversible treatment for his/her mental disorder.

(2) If applicable, indicate if person is

a voluntary patient .............................

an involuntary patient under an Involuntary Admission for Observation

IAO Ref No ..............

an involuntary patient under an Involuntary Admission for Treatment

Order

IATO Ref No .............

an involuntary patient under an Extension of Involuntary Admission for

Treatment OrderEIATO Ref No ..........

an involuntary patient under a Continuing Detention Order

CDO Ref No ..............

an involuntary patient under a Community Treatment Order

CTO Ref No ..............

(3) Specify treatment to be given

(4) Treatment is to be performed by .................................................

(5) I certify that

• the patient has the mental capacity to give, and has given, informed consent

to undergo such treatment;

• the consent is in writing and signed by the person (copy attached);

• there is sufficient evidence-based knowledge about this treatment;

• the treatment benefits the health needs of the patient;

• every available alternative treatment that could reasonably be regarded as

likely to produce a sufficient and lasting benefit has been given to this patient

without a sufficient and lasting benefit.

(6) Attached is a clinical report on the recommended treatment including the

• patient’s treatment history;

• proposed treatment;

• reasons for such treatment;

• evidence-based knowledge about this treatment; and

• benefits for this patient.

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Application received on (date) ............................

Action

Comments

Decision

Treatment approved

Treatment not approved

My decision was communicated in writing to the responsible specialist on

(date) .....................

(Signature)

(Official Stamp)

(Date)

(Time)

A person who is a voluntary or involuntary patient within Medical

a licensed facility or who is living in the community, may be placed recommen-

dation for a

on a Community Treatment Order following a medical Community

Treatment

recommendation which shall be made by a specialist, preferably the Order.

responsible specialist where applicable, and a medical practitioner,

preferably the medical practitioner who will be following the patient

in the community under the supervision of the responsible specialist,

after assessing the person within a maximum period of 24 hours of

each other and who are to fill Part (A) and Part (B) respectively of the

relevant application in accordance with the Seventh Schedule.

[Article 37(1)]

Mental Health Act This application shall be submitted to the Minister responsible for Justice.

APPLICATION FOR LEAVE UNDER ARTICLE 37

FOR A PERSON DETAINED UNDER COURT ORDER

To the Minister of Justice.

(1) I the undersigned, a specialist in mental health, request that

M / F

(Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

of (address) ......................................................................................................

who is an involuntary patient under the Mental Health Act and is subject to a

court order issued on .............................., be allowed to leave this facility on

special leave from (date) ........................ to (date) .............................. as part

of his care plan.

(2) Give reasons why special leave is recommended

(3) The following conditions shall apply if special leave is approved

(Official Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

Special leave is not granted

Special leave is granted

Special leave is granted subject to the following conditions

(Signature)

(Official Stamp)

(Date)

(Time)

Passed by the House of Representatives at Sitting No. 531 of the 3rd

December, 2012.

M ICHAEL F RENDO

Speaker

R AYMOND S CICLUNA

Clerk to the House of Representatives

(1) No application for a Community Treatment Order Application for

may be made unless the medical recommendation has been Community

Treatment

completed.

Order.

(2)

An application for a Community Treatment Order may

be made by the responsible carer in Part (C) of the relevant

application form in accordance with the Seventh Schedule, failing

which or when the responsible carer explicitly refuses consent for

such an application, a mental welfare officer may make such an

application certifying on Part (D) of the relevant application form in

accordance with the Seventh Schedule that he is satisfied that such an

application ought to be made and is of the opinion that there are valid

reasons for a Community Treatment Order. If the mental welfare

officer is of the opinion that such Community Treatment Order is not

justified, he shall fill the relevant part of the application form giving

reasons for his disagreement, provided that such disagreement shall

not prevent or delay the submission of the application to the

Commissioner for consideration.

(3)

An application for a Community Treatment Order shall

be accompanied by a care plan which shall

(a)

indicate a key healthcare professional responsible

for co-ordinating the various interventions and for explaining to

the patient his rights and the care plan in a language that the

patient can understand;

(b) be formulated by the responsible specialist in

collaboration with other healthcare professionals as appropriate,

with the patient concerned and with the responsible carer;

(c)

specify the medicinal products, appointments and

other aspects of care that the healthcare professionals believe

are necessary to enable the person to live in the community; and

(d) specify the names of the healthcare professionals

responsible to provide each identified intervention required by

the patient.

