Nearest relative (NR)
This is a technical term which gives certain rights under the Mental Health Act. The NR is not the same as the next of kin and not the same as the Carer. Of course, one person can be the next of kin, Carer and nearest relative which makes life more straightforward!
The person nearest the top of this list is treated as the nearest relative:
- Husband, wife or civil partner
- Son or daughter
- Father or mother
- Brother or sister
- Uncle or Aunt
- Niece or nephew
They must be over 18 years old. If partners (including same sex) have been living together for 6 months or more this counts, but partners/spouses who are permanently separated have no NR rights.
With two ‘equal’ people, perhaps Father and Mother, the eldest would be appointed and
similarly full blood relatives over ‘step’ ones.
Those who live abroad are discounted. There are other more complex rules which are
best researched on reputable websites like www.mind.org.uk or by asking professionals
such as the AMHP.
An AMHP can also apply to the county court to have an NR removed when they have a health problem themselves or are seen as being unsuitable. This removal can be challenged in court. A NR can delegate someone else, but they have to put it in writing to their chosen person and to the NHS Trust involved. The AMHP is the best source of information in these situations.
The patient can also apply to have their NR removed, but this is also a county court process. They can also nominate someone if they don’t have a NR, or one that is prepared to get involved, but again, this has to be agreed by the court.
This may seem unnecessarily complex but not all close relatives have the best interest of their cared-for person at heart and this helps to protect those who live with damaging relationships or with abuse.
The patient still has a right to withhold consent to give a NR information about them, they have no more rights here than any other involved Carer.
Nearest relative rights
Most importantly a NR can apply for a person to be assessed under the Mental Health Act.
This doesn’t mean they will automatically be admitted, it still has to be agreed by an AMPH and two doctors, but it can start the process. You can request an assessment by letter or verbally by contacting the duty social worker in the Assessment and Treatment team.
Other NR rights include:
• To be informed if your relative is detained under Section 2.
• To be consulted if Section 3 is being considered – which may happen after a shorter section and perhaps where treatment needs to be enforced (although staff always prefer to persuade someone than make them).
• The NR can request discharge under Sections 2 and 3 and under CTOs. This involves presenting a case to a psychiatrist that a safe alternative is available such as caring at home, but they have the final decision. If the psychiatrist refuses a NR request to discharge, then it goes to the hospital managers who hear evidence from professionals and the patient themselves.
• NRs should be given notification of the end of a section as often this will mean coming home, unless the patient is required to and willing to stay in informally.
The NR or any other relative, partner or friend is never solely responsible for someone being sectioned. The person will always be assessed by professionals who will take the final decision. But if you play any part it will almost certainly cause tension with the cared-for person in the short term.
All people detained under the Mental Health Act have the right to an independent mental health advocate and should be offered this fairly promptly. A NR can request this for the patient, but this doesn’t stop them seeking independent legal advice too if they want to.
Discharge from hospital
Sometimes this happens with little notice whether the person is in under a section or informally. It can be presumed that the Carer is willing to offer a home or their support again. If you feel you can no longer do this state it clearly and frequently, preferably before going home is even mentioned. It can be hard to stay firm when the alternatives are to stay in hospital until accommodation is found – frequently a lengthy process. Emergency
accommodation is often pretty basic and less than ideal. But it is important if you are concerned about your own wellbeing to hold out if you feel it is necessary. A suitable alternative is often found but it takes time.
Professional support will be available at home after discharge, but the Carer is often alone for long periods. If it is the first admission the person may seem different now they are taking medication.
Contact Sussex Partnership’s complaints service or the Care Quality Commission
Complaints about treatment go through the NHS procedures. Going directly to the relevant service manager first can help avoid a formal complaint and be quicker. A formal complaint can take a time to be answered, so won’t produce urgent results. The Patient Advice and Liaison Servcie (PALS) can provide information on how to take a formal complaint forward or get an advocate involved. If the patient doesn’t consent to their files being used then the complaint can get stalled and it may be better to present the evidence from the Carer’s perspective: it could be useful to get advice first, http://www.carersuk.org/ can be helpful here.
For complaints about Adult Social Care services phone the direct social care contact line and ask for information about who to contact or visit their website.