Specialist registrars and responsible medical officer status

Sir: The Mental Health Act 1983 defines certain duties as being the sole remit of the responsible medical officer (RMO). These include the ability to discharge a section; power to bar discharge of a detained patient by the nearest relative; the granting of Section 17 leave; authorisation of consent to treatment and formulation of aftercare under Section 117 of the Act. The RMO, in relation to a detained patient is “the registered medical practitioner in charge of the treatment of the patient” (Mental Health Act 1983, Section 34(1)). The term ‘in charge’ is defined in the 1998 Memorandum as meaning “not responsible or accountable for the patients treatment to any other doctor”. In the absence of the RMO, such duties are delegated to the acting RMO — usually another consultant covering their colleague's duties.

Can the RMO delegate such tasks to his or her specialist registrar (SpR) during leave of absence? In practice it would appear not, as is the case at present in our trust. However, we argue that delegation should be adopted as best practice. The SpR is a senior psychiatric trainee, is member of the Royal College of Psychiatrists (having passed the Membership Exam) and is likely to have a better knowledge of the RMO's patients than a consultant colleague nominally deputising. Furthermore, should not a SpR be able to practise, under supervised conditions, the skills of the RMO, the role for which they are training? Indeed, if a SpR covers as a locum consultant, they exercise full RMO powers. It is difficult in our view to understand how training to become a consultant could be considered complete without supervised experience of working with the complexities of the Mental Health Act.

There is support for our proposal in the relevant literature. Jones (1996) discusses the role of the RMO and notes that the medical practitioner need not necessarily have consultant status. The Mental Health Act Memorandum (1998) states that a SpR approved under Section 12(2) can exercise the role of the RMO when the patient's usual doctor is not available and swift action under the Act is required. The new Code of Practice (1999) names the Specialist Registrar as one of those able to grant Section 17 leave in the absence of the RMO, if they are at the time “the doctor in charge of the patient's treatment” (Section 20.3). Indeed, being the doctor ‘in charge’ of detained patient's treatment at a given time appears to be the key determinant in defining RMO status.

To conclude, we propose that in the absence of a consultant it should be accepted practice that the SpR may practise, under supervised conditions, utilising all the powers allocated by Section 12(2) status and exercising full responsibilities vested in the RMO role. We refer specifically to four areas:

1. (a) Granting of Section 17 leave.

2. (b) Review of consent to treatment under section.

3. (c) Discharge of sections, with aftercare planning under Section 117.

4. (d) Attendance at mental health review tribunals or hospital manager review meetings, to review the section.

We argue that new mental health legislation or guidance should encourage such practice.