(1) In those cases where the medical practitioner

responsible to provide treatment to the person on a Community

Treatment Order is not the specialist or the medical practitioner

making the recommendation, such medical practitioner shall signify

his agreement to provide the treatment on the prescribed form in

accordance with the Eighth Schedule and forward it to the

Commissioner.

(2)

When the medical practitioner providing community

medical treatment is not the specialist making the medical

recommendation, the patient shall remain under the supervision of the

responsible specialist, provided that the responsible specialist and the

medical practitioner providing treatment to the patient shall keep

regular liaison with each other.

A Community Treatment Order shall only be granted for Duration.

a maximum period of six months which may be renewed for further

periods of up to six months after the submission of a new application

and provided that the criteria for granting such an order exist.

(a)

It shall be the duty of the key healthcare Failure by

professional responsible for the co-ordination of the care plan to patient

comply with

ensure that the patient is following the prescribed care plan.

care plan.

(b)

If such healthcare professional believes that the

patient is not complying with his obligations and the responsible carer

can not ensure that the patient complies with the care plan, he shall

inform the responsible specialist who then may issue a Conveyance

Order on the prescribed form in accordance with Part I of the Ninth

Schedule asking the police to bring such patient to the responsible

specialist for an assessment.

(c) The responsible specialist shall assess the patient

and order treatment accordingly.

(d) If such treatment is refused, the patient may be

detained involuntarily in a licensed facility for a period not exceeding

two hundred and forty hours after which period the patient shall either

be discharged on the Community Treatment Order, or detained as a

voluntary patient or if it becomes evident that the patient requires

further involuntary admission for therapeutic reasons, an application

for an Involuntary Admission for Treatment Order shall be made in

accordance with article 12, concurrently with an application for the

revocation of the Community Treatment Order in accordance with

article 23.

No disclosure of information by healthcare professionals Disclosure of

information.

to third parties shall take place unless

(a)

the patient consents in writing, or

(b) the release of information to the responsible carer or

other person is required for the ongoing care of the patient under

the Community Treatment Order, or

(c)

for the care or safety of other persons, or

(d)

to any person or authority entitled by law to receive

it.

A Community Treatment Order may be revoked by the

Commissioner following an application for the purpose submitted by

the responsible specialist, on the prescribed form in accordance with

the Tenth Schedule.

PART V

MENTAL CAPACITY

(1) A person suffering from a mental disorder shall be

deemed able and competent to make decisions unless certified by a

specialist as lacking mental capacity to do so.

(2)

Only a specialist may certify a person suffering from a

mental disorder as having mental capacity or lack thereof.

(3)

Whenever it is deemed by a specialist that lack of mental

capacity is of a transient nature not exceeding fourteen days, such

transient lack of mental capacity shall be duly documented in the

patient’s clinical records.

(4)

Certification of lack of mental capacity for a period

exceeding fourteen days but not exceeding twenty-six weeks or for

the purpose of an application for incapacitation or interdiction in

terms of the relevant provisions of the Civil Code and the Code of

Organisation and Civil Procedure shall be made by the specialist on

the prescribed form in accordance with the Eleventh Schedule giving

(a)

the reasons for such a decision; and

(b) the category and, or type of decisions that the person

is incapable of taking; and

(c)

the estimated duration of such lack of mental

capacity.

(5)

It shall be the duty of the specialist to refer the duly filled

prescribed form to the Commissioner within twenty-four hours of

such certification and the Commissioner shall appoint an independent

specialist to verify such certification.

(6)

Certification in terms of the Eleventh Schedule shall only

be valid as approved by the Commissioner, and if such approval

includes the recommendation of an application for incapacitation or

interdiction, such certification shall cease to be valid after the lapse of

twenty-six weeks from the date of approval, unless procedures for

incapacitation or interdiction have been initiated.

(7)

If during an approved period of lack of mental capacity,

it is found that the person concerned no longer lacks mental capacity,

a specialist shall apply to the Commissioner for the revocation of the

certificate of lack of mental capacity in terms of the Twelfth

Schedule, and the Commissioner shall appoint an independent

specialist to assess the person and approve or otherwise the

revocation of the certificate of lack of mental capacity.

