Ethical And Legal Issues In Psychiatry

Question 1

What year was the common law and mental capacity act

Answer 1

2005

Question 2

What is competency

Answer 2

Cognitive ability to understand and weigh up the key issues relevant to the decision

Question 3

Justifying a mental health Act

Answer 3

Mental illness may affect the process of decision - other than cognitively
Moderate depression may alter values but the person may still have good cognitive abilities

Question 4

Justifying overruling refusal of treatment

Answer 4

Argue that the illness interferes with their normal values - so respecting the patients autonomy is to respect what that person wages when free from depressive illness
Argue that it is right because it is in their best interests and others to do so and they are suffering from a mental illness
English law takes this second paternalistic approach at least about the treatment of the mental not physical illness

Question 5

Overruling refusal of treatment

Answer 5

A person can be treated for a mental disorder under the MHA without reference their capacity

Question 6

What are the ethical problems with overruling refusal of treatment without reference to capacity

Answer 6

It either assumes that the presence of a mental illness automatically renders someone incompetent which is false or it simply discriminates between the physically and mentally ill
Protection of others as well as the patient - not usual in physical disorders to be treated for someone else’s sake

Question 7

Protection of the patient or the protection of others

Answer 7

The main method by which society protects itself from those dangerous to others is through criminal law - it maybe inappropriate to use the criminal law in the case of the mentally ill they are not responsible for their dangerous acts. The central issue in the case of dangerousness to others in not capacity but responsibility

Question 8

What is central to overriding refusal for the sake of the person himself

Answer 8

Question of capacity

Question 9

Is the MHA discriminatory

Answer 9

It allows a competent patients refusal to be overruled
Gives society much wider powers to forcibly restrain, for the protection of others mentally disordered people compared to those without a mental disorder
-dangerously mentally ill people can be detained almost indefinitely
But those without a mental disorder cannot be kept in a secure place if they have no yet committed a crime or have served their prison sentence

Question 10

Mental health act 1983

Answer 10

Dangerous to either themselves or others

Informal and compulsory admissions

Question 11

Routes to compulsory admission.

Answer 11

Admission for assessment S2
Emergency assessment s4
Admission for treatment S3

Question 12

Admission for assessment s2

Answer 12

Grounds:
A: mental disorder = nature and degree which Warrants detention - assessment
AND
Dangerous
Application by relative or social worker
Supported by 2 Drs 1 psychiatrist
Lasts for 28 days

Question 13

Emergency assessment s4

Answer 13

Grounds the same as s2
Mental disorder = nature and decree which warrants