Capacity and sectioning (legal stuff) Flashcards
How should violent pts be managed?
- regonise early warning signs and deescalate
- make sure not alone
- make sure near door
- low threshold to request security
- remove from crowded environment
- talking calmly to pt
- tranquilisation
What tranquilisers should be used if the pt is on regular antipsychotics and if theyre not?
- on regular antipsychotics: oral lorazepam or promethazine
- not: olanzapine, haloperidol or resperidone
- repeat 45-60 mins with buccal midazolam
- if 2 fail: IM lorazepam, promethazine or olanzapine
What monitoring should be done for a pt who has been tranquilised?
- vital signs every 5-10 mins for 1 hr
- monitor ECG, U+E, FBC if high dose antipsychotic used
What are the 5 principles of the mental health act
- Purpose principle: minimise undesirable effects of mental illness
- Least restrictive: minimise restrictions on the patients liberty
- Respect principle: recognise and respect the pt, including race, religion and culture
- Participation: participation of pt and nearest relative
- Equity, effectiveness and efficiency: most effective use of resources
What are the criteria for implementing the mental health act?
- presence of a mental disorder- defined by law as ‘any disorder or disability of the mind’
- needs detention for assessment/ treatment
- significant risk to persons health or safety or safety of others
- no alternative to hospital admission as a means of safeguarding that risk
What is the difference between a section 5 (2) and a section 5 (4)
5 (2): doctor detention of pt already in hospital (being in A&E doesnt count) for 72 hrs, to allow for formal mental health act assessment to be completed and plan where the the pt will go after 72 hrs, cannot be used in ED.
5 (4): nursing holding powers for up to 6 hrs. Must be authorised psychiatric nurse, to detain a pt trying to discharge against advice if discharge is likely to harm pt or others, gives time to allow for a section 5 (2)
What are section 2 and 3?
2: admission for assessment for up to 28 days. Needs 2 doctors (1 is section 12 approved under MHA and other is from a different trust) and an approved mental health practitioner. Appeal within first 14 days, heard within 7 days by a tribunal.
3: admission for treatment for up to 6 months. Needs 2 drs plus 1 AMHP- drs must state why treatment in the community is contraindicated and must have seen the pt within 24 hrs. Pt may appeal to hospital managers panel and tribunals.
What is a section 4?
- admission for emergency treatment for up to 72 hrs
- used when admission urgently necessary
- used if section 2 would cause undesirable delay
- AMPH makes application after recommendation from 1 dr and must be seen by 2nd dr within 72 hrs for section2,3 or discharge
- can be considered for community treatment order: pt can leave hospital but recalled if they do not comply with treatment or attend appointments
What is a section 17 and 117?
17: leave of absence from hospital while under a section 2/3. May be for a walk, to go home for a few hrs, overnight or longer
117: aftercare and the care programme approach (CPA). required provision of care for pts who have been detained on long term sections. CPA stipulates no pts should be discharged without planned aftercare.
What is a section7/8?
- allocated guardian (usually a social worker) who acts in best interests of someone with a mental disorder for up to 6 months
- application made by AMHP and needs 2 drs recommendations
- in section 8 the guardian can require the pt to live in a specific place, attend treatment and allow authorised persons access to residence but doesnt allow treatment to be given without pts consent
What are sections 135 and 136?
- police powers
- 135 allows police to forcibly enter a persons home to allow assesment under MHA or bring them to place of saftey, warrant from magistrates court needed and they must be accompanied by AMHP or dr
- 136 allows police to remove person suffering from a mental disorder from a place the public can access (IE not their home) to a place of safety (may be a police cell, A&E, psych hospital). They can be held there for up to 72 hrs during which time they should be seen by a dr and an AMHP
What are sections 57, 58 and 62?
57: needed for treatments which are so restricting pts cannot automatically have them even if they do consent (destruction of brain tissue, functioning or hormones to reduces sex drive), needs consent and 2nd opinion
58: for treatments that require consent OR a second opinion (if consent not/ cannot be given)
62: for urgent treatment to save a pts life, prevent serious deterioration or alleviate serious suffering
What are the 5 things to assess when assessing mental capacity?
- do they have a disorder of brain functioning (dementia, delirium, drunk)
- do they understand the information needed to decide
- can they retain the information given to them (for long enough to make a decision)
- can they weigh up the pros and cons of the information given to them
- can they communicate their decision by any means
What should be considered while making a best interest decision?
- if pt will regain capacity then its appropriate to wait
- decision maker must ascertain and consider the pts past and present wishes and feelings
- pt should participate even if lacking capacity
When are deprivation of liberty safeguards used?
- for pts in hospital or care who lack capacity