(8)

The Commissioner shall notify the Registrar of the Court

of Voluntary Jurisdiction of all certificates of lack of mental capacity

approved or revoked in terms of the Eleventh and Twelfth Schedules

respectively and the Minister with the concurrence of the Minister

responsible for Justice, shall make regulations to establish the

procedure for entry and removal of such registrations.

(9)

Every decree of incapacitation or interdiction given by a Incapacitation

court of law on grounds of lack of mental capacity shall be notified to or interdiction.

the Commissioner who may, if he so deems necessary, during the

period of incapacitation or interdiction request the assessment by

three specialists to review the mental capacity of the person

concerned and where, after considering the said review, the

Commissioner is of the opinion that the person concerned no longer

lacks mental capacity, the Commissioner shall inform the court

accordingly.

(10) Nothing in this article shall be construed or interpreted in

such a way to affect the application of the Criminal Code.

During any court proceedings regarding the Report to Court

incapacitation or interdiction of a person, the Commissioner may by

Commissioner.

submit a report to the Court before which the proceedings are pending

if he suspects or has knowledge that such court proceedings were

initiated for vexatious or fraudulent reasons.

In addition to any other function, duty or responsibility Additional

imposed by any other law, a person appointed to act as a curator for a functions

curator.

person who lacks mental capacity and who has been incapacitated or

interdicted by order of a court shall also

(a)

encourage and support the person to live a normal

life in the community;

(b) ensure that the person is complying with any

treatment prescribed for his mental and physical conditions;

(c)

ensure that the person, as far as possible, be self

reliant in matters relating to his personal, domestic and financial

affairs;

(d) protect the person from any neglect, abuse or

exploitation;

(e)

submit to the Commissioner within three months of

his appointment a register of assets belonging to the person;

(f)

notify and seek the approval of the Commissioner of

any transfer of assets belonging to the person to a third party

prior to such transfer taking place;

(g) submit every six months to the Court and to the

Commissioner an income and expenditure account of the person

backed by all relevant documents.

(1) The Commissioner shall monitor and seek any

information from the curator in order to ascertain that the person is

not being neglected, abused or exploited and that the functions

referred to in the preceding article are being carried out.

(2)

If the Commissioner finds or has reason to believe that

the curator is not acting in the best interests of the person, he shall file

an application in the competent court asking for a change of curator.

PART VI

MINORS

When a person who is still a minor is admitted to a

licensed facility, the admitting licensed facility shall, within

reasonable limits, grant flexible visiting hours to parents to minimise

the effects of parent-child separation, unless the responsible specialist

in consultation with the other members of the multidisciplinary team,

believes that such separation is in the best interests of the minor

Provided that when neither of the parents of the minor is

the responsible carer, this article shall apply to the responsible carer

Provided further that if there is a potential or real conflict

of interest between the minor and the parent or the responsible carer,

the Commissioner may, after consultation with the multidisciplinary

team, direct that access to the minor is not to be provided to the parent

or the responsible carer and the Commissioner may refer the case to

the competent authority for the commencement of proceedings for an

interim care order and the appointment of a tutor.

When the patient is a parent with dependent minors, the

licensed facility shall, within reasonable limits, grant flexible visiting

hours to the minors to minimise the effects of parent-child separation,

unless the responsible specialist in consultation with the other

members of the multidisciplinary team, believes that such separation

is in the best interest of the minors and, or the parent.

(1) Without prejudice to the provisions relating to Involuntary

involuntary admission for observation under this Act, an involuntary admission

observation.

admission for observation of a minor suffering from a mental disorder

shall only be permissible if a specialist who has clinical experience of

working with minors with mental health problems and has so been

appointed for the purpose by the Minister certifies on the prescribed

form in accordance with the Thirteenth Schedule that community

based alternatives are not available or are unlikely to be effective or

have been tried and failed or are unsafe.

(2)

Without prejudice to the provisions relating to the Involuntary

Involuntary Admission for Treatment Order under this Act, an Admission

Treatment

Involuntary Admission for Treatment Order in the case of minors Order.

shall be granted by the Commissioner for a maximum period of four

weeks.

(3)

Without prejudice to the provisions relating to the Extension of

Extension of Involuntary Admission for Treatment Order under this Involuntary

Admission for

Act, an Involuntary Admission for Treatment Order in the case of Treatment

Order.

minors shall only be extended for a period of four weeks or less up to

a maximum period of twelve weeks from the initial date of the

involuntary admission.

