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It is always a matter of regret if any patient experiences a serious adverse event associated with medication. The risks associated with medicines must be considered against the potential benefits of the treatment and antipsychotics are extremely effective medicines for the treatment of serious conditions including schizophrenia, agitation, anxiety, mania and aggression. The decision to treat a patient with an antipsychotic drug is primarily based on clinical judgement taking into account the patient''s condition as well as the risks and benefits of treatment.

The Medicines and Healthcare products Regulatory Agency (MHRA) and the expert independent scientific advisory group the Commission for Human Medicines continuously monitor the safety of all medicines available on the UK market. The MHRA ensures that all medicines are supplied with product information which accurately reflects current knowledge and contains the necessary information to aid the safe use of medicine. This includes information about risk minimisation measures for important risks and, where appropriate, also as advice about how patients should be monitored and under what circumstances consideration should be given to stopping the medicine.

More generally, it is important to note that the occurrence of an adverse event may not necessarily mean that it was caused by the medicine. Many factors have to be taken into account in assessing causal relationships, including the possible contribution of concomitant medication and the patient''s underlying condition.

Two pilot announced inspections were undertaken in the Beatson Oncology Centre (NHS Greater Glasgow and Clyde) and Perth Royal Infirmary (NHS Tayside) during June and July 2009. The key learning points were published on:

http://www.nhshealthquality.org/nhsqis/6710.140.1366.html.

This information is not collected centrally. Complaints from individuals about being subject to compulsory measures of treatment under the Mental Health (Care and Treatment) (Scotland) Act 2003 are made locally to the appropriate NHS board.

For short term detention certificates (STDCs), statistics in relation to those who challenge their having been made subject to the certificate may be inferred by the numbers who appeal to the Mental Health Tribunal against the STDC. An individual can appeal to the Mental Health Tribunal for a revocation of a STDC, and Volume 2, Chapter 2 of the Mental Health (Care and Treatment) (Scotland) Act 2003 Code of Practice provides guidance on this. Approximately 100 applications for revocation of a STDC are made each quarter, of these around 50% are withdrawn before being heard and between 10 to 25% are revoked. Source Mental Health Tribunal quarterly statistics:

http://www.mhtscotland.gov.uk/mhts/files/Quarterly%20Report%20April%20to%20June%202009.pdf.

For Compulsory Treatment Orders (CTOs), these longer term orders may be made directly by the tribunal on the application of a mental health officer, and following a Tribunal hearing at which the patient will have been involved to give their view. Again, the most recent Mental Health Tribunal quarterly statistics (for April to June 2009) provide an indication of the percentages of CTOs made by the tribunal (around 77%) of those applied for. Thereafter, statistics in relation to those who continue to object to the CTO having been granted by the Tribunal might be inferred from the number of appeals made to the Sheriff Principal under the statutory mechanisms. In the period September 2008 to August 2009 inclusive the tribunal was served with 14 appeals to sheriff principals, not all of which went to full hearings having been dismissed as incompetent or because the appellant no longer wished to appeal; it should also be noted that not all of those appeals from the tribunal will have been made by patients, some may have been made by health boards.

There are, at present, two established international classification systems for mental disorders - ICD.1O and DSM-IV which have specific criteria laid down which have to fulfilled to enable a diagnosis to be made.

Sometimes a diagnosis may change e.g. an individual may appear to have a psychotic condition such as schizophrenia, due to drug taking, which then disappears after treatment and drug withdrawal.

Also throughout a lifetime an individual''s diagnosis may change as different symptoms emerge.

If an individual has concerns that they have been misdiagnosed then there are a range of options open to them, including that: they may ask for a second opinion; they may apply to the tribunal for revocation of the order; or they may contact the Mental Welfare Commission to look into their complaint.

Volume 2, Chapter 7 of the Mental Health (Care and Treatment) (Scotland) Act 2003 Code of Practice provides guidance on the processes involved in preparing an application for a compulsory treatment order. This includes guidance on the involvement of the Mental Health Tribunal which determines the application and on the individuals who will be allowed to give evidence at a hearing.

The Mental Health Tribunal has a wide discretion in terms of its powers to allow a patient''s solicitor to examine the responsible medical officer and the mental health officer''s evidence. The tribunal also has wide powers of its own to inquire into the evidence available. Scottish ministers would expect that a patient''s legal representative would have the opportunity to examine the evidence before the tribunal and that the tribunal would otherwise probe the evidence itself.

