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Psychiatry (Y4) > 7- Legal issues in psychiatry (MCA, MHA sections, safeguarding) > Flashcards

7- Legal issues in psychiatry (MCA, MHA sections, safeguarding) Flashcards

1
Q

consent must be

A
  • Informed
    o Appropriate level of information
  • Competent
    o Capacity to consent
  • Voluntary
    o Not coerced by relatives, medics, nurses etc
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2
Q

what is capacity

A
  • Ability to make a decision
  • Can involve personal welfare, healthcare and financial decision
  • Empowers adults to make as many decisions as possible
  • Some adults will have fluctuating capacity- time specific
  • Some adults will have the capacity for some things but not others- decision specific/ issue specific
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3
Q

capacity is both

A

decision and time specific

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4
Q

Types of consent

A
  • Implied
  • Withdrawn
  • Verbal, non verbal or written
  • Under age 16 may be competent
    o But cannot refuse life saving treatment until 18
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5
Q

capacity threshold

A
  • Could be drunk or intoxicated with drugs
  • Lack of capacity could be temporary or permanent- may be possible to defer a decision to await return of capacity
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6
Q

two stage capacity test

A
  1. Is there an impairment or disturbance in the functioning of the person mind?
  2. Has it made the person unable to make a particular decision?
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7
Q

How to decide if the person can make that decision?
LEARN

A
  • Understand information given to them
  • Retain that information long enough to be able to make the decision
  • Weigh up the information available to make the decision
  • Communicate their decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.
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8
Q

Incapacitated adult

A
  • MCA places in statute law the ability to make decisions in advance of becoming incapacitated (advanced decision)
    o E.g. a Jehovah’s witness refusing blood in advance
  • If AD have not been made ensure that decisions are made in the patients best interest
  • LPA allows someone else to legally make healthcare decisions for another- but must be made at a time when the person had capacity
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9
Q

principles of the mental capacity act
LEARN

A
  1. Presumption of capacity
  2. All efforts to help them make a decision with capacity e.g. translation, braille
  3. Allowed to make unwise decisions
  4. Best interest decisions
  5. Least restrictive options
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10
Q

best interest decisions and the MCA

A
  • All relevant circumstances must be considered
  • The patient should participate even if lacking in capacity
  • If patient will regain capacity may be appropriate to wait
  • Decision maker MUST ascertain and consider the patients past and present wishes an feelings
  • Must take into account if both practical and appropriate the views of their advance decisions
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11
Q

lasting power of attorney

A
  • Must be made on the prescribed form and registered with the public guardian (essentially a judge)
  • Enables a mentally capable person to plan for incapacity
  • Can extent to propery, welfare , healthcare matters
  • Decisions taken by the LPA are still subject to best interest requirement (go to public guardian if unsure)
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12
Q

DOLS- deprivation of liberty safeguards

A
  • For patients in hospital or care homes who lack capacity
  • MDT assessment
  • Lead by social workers
  • Example: yes you can stop this person from leaving the premises, but twice a week carers will take this patient outside
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13
Q

Difference between the mental capacity act and mental health act

A

- MHA- can only force you to take mental health treatment and not treatment for other physical conditions such as insulin for T1DM
- MCA- can force patients to take medication for both physical and mental health conditions

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14
Q

can a person <18 yo refuse lifesaving treatment

A

No - even if gillick competent

however if over 16 can consent to surgery if gillick competent

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15
Q

example of a pregnant women who needs a cat 1 emergency C-section however refuses to have any injections and is therefore refusing C-section putting her life at risk

A

Needle phobic- try and reason with patient, however due to their needle phobia she does lack capacity- therefore can hold her down

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16
Q

a 16 yo boy has consented to have surgery for abdominal trauma. Just before anaesthetic he clearly says he has changed his mind

A
  • Should try and reconsent patient by chatting to them
  • Have they lost capacity by this point?
  • Is the surgery life saving
17
Q

patient with abdominal trauma is unconscious - if you dont operatr he will die

A

Operate- best interest decision
- Try and speak to best of kin- legal duty
- See if they have a card saying their wishes
- least restrictive

18
Q

patient with abdominal trauma needs surgery but is too drunk to have capacity

A

if it can wait would be best to wait for the patient to have capacity

19
Q

mental health act 1983 (amended in 2007)

A
  • Can only be used to enforce treatment for mental health conditions
20
Q

guiding principles of the MHA

A
  • minimise the undesirable effects of the mental illness
  • least restrictive
  • participation of patient and NoK
  • equity, effectiveness and efficiency
21
Q

Criteria for implementing the act (learn)

A
  • Presence of a mental disorder as defined by law ‘any disorder or disability of the mind’
  • Disorder is of a certain nature (relapsing etc) or degree (severity)
  • Significant risk to the persons health, safety, or safety of other
  • No alternative to hospital admission as a means of safeguarding that risk
22
Q

Important sections of the mental health act

A
  • Section 5(4)
  • Section 5(2)
  • Section 2
  • Section3
  • Section 136
  • Section 17/117
23
Q

Section 5(4)

A
  • Power granted to RMNs (mental health nurse) to detain an inpatient
    (emergency department does not count as being admitted to hospital)

Length and purpose of section
- up to 6 hours for assessment where mental illness is suspected

Protocol
- pink form needs to be completed and submitted to hospital manage

24
Q

Section 5(2)

A
  • Resident Medical Officer (RMO) doctor or nominated deputy (e.g. junior doctor) can detain inpatient (have to have been admitted) for up to 72 hours under the MHA
  • no appeal

Protocol
- legal form for hospital managers
- to allow formal mental health act to be completed

25
Q

Section 2

A
  • 2 doctors (at least 1 of whom should be Section 12(2) approved and 1 AMHP (mental health approved) (not just social worker now)
  • can be done in community or inpatient (not prison)

Length and purpose of section
- up to 28 days
- for assessment (and treatment) of a mental disorder

Protocol
- can appeal within first 14 days- heard within 7 days by tribunal

26
Q

section 3

A
  • 2 doctors (at least 1 of whom should be Section 12(2) approved and 1 AMHP (mental health approved) (not just social worker now)
  • community or inpatient (except prison)

Length and purpose of section
- maximum of 6 months for treatment of mental disorder
- may have another 6 months added

protocol
- appeal to both hospital amangers panel and tribunel

27
Q

section 136

A

police power to remove to a place of safety (mental health hospital, police station, a and e) from a public place for an assessment by AMHP and 1 doctor
- if needed a second doctor attends for a MHA assessment for section 2 and 3

Length and purpose of section
- 72 hours to allow assessment

28
Q

section 17

A
  • whilst detained in hopsital under S2, S3 a patient may have leave under S17
  • leave to walk outside, go home for several hours or overnights
29
Q

section 117

A

anyone who has been on a section 3 is entitled to S117 aftercare from local authority

30
Q

community treatment order

A
  • patients on S3 can be considered for a CTO
  • patients well enough to leave hospital but may default from treatment/follow up
  • treatment is necessary for the patients health, safety or protection of others
  • patient can be recalled to hospital if they do not comply with treatment, attent appointments etc
  • can still appeat to the tribunal
31
Q

which section

A

Section 5(2)

32
Q

which section

A
  • Section 135 (for person in own home/ hotel room)
  • Section 136 (for person in public space)
33
Q

which section

A

section 2

Psychiatry (Y4) (15 decks)

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