(4)

Without prejudice to the provisions relating to the Continuing

Continuing Detention Order under this Act, a Continuing Detention Detention

Order.

Order in the case of minors shall only be granted by the

Commissioner for a maximum period of three months which may be

renewed for further periods of up to three months after a new

application is submitted to the Commissioner.

(1) (a) In those cases where in the opinion of the Treatment and

responsible specialist, a minor has sufficient maturity and care of minors.

understanding to consent to treatment, no treatment or care shall be

given to the minor unless the minor consents to it

Provided that in the case of an involuntary admission if

the minor refuses to give consent, treatment can be given to prevent

physical harm to self or others or to prevent mental deterioration and

notes to this effect shall be entered in the clinical records

(b) In those cases where in the opinion of the

responsible specialist, the minor lacks sufficient maturity and

understanding to consent to treatment, the consent of the responsible

carer shall be required

Provided that in the case of an involuntary admission, if

the responsible carer cannot be traced or refuses to give consent,

treatment can be given to prevent physical harm to self or others or to

prevent mental deterioration and notes to this effect shall be entered

in the clinical records and in such cases measures to replace the

responsible carer in terms of article 4 may be taken.

(2)

No psychosurgery, sterilisation, implantation of

hormonal or other invasive devices to modify sexual and, or

emotional and, or behavioural changes arising from mental illness

shall be carried out on minors.

(3)

No clinical trials or other medical or scientific research

shall be carried out on minors suffering from a mental disorder unless

the Commissioner is satisfied, after an independent review by two

specialists, that the expected benefits of the trials or research are

likely to outweigh any potential harm to that minor. Such trials or

research shall be subject to ethical and any other additional

safeguards that may be applicable. Furthermore, the Commissioner

shall appoint an appropriate independent specialist to monitor the

minor during such trials or research.

PART VII

SPECIAL TREATMENTS, RESTRICTIVE CARE AND CLINICAL

TRIALS OR OTHER MEDICAL OR SCIENTIFIC RESEARCH

(a) No major medical or surgical procedure shall be

carried out on a patient suffering from a mental disorder unless such

person gives written informed consent.

(b) In those cases where in the opinion of the

responsible specialist, the person lacks mental capacity to give

consent, or being a minor lacks sufficient maturity and understanding

to consent to treatment, then consent shall be given by his responsible

carer.

(c) The provisions of paragraphs (a) and (b) shall not

be applicable in an emergency where the patient’s life is at risk.

(1) The Minister may by regulations under this Act

determine which therapeutic interventions considered to be invasive

or irreversible treatments for mental illness are to be included in the

Special Treatment List in Part I of the Fourteenth Schedule.

(2)

Special treatments shall only be carried out on a patient

with a mental disorder if

(a)

free and informed consent is given by the patient or

by the responsible carer if in the opinion of the responsible

specialist the patient lacks the mental capacity to give consent

or being a minor lacks sufficient maturity and understanding to

consent to treatment; and

(b) the Commissioner has approved such treatment after

an application in accordance with Part II of the Fourteenth

Schedule has been submitted by the responsible specialist, and

he is satisfied that consent is free and informed and that there is

sufficient evidence based knowledge that the procedure benefits

the health needs of the patient.

(3)

Electro-convulsive therapy shall only be administered

after obtaining

(a)

a second opinion from another specialist other than

the responsible specialist confirming the appropriateness of

such treatment; and

(b) informed consent from the patient, or from the

responsible carer if in the opinion of the responsible specialist,

the patient lacks the mental capacity to give consent or being a

minor lacks sufficient maturity and understanding to consent to

treatment.

(1)

Restrictive care shall only be permissible if it is

Restrictive care.

(a)

the only means that will prevent imminent harm and

danger to self and others; and

(b) prescribed by a medical practitioner duly authorised

by the clinical director of the licensed facility to order such

interventions.

(2)

The reasons and duration of restrictive care and the

treatment given shall be entered in the patient’s clinical records by the

medical practitioner authorising such procedures who shall also enter

all the details required in a register made available to the

Commissioner.

(3)

Restrictive care shall only be provided under the care and

close and regular supervision of trained members of staff.

(4)

Whenever restrictive care is ordered, the responsible

carer shall be informed within twenty-four hours of such intervention.

(5)

Restrictive care shall not be

(a)

prolonged beyond the period necessary for the

purpose for which it was prescribed and administered;

(b) used as a means of punishment or for the

convenience of staff.

