Att dwar is-Saћћa Mentali

The short title of this Act is the Mental Health Act.

PART I

PRELIMINARY

[Article 3(1) ]

Mental Health 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.

To be filled by (1) Please approve my request to restrict freedom of

communication in respect

of

M / F

mental health. ................ .................... ...............

(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)

MENTAL HEALTH

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)

MENTAL HEALTH

In this Act unless the context otherwise requires

"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,

o r p s y c h o l o g y, a n d " h e a l t h c a r e s t a ff " s h a l l b e c o n s t r u e d

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

o f t h e C i v i l Co d e a nd t h e Co d e o f O rg a ni z a ti o n a nd Ci v i l

Procedure;

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

facility or in the community receiving treatment and care against

*see article 1(2) of the Act as originally enacted, and Legal Notice 276 of 2013

(a) articles 1, 2, 3, 4, 5, 6, 7(1), 7(3), 14, 22, 25, 26, 27, 28, 29, 31, 32, 33, 34, 35,

38, 39, 40, 41, 42, 43, 45, 46 and 47, and the First and Fourteenth Schedules came into

force on 10th October, 2013; and

(b) articles 7(2), 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 23, 24, 30, 36, 37, 44

and 48, and the Second, Third, Fourth, Fifth, Sixth, Seventh, Eighth, Ninth, Tenth,

Eleventh, Twelfth, Thirteenth and Fifteenth Schedules came into force on 10th

October, 2014.

MENTAL HEALTH

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

MENTAL HEALTH

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 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) ....................................................................................................................

To be filled by 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)

MENTAL HEALTH

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)

MENTAL HEALTH

PART (B) - APPLICATION BY RESPONSIBLE CARER

Please make an Involuntary Admission for Observation for

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

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

 Request that .............................................. ID No ....................

be involuntarily admitted for observation in a licensed mental

health facility.

 Do not request that .................................... ID No ....................

be 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 welfare officer appointed by the Minister in terms of the

mental welfare Mental Health Act request that ....................................... ID No

if .......................... be involuntarily admitted for observation in a

licensed mental health facility.

that I certify that

an involuntary  the responsible carer has not agreed to such an admission

 the responsible carer can not be found

carer 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

MENTAL HEALTH

OR

has been filled. 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

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) .................................................

(Official Stamp)

(Date)

(Time)

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

Comments

(Signature)

(Date)

(Time)

MENTAL HEALTH

(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

MENTAL HEALTH

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 This application shall be submitted to the Commissioner within 240

Act

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

(Surname)

(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) ..........................

To be filled by I am the responsible specialist of the above mentioned person in

responsible

terms of the Mental Health Act. It is my opinion that

specialist in

mental health. (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)

MENTAL HEALTH

To be filled by 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)

MENTAL HEALTH

(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

MENTAL HEALTH

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 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 ...............

To be filled by I am the responsible specialist of the above mentioned person in terms

of the Mental Health Act. It is my opinion that

mental health. (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)

MENTAL HEALTH

To be filled by 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)

MENTAL HEALTH

(1) There shall be established a Commissioner for the

Promotion of Rights of Persons with Mental Disorders, hereinafter

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

Minister after consulting the Leader of the Opposition under such

terms as he deems appropriate.

MENTAL HEALTH

(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

(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 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

M / F

(Name)

(ID No)

(D.O.B.)

(Sex)

(Ward)

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

To be filled by I am the responsible specialist of the above mentioned person in

terms of the Mental Health Act. It is my opinion that

mental health. (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)

MENTAL HEALTH

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)

MENTAL HEALTH



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

MENTAL HEALTH

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 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

specialist in Involuntary Admission for Treatment Order, IATO Ref No

................... or

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

MENTAL HEALTH

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

facility when he needs inpatient treatment and is willing to receive

(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

MENTAL HEALTH

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 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

(Name)

(ID No)

(D.O.B.)

(Sex)

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

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

Treatment Order?

IATO Ref No

EIATO Ref No

CDO Ref No

Is person already under a Community Treatment Order?

 NO

 YES

CTO Ref No:

MENTAL HEALTH

PART (A) - MEDICAL RECOMMENDATION BY RESPONSIBLE SPECIALIST

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

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

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

 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 .........

Eighth Schedule is enclosed (only 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

MENTAL HEALTH

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

 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

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

mental welfare mental welfare officer appointed by the Minister in terms of the

Mental Health Act request that ........................................ ID No

.................................... be placed on a Community Treatment Order.

I certify that

the responsible carer has not agreed to such an Order

the responsible carer can not be found

carer is absent. 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)

MENTAL HEALTH

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)

MENTAL HEALTH

(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 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

treatment to a (Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

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

(Official

Stamp)

(Signature)

(Reg. No)

(Date)

(Time)

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

Commissione Comments

(Signature)

(Date)

(Time)

MENTAL HEALTH

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

initial medical assessment shall be made by two medical

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

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

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 of

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

single medical a ssessment shall suffice for t he purpose of

application for involuntary admission for observation. The second

medical 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 second

assessment has been carried out unless it is 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 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)

MENTAL HEALTH

(1) No application for involuntary admission for

observation can be made unless the medical assessment has been

carried out and the medical recommendation for admission filled

in.

