Capacity, Consent and Legal Frameworks Flashcards
Define consent
The voluntary (non-pressure) and continuing permission for a specific event, is based on sufficient information.
What is the purpose of the Mental Capacity Act (2005)?
Applies to 16yrs and above
Empower and protect who lack capacity to make own decisions
Typically applies to physical health concerns
What is the purpose of DoLS?
Addition to MCA in 2009
Legal process to restrict freedom within a care setting, if person lacks capacity to consent to care and environment is deemed in best interest
Place under continuous supervision and control.
Regards location, does not control treatment decisions
What are the five key principles of the Mental Capacity Act?
- Presumption of capacity - until proved otherwise
- Individuals being supported to make own decisions - praticable help e.g translator
- Unwise decision does not equal lack of capacity
- Decisions made must be in Best Interests
- Decision must be least restrictive of basic freedom
What is the two-stage test of capacity?
- Impairement of mind or brain? Disturbance of function?
- Does this make them unable to make a specific decision at a specific time?
What are the four principles of capacity?
CURB
- Understand the information (decision and consequences)
- Retain information
- Balance or weight up information
- Communicate the decision
What decision pathway is used if a patients capacity is being questioned?
- Formal capacity asessment on MCA 1 - decide if lacks capacity for specific decision
- Decide lacks capacity
- Make treatment based on best interest - record on MCA 2
- Reasses if reason to believe capacity changes
If patient has capacity must have their consent.
What is the Mental Health Act 1983?
Legal paperwork for detaining and treating patients with psychiatric illness
Used when patients are unwilling or lack capacity to consent
What are the main criteria required to enact the mental health act?
- Mental disorder or nature or degree that requires hospitalisation
- Risk to self or others
- Appropriate treatment is available
What are the two exclusions to the mental health act?
Person can not be sectioned based on Dependence on drug or alcohol or Learning Disabilities alone
Must have additional risk or needs.
When can the police use the mental health act?
If a mental illness is suspected and the person needs ‘care or control’
What does Section 135 of the mental health act allow police to do?
Private addnress
Allows access to private property (specified) without permission
Requires magistrate permission
Can used to take to place of safety
Can by kept on this section for up to 36 hours
What does section 136 of the mental health act allow police to do?
Public Place
Used to take someone to a place of safety = Can be home/friends home, hospital or police station.
Some places have specific 136 suites
Can be kept for 24hrs - can be extended for 12 hours
What does Section 5(4) of the mental Health act enable?
Hospital Holding powers
Mental health or learning disability nurse to hold patient for up to 6 hours when no doctor is available
Only used in psychiatric hospitals
Terminates when doctor arrives
What is the purpose of section 5 of the mental health act?
Stops patients from leaving hospital is they are in hospital voluntarily.
Only when section 2,3 or 4 are not possible or safe
What does section 5(2) of the mental health act enable?
Doctors holding power - FY2 or above
Hold for 72hrs - if previously on 5(4) starts from this time
Written report must be submitted to hospital managers
Do not enable treatment unless significant risk
What does section 2 of the mental health act enable?
‘Assessment section’
Allow doctors time to determine diagnosis, if treatment needed, if so what
Can give treatment against will
May be kept for 28 days - can not be renewed
Specific required persons to enact
Who is required to make a Section 2 Mental Health act decision?
2 doctors FY2 and above
One of which much have seen patient within prev 14days, one of which must be section 12 approved
Also requires a social worker
When is a section 2 used instead of a section 3?
If patient never been assessed or long time since lass assessment - aka no known treatment plan in place
What is the purpose of Section 4 of the mental Health Act?
Emergency Section
Used when only 1 doctor and AMPH is available and admission is urgent
Lasts 72hrs or until MHS assessment arranged with second doctor (whatever sooner)
What does Section 3 of the mental health act enable?
Treatment section
Requires 2 doctors and AMPH
Keeps patient in hospital for 6 months - renwe for 6months, then yearly basis - must be 2 months before ends
Allows treatment without consent for 3 months that must be approved by SOAD (second opinion approved doctor)
What are the options if the patient does not agree with the Mental Health Act?
Section 2 and 3 can be appealed - hospital managers or mental health tribunal
Section 3 - after 3 months patient has to agree to medication and independent doctor has to agree
Or Nearest Relative powers - request discharge must be reviewed in 72hrs.
When might a patient be considered an Informal Hospital Admission?
If has capacity to consent, and is agreeing to admission.
What is the key difference between MHA and MCA?
MHA - psychiatric illness or direct physical consequence, can be used even if the person has capacity
MCA - only used when lacking capacity, treat physical health conditions, extended with a DoLS -> prevent someone from leaving.