(1) No person with a mental disorder may be subjected

to clinical trials or other medical or scientific research unless

(a)

free and informed consent is given by the said

person; and

(b) an independent specialist appointed by the

Commissioner examines the person and certifies in the clinical

records that in his opinion the person is capable to give free and

informed consent and that the expected benefits of the trials or

research are likely to outweigh any potential harm to that

person; and

(c)

there is the approval of the ethics committee

appointed by the Minister under the Clinical Trials Regulations.

(2)

No person who lacks the mental capacity to give free and

informed consent may be subjected to clinical trials or other medical

or scientific research unless

(a)

the Commissioner is satisfied after assessment by

two independent experts, one of whom shall be a specialist in

mental health, that the expected benefits of the trials or research

are likely to outweigh any potential harm to that person; and

(b)

there is the approval of the responsible carer; and

(c)

there is the approval of the Ethics Committee

appointed by the Minister under the Clinical Trials Regulations.

(3)

The person or, in the case of a person lacking mental

capacity to give free and informed consent, the responsible carer, has

the right to withdraw his consent for participation in any clinical trials

or medical or scientific research at any time.

(4)

Notwithstanding the provisions of this article, article

31(3) shall apply in the case of minors.

PART VIII

PATIENTS CONCERNED IN CRIMINAL PROCEEDINGS

(1) Where in the course of any proceedings on the Detention for

charge of a criminal offence the question of the mental capacity of the observation

persons charged

accused, whether at the time of the offence or of the proceedings with

offence.

arises, the court shall request independent specialist opinion in order

to assist it in establishing whether it would be necessary or expedient

to order that the accused be admitted to a licensed facility for forensic

patients for observation, and may also give such other directions as

may be appropriate.

(2)

Where an order is made as provided in subarticle (1), the

period of the detention of the accused shall be regulated by the court

by which the order has been made, and such order shall be sufficient

authority for the detention of the accused in the licensed facility for

the period allowed by court

Provided that an order as provided in sub-article (1) shall

be reviewed by the court at intervals of not more than three months

and in such review the court shall hear independent specialist opinion.

(3)

For the purposes of this article, the expression "criminal

offence" includes a military offence under the Malta Armed Forces Cap. 220.

Act.

Where an order has been made by a court of criminal Persons ordered

jurisdiction under article 402(4), or under article 525(3) or under to

custody on plea

article 623 of the Criminal Code or by a court martial under article of

122 of the Malta Armed Forces Act, upon a finding that the accused Cap. 220.

was insane at the time of the offence, whether or not he is insane at

the time of the criminal proceedings, or if found to be insane at the

time of the proceedings, or by any other court under any other

provision of law upon similar grounds, directing that the accused be

kept in custody in a licensed facility for forensic patients, the accused

shall be conveyed to and detained and kept in custody in that licensed

facility by virtue of the order of the court and shall be treated as if he

were a patient liable to be detained in the licensed facility under Part

IV subject to the following restrictions

(a)

none of the provisions of Part IV relating to the

duration, renewal and expiration of authority for the detention

of patients shall apply, and the patient shall continue to be liable

to be detained by virtue of the court order until he is discharged

by the court on the submission of a report by three specialists,

one of whom is the responsible specialist, that the person can be

so discharged. The court may remit the accused to prison for the

continuation of the proceedings on the charge preferred against

him, subject to the application thereafter of the provisions of the

Criminal Code relating to the granting of bail;

(b) leave of absence can be given to the patient as part

of the treatment plan following the approval granted and under

such conditions imposed by the Minister responsible for justice.

An application for leave to the Minister responsible for justice

shall be made by the responsible specialist responsible for the

patient during his stay in a licensed facility, on the prescribed

form in accordance with the Fifteenth Schedule. The Minister

responsible for justice or the responsible specialist may recall

the patient at any time and order the police in accordance with

Part II of the Ninth Schedule to take the patient in custody and

convey him to the licensed facility;

(c)

notwithstanding any other provisions of this Act, the

Minister responsible for justice may, if satisfied that the

attendance at any place in Malta of a patient liable to be

detained by virtue of a court order is desirable in the interests of

justice or for the purpose of any public enquiry or for any other

public interest, direct that he be taken to that place; and where

such a direction is so given the patient shall be so taken and be

kept in custody while being taken, while at that place and while

being taken back to the licensed facility in which he is liable to

be detained; and

(d) no application or reference may be made to the

Commissioner in respect of the patient provided that the

Minister responsible for justice may refer the case of the patient

to the Commissioner for advice.

