Category Archives: Mental Health Law

Registered Nurse Plumber?


I have noted with interest over the years that nurses (and I am one)  have had an attitude of “I can do that. Give me that job” and indeed nurses have expanded their role quite considerably. When accused of trying to be ‘mini doctors’ nurses have responded ‘no we are maxi nurses’.  We have clearly demonstrated that we are capable of so much.

So…with the latest MHA nurses can (after appropriate hoop jumping) can be the responsible clinician or the approved mental health professional, posts previously filled solely by doctors and social workers.

Surely nurses (and the Act) are missing the point?

The greatest strength of any team revolves around the idiosyncrasies that each individual brings to the table but now, oh no, we are removing this uniqueness to leave one ‘new’ professional that simply changes hats to fit the job in hand. 


I am strongly in favour of social workers retaining their role – it is after all a vital position to ensure that the medical model does not dominate. I remember as a newly qualified nurse being impressed by a social worker refusing to ‘sign off’ a detention after two doctors had recommended it – this social worker exerted his own standards and whilst I disagreed with him, I thought that he was doing a splendid job that he was trained to do. He was able to step away from the medical needs and look at the social needs in a wider context.

Nurses, whilst we strive to be separated from it, are biased in the ways of the medical model -Face it.

What is wrong with being a nurse anyhow? I plumbed in a washing machine the other week but I am not asking to be registered as a nurse plumber. Leave the plumbing to the person who trained to be a plumber and who does it day in and day out and the plumber can leave me to nurse.

And another thing….following on from nurses saying “I can do that. Give me that job” there is the follow up call of “Hang on. Have you seen my workload? I’m not paid enough you know!”

washing machine

Images from Flickr creative commons:

1. Plumber James #2 by MoToMo

2. Plumbing by basykes

3. Day 719 / 365 – Wrong Setting by JasonRogersFotographie

A case for appropriate treatment?

Since the “Treatability Clause was removed from the Mental Health Act in 2007 and the phrase ” Appropriate treatment must be available” replaced it we have to consider what is “appropriate treatment”? 

For example can detention alone be appropriate treatment?

In the case of   R(Home Secretary) v MHRT (2004) this matter was ruled on.

It concerned a person alleged to have a psychopathic disorder. Both the medical team and the court felt that in the community he was extremely dangerous. The question was, was he treatable? He was deriving no benefit from treatment programmes. However, it was felt that he could cope in the structured hospital environment.

The Court held that this was enough. The Tribunal accepted that hospital could prevent deterioration by his continuing in custody. Having accepted that factual proposition it was bound to conclude that the condition was susceptible to treatment as it would prevent deterioration of the symptoms of mental disorder were he suffering from a mental disorder

What can we foresee as the implications of such a legal precedent? How will this type of detention impact on our wards? At what point can the detained person hope for discharge?If it is detention alone that prevents the worsening of a disorder will the person ever be fit for discharge?

I would love to hear your views on this case. If there is enough interest I will post another legal and ethical poser soon.