Civil Admissions Flashcards
section 72
discharge by a tribunal (every detention period)
section 2 + days
application for assessment (28 days)
section 3 + days
application for treatment (28 days) usually in a home, can be prison or doctors
section 4 + time
emergency application for assessment (72 hours)
section 5 + time
Doctors 5(2) and nurses 5(4) holding power - 6 hours, 7 to hours
Winterbourne View and Bubb Report
led to increased calls for scrutiny over decisions to remove people with learning disabilities in their homes.
Winterborne View
showed the perils of taking seriously the principle of LR, scandal of warehousing 10,000s learning disabled people receiving no care or support but each had a review prior to being detained. Patients must be continuously assessed.
Connor Sparrowhawk
drowned in a bath whilst having a seizure unsupervised, death contributed to by negligence in the hospital trust.
convicted of breach of 3(1) health and safety at work act 1974
No Voice Unheard no Rights Ignored 2015
2 recommendations
Recommended:
1. introduction of regulations to require more explicit recording of why P cannot be looked after at home
2. exploring whether there should be increased right to challenge decisions to admit
Gov responded positively in green paper but no change yet
Assessment section 2
The disorder is ‘of a nature or degree which warrants the detention of the patient in a hospital for assessment’ (followed by treatment)
Treatment section 3
The disorder being ‘of a nature or degree which makes it appropriate for him to receive medical treatment in hospital’ treatment cannot be provided unless the patient is detained
Phil Fennell relapsing patient
if the p’s history indicates a strong likelihood of relapse, p’s should be re-admitted before relapse occurs. It is not necessary to wait for p’s psychosis to ‘ripen’ before admission
R v MHRT for South Thames Region ex p Smith
where p has episodic and relapsing condition, entirely legitimate to preventatively detain, conflict between this and human rights
CM v Derbyshire
following convictions for violence and paranoid schizophrenia, hospitalised. free from psychosis symptoms for over 10 years, no relapse following discharge but returned for drug use alone. the nature of the disorder did not mandate the return or continued residence.
Lawful section 3 detentions showing “no magic in a bed”
CS v MHRT
attendance at the ward round every four weeks
B v Barking
inpatient monitoring and assessment every week, lived at home Thursday to Monday
KL v Somerset
attendance at a community mental health ‘base’ fortnightly and meetings with a key worker for outpatient reviews
criteria for admission s3, renewal s20, discharge s72
“medical treatment which is appropriate in his case, taking into account the nature and degree of the mental disorder and all other circumstances” s3(4)
definition of medical treatment s145
“Includes nursing, psychological intervention and specialist health habilitation, rehabilitation and care”
key focus of section 3
“the purpose of which is to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations”
Code of Practice 23.13
Medical treatment must always be an appropriate response to the condition
Code of Practice 23.14
Medical treatment must be actually available to P
Code of Practice 23.17
may be patients whose particular circumstances mean treatment may be appropriate even if it consists only of nursing and specialist day to day care
Code of Practice 23.18
simply detaining someone, even in hospital does not constitute medical treatment
Conflict between section 23.13, and 23.14 with 21.17
How can treatment be an appropriate response and actually available whilst not being proper treatment beyond day to day care?
MD v Nottinghamshire Health Care NHS Trust
MD detained for violence, claimed detention was unlawful as no appropriate treatment was available. held he benefitted from care and milieu therefore apt treatment was available
Article 5
the patient must reliably be shown to be of unsound mind, of a kind warranting compulsory confinement, validity of such depends on the persistence of the disorder (Winterwerp)
Reid v UK
argued by being a psychopath he was untreatable therefore unlawful to detain, P must be established as suffering from a mental disorder of the kind warranting compulsory confinement, this may be necessary even when P needs control and supervision to prevent harm to himself or others.
National law greater degree of protection than ECHR
Partnerships in Care v W
antisocial personality disorder, string of convictions, difficult to distinguish between appropriate treatment from mere detention, key lies in 145(4)
145(4)
Purpose of treatment must be to benefit the patient, if the purpose is to prevent a worsening of symptoms or manifestations likely to constitute apt treatment likely to amount to this