(1) A person who, for whatever reason is in prison,

develops a mental disorder whilst in prison and can not be adequately

treated in prison, shall be transferred to a licensed facility for forensic

patients on the approval of the person responsible for the

management of such prison.

(2)

(a) Such person shall have the same rights of a

voluntarily admitted patient unless the criteria of involuntary

admission are applicable, in which case he shall have the same rights

of an involuntarily admitted patient.

(b) Such person shall be subject to any restrictions

imposed by prison regulations.

(c) If involuntary treatment is necessary, the formal

procedures provided for under this Act shall be followed.

(d) A person shall be transferred back to prison once

care in a licensed facility is no longer required and the term of

imprisonment has not expired.

(e) In those cases where the term of imprisonment has

expired but the patient still requires care, then such person shall be

transferred from the licensed facility for forensic patients and

detained in such other place within a licensed facility such that care

be given according to the provisions of Part IV.

(3)

The Minister responsible for justice or the Commissioner

may seek the advice of two independent specialists not responsible

for the care of the prisoner to certify that in-patient care, whether

voluntary or involuntary, is required by the prisoner.

The Minister responsible for justice may make Power to make

regulations for prescribing anything which is required or authorised regulations

under this Part.

to be prescribed under this Part and otherwise for carrying this Part

into full effect.

PART IX

MENTAL HEALTH LICENSED FACILITY

(1) (a) Any facility purporting to provide mental health Licensing of

services shall be duly licensed and regulated by the competent mental

facilities.

authority and shall abide by all the conditions specified in such

licence.

(b) Furthermore a mental health facility purporting to

provide services to involuntary patients, minors and forensic patients

shall be so specifically licensed.

(2)

A licensed mental health facility shall draw up

operational guidelines in furtherance of the provisions of this Act.

(a) Every licensed facility shall have a written patient Patient care

care management protocol supported by adequate resources to ensure management

protocol.

that effective and efficient care is provided and the risk of

institutionalisation is minimised.

(b) It is the duty of the clinical director of the licensed

facility to ensure that all healthcare staff comply with such patient

care management protocol and to inform the chief executive officer of

that facility when any healthcare professional fails to comply with

such a protocol.

(c) It is the duty of the chief executive officer to

investigate and take appropriate remedial action where staff is not

complying with such protocols.

It shall be the duty of the chief executive officer of a

licensed facility to forward on a monthly basis to the Commissioner

all patient incident reports occurring in that facility and death records

of patients dying in the same facility.

PART X

PROMOTION OF SOCIAL INCLUSION

(1) Any person suffering from a mental disorder shall,

as any other citizen, have access to or provision of any available

health, educational or social service, including social housing and

appropriate work training programmes, provided by the State and

shall have the right to the same quality of treatment, and subject to the

other provisions of this Act, to confidentiality and consent to

treatment.

(2)

The Commissioner may make recommendations to the

Minister responsible for Social Policy in respect of social welfare,

social assistance schemes and subsidies in order to address the needs

of persons with mental disorders and to facilitate their integration in

the socio economic environment.

(3)

Persons with mental disorders shall enjoy equal

opportunities and protection from discrimination. The Commissioner

shall take appropriate action against anyone who discriminates, or

exploits a person by reason of his mental health status.

(4)

The Commissioner shall make recommendations to

competent authorities to further promote the social inclusion of

persons suffering from a mental disorder.

PART XI

MISCELLANEOUS

(1) Where an application for involuntary admission of

a person for observation in a licensed facility has been completed in

accordance with articles 9 and 10, and the person refuses to cooperate

such that the admission cannot occur, any of the medical practitioners

or the responsible carer or the mental welfare officer signing the

application shall request police assistance, and such police assistance

shall be provided so that the person is taken to the licensed facility.