One of the criteria for a person to be made subject to compulsory measures of treatment under the Mental Health (Care and Treatment) (Scotland) Act 2003 is that they have a mental disorder. I refer the member to the answer to question S3W-27157 on 22 September 2009. All answers to written parliamentary questions are available on the Parliament''s website, the search facility for which can be found at http://www.scottish.parliament.uk/Apps2/Business/PQA/Default.aspx.

Volume 2, Chapter 2 of the Mental Health (Care and Treatment) (Scotland) Act 2003 Code of Practice provides guidance on the mental health officer''s interview with the patient. The guidance does not stipulate who may or may not be present at such interviews, although it is expected that independent interviews with the patient by medical professionals would be carried out separately. This is an issue which has already been drawn to officials'' attention and will be considered in the next review of the Code of Practice.

Volume 2, Chapter 2 of the Mental Health (Care and Treatment) (Scotland) Act 2003 Code of Practice clearly sets out the procedures which must be followed before a short-term detention certificate may be granted. The duty on the approved medical practitioner under section 44(10) of the 2003 Act to consult the patient''s named person is subject to the caveat at subsection (11) of section 44, that he or she need not consult the named person where it is impracticable to do so. Likewise, the duty on the mental health officer to interview the patient and take the other required steps before deciding whether to consent to the granting of a short-term detention certificate is subject to the caveat at subsection (2) of section 45, where it is impracticable to do so.

There are three ways in which a person may be subjected to compulsory measures of treatment under the civil regime in the Mental Health (Care and Treatment) (Scotland) Act 2003 (the 2003 Act), namely: (a) emergency detention; (b) short-term detention, and (c) long-term detention or compulsory measures under the authority of a compulsory treatment order. In addition, mentally disordered offenders may be made subject to compulsory measures of treatment by the courts under the Criminal Procedure (Scotland) Act 1995 (the 1995 Act).

The majority of compulsory measures of treatment for mental disorder are first approved by either the Mental Health Tribunal for Scotland under Part 7 of the 2003 Act (compulsory treatment orders) or by a court under the 1995 Act in relation to mentally disordered offenders. The two exceptions to this prior authority for treatment for mental disorder by a court or tribunal are: civil emergency detention under Part 5 of the 2003 Act, and short-term detention under Part 6 of the 2003 Act.

In relation to emergency detention, the authorised period of detention is just 72 hours and the purpose of the detention is to determine what medical treatment requires to be provided to the patient. There is no general authority to give treatment for mental disorder under an emergency detention certificate.

A short-term detention certificate does enable treatment to be given, in accordance with part 16 of the 2003 Act. Volume 1, Chapter 10 of the Mental Health (Care and Treatment) (Scotland) Act 2003 Code of Practice provides guidance on the provision of medical treatment for mental disorder which are set out in part 16, including the issue of consent.

Volume 2, Chapter 7 of the Mental Health (Care and Treatment) (Scotland) Act 2003 Code of Practice details the procedures to be followed by the responsible medical officer (RMO). Where practicable the RMO must consult a Mental Health Officer (MHO) and obtain their consent to the granting of the emergency detention certificate. Where MHO consent is refused the emergency detention certificate may not be granted and the patient may not be detained.

A range of professionals are involved in the care and treatment of an individual under the act. An individual who is required to receive care and/or treatment will have an MHO appointed to work for them. The MHO''s responsibilities include interviewing the individual, advising them of their rights, providing consent for the individual to be assessed or treated in hospital under compulsory measures, applying for a CTO and advising the Mental Welfare Commission and the individual''s named person if they have been detained in hospital or when an application is being made for a CTO. The MHO may also liaise with hospital staff and other members of the multi-disciplinary team involved in the care of an individual.

Anyone carrying out duties or giving someone treatment under the act, e.g. doctors, nurses and social workers, has to follow the principles set out in the act which are to ensure that individuals are treated with respect. This includes taking account of; the patient''s past and present wishes about their care and treatment; the views of their named person, guardian or welfare attorney; the range of options available for their care and treatment; what will ensure the maximum benefit for them; making sure that they are not being treated any less favourably because they are being treated under the act, and the individual''s abilities and background.