MENTAL HEALTH

(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 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)

MENTAL HEALTH

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

facility as an involuntary patient he shall be initially detained

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 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.

To be filled by (1) Please withdraw the Community Treatment Order, CTO Ref No

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

M / F

mental health. ..................

(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)

MENTAL HEALTH

(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

MENTAL HEALTH

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 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.

To be filled by (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.

MENTAL HEALTH

(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 Order

EIATO 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)

MENTAL HEALTH

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)

MENTAL HEALTH

To be filled by Independent specialist opinion received on (date) ................ at

Commissioner (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)

MENTAL HEALTH

(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

specialist for a Continuing Detention Order on the prescribed form

in 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 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.

To be filled by (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 Order

EIATO Ref No ..........

an involuntary patient under a Continuing Detention Order

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

an involuntary patient under a Community Treatment Order

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

MENTAL HEALTH

(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)

MENTAL HEALTH

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)

MENTAL HEALTH

Prior to the administration of any treatment, informed

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

patient lacks the mental capacity to give consent, such consent

MENTAL HEALTH

shall 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 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

To be filled by I the undersigned, a specialist with clinical experience of working

with minors with mental health problems, and having been so

appointed by the Minister in terms of the Mental Health Act certify

that

working with (a) I have personally reviewed the minor

M / F

mental health ................

problems and (Surname)

(Name)

(ID No)

(D.O.B.)

(Sex)

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

Mental Health (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)

MENTAL HEALTH

(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.

L.N. 206 of 2017.

[Article 33(1)]

Part I

Mental Health

SPECIAL TREATMENT LIST

Only the following therapeutic invasive or irreversible interventions for mental

illness, as determined by the Minister, may be carried out on a patient with a

mental disorder

Stereotactic Ablative Anterior Capsulotomy for severe refractory Major

Depressive Disorder

Stereotactic Ablative Anterior Capsulotomy for severe refractory

Obsessive Compulsive Disorder

Stereotactic Ablative Anterior Cingulotomy for severe refractory Major

Depressive Disorder

Stereotactic Ablative Anterior Cingulotomy for severe refractory

Obsessive Compulsive Disorder

MENTAL HEALTH

(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

MENTAL HEALTH

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

clinical director responsible for psychiatric care in the public sector

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 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.

To be filled by (1) Please approve my request in respect of

M / F

mental health. (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 Order

EIATO 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.

MENTAL HEALTH

(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)

MENTAL HEALTH

A person who is a voluntary or involuntary patient within a

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

o n a C o m m u n i t y Tr e a t m e n t O r d e r f o l l o w i n g a m e d i c a l

recommendation which shall be made by a specialist, preferably the

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 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.

To be filled by (1) I the undersigned, a specialist in mental health, request that

M / F

mental health. (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)

MENTAL HEALTH

Special leave is not granted

To be filled by

Minister

 Special leave is granted

responsible

for Justice

 Special leave is granted subject to the following conditions

(Signature)

(Official Stamp)

(Date)

(Time)

(1) No application for a Community Treatment Order may

be made unless the medical recommendation has been completed.

(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

MENTAL HEALTH

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 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

(a) It shall be the duty of the key healthcare professional

responsible for the co-ordination of the care plan to

ensure that the patient is following the prescribed 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.

MENTAL HEALTH

(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 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

Organization 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

MENTAL HEALTH

(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 a nd 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

court of law on grounds of lack of mental capacity shall be notified

to 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 incapacitation

or interdiction of a person, the Commissioner may 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

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

a 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

MENTAL HEALTH

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

c a r e r, t h e C o m m i s s i o n e r m a y, a f t e r c o n s u l t a t i o n w i t h t h e

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.

MENTAL HEALTH

(1) Without prejudice to the provisions relating to

involuntary admission for observation under this Act, an

involuntary 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 Admission for Treatment Order under this Act, an

Involuntary Admission for Treatment Order in the case of minors

shall be granted by the Commissioner for a maximum period of

four weeks.

(3) Without prejudice to the provisions relating to the

Extension of Involuntary Admission for Treatment Order under this

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

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 Detention Order under this Act, a Continuing Detention

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.

31.(1)(a) In those cases where in the opinion of the responsible

s p e c i a l i s t , a m i n o r h a s s u ff i c i e n t m a t u r i t y a n d

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

MENTAL HEALTH

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

(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

MENTAL HEALTH

(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

(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

MENTAL HEALTH

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 charge

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

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

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

Act.

Where an order has been made by a court of criminal

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

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

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

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

MENTAL HEALTH

(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.

MENTAL HEALTH

(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 regulations

for prescribing anything which is required or authorised to be

prescribed under this Part and otherwise for carrying this Part into

PART IX

MENTAL HEALTH LICENSED FACILITY

40.(1)(a) Any facility purporting to provide mental health

services shall be duly licensed and regulated by the

competent 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 care

management protocol supported by adequate resources

to ensure 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.

MENTAL HEALTH

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

MENTAL HEALTH

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.

MENTAL HEALTH

(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) Any regulations or orders made under the provisions

of the Mental Health Act, hereinafter referred to as "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.

(2) 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.

MENTAL HEALTH