(2)

Where a patient who is liable to be detained as an

involuntary patient in a licensed facility under Part IV -

(a)

has absconded from the licensed facility without

leave or permission, or

(b) is on leave from the licensed facility and fails to

observe the conditions of the release specified in the care plan,

he shall in the first instance be recalled to that facility by the

responsible specialist or a delegated member of the multidisciplinary

team with the help of the responsible carer

Provided that if the patient still refuses to return to that

facility, the responsible specialist shall request police assistance by

issuing a Conveyance Order in accordance with Part I of the Ninth

Schedule, and such police assistance shall be provided so that the

patient is returned to the licensed facility

Provided further that if the responsible specialist or

delegated member of the multidisciplinary team fails to locate the

patient’s whereabouts, the police shall be obliged to seek the said

patient, determine his whereabouts and return the patient to the

licensed facility.

(3)

Where a patient who is under a compulsory Community

Treatment Order fails to abide by the conditions and obligations of

the treatment plan, the key healthcare worker shall make reasonable

attempts to obtain his co-operation with the help of the responsible

carer

Provided that if the patient still refuses to comply with

the conditions and obligations of his care plan the key healthcare

worker shall inform the responsible specialist who may then request

police assistance by issuing a Conveyance Order in accordance with

Part I of the Ninth Schedule, and such police assistance shall be

provided so that the patient is brought to the responsible specialist for

assessment and treatment if necessary in accordance with the

provisions of article 21.

(4)

When a person is suspected of suffering from a serious

mental disorder and is considered to be a danger to himself or others,

the responsible carer, the key healthcare professional in terms of

article 18(3)(a), a social worker or the police may file an application

before a magistrate asking authorisation to enter that person’s house

and take such person to a licensed facility for immediate assessment

Provided that a warrant to enter private premises shall

not be required in an emergency situation where there is a serious

likelihood of immediate physical harm to the patient or to third

parties.

(5)

For the purposes of providing such assistance as may be

required in terms of this article, the police shall have the power to

enter any premises, and to seek, detain and take a person to a licensed

facility for assessment and, or treatment as provided for in this Act.

(1) No healthcare professional or other person may

apply any of the provisions of this Act in respect of a person related to

him up to and including the third degree by consanguinity or affinity,

except if appointed as the responsible carer, in which instance, such

healthcare professional or person may only perform the duties and

roles of responsible carer as provided for in this Act.

(2)

A person who may demand incapacitation or interdiction

of another person, shall not be a healthcare professional or other

person involved in the application of any of the provisions of this Act

with respect to that person, except if appointed as the responsible

carer, in which instance, such healthcare professional or person may

only perform the duties and roles of responsible carer as provided for

in this Act.

Any decision or order taken or made by the

Commissioner under any of the provisions of this Act shall be subject

to appeal to the Court of Voluntary Jurisdiction.

(1) Without prejudice to any provisions of this Act or

to any other power or function conferred on him by any other law, it

shall be the function and responsibility of the Minister generally to

promote, protect, improve and maintain the mental health and well-

being of all persons in Malta.

(2)

For the purposes of subarticle (1), the Minister shall

ensure the provision of an integrated and comprehensive network of

quality mental health services within the available resources.

(3)

In particular the Minister may, subject to the provisions

of this Act, make regulations to give effect to any provisions of this

Act or to regulate or otherwise provide for any thing in respect of the

functions and the activities which affect the provision of healthcare,

and may in particular, but without prejudice to the generality of the

aforesaid, make regulations for any of the following purposes

(a)

to give effect, regulate or otherwise provide for the

rights of mental healthcare users and the support to be given to

their carers;

(b) to provide for any form or procedure which may be

required or expedient and for which there would be no specific

procedure in this Act;

(c)

to establish or prescribe anything which is due or

may be due to be established under this Act and to provide on

any other matters as may be provided for in this Act;

(d) to establish a range of fines which shall not exceed a

maximum of a fine (multa) of three thousand euro (€3,000) for

any contravention or breach of any provision of regulations

made under this Act, or for non-compliance with any provision

or any requirement imposed under such provision;

(e)

to amend any Schedule to this Act.

(1) Without prejudice to the provisions of subarticles Repeal and

(2) and (3), the Mental Health Act, hereinafter referred to as "the saving.

repealed Act", is hereby repealed.

(2)

Notwithstanding the provisions of subarticle (1), any

regulations or orders made under the provisions of the repealed Act

and still in force on the commencement of this Act shall, until

provision is made by or by virtue of this Act, continue in force and

have effect as if made under this Act.

(3)

Any action or proceedings taken in relation to any person

under the repealed Act shall continue to have effect as if it were an

action or proceedings taken or commenced under a corresponding

provision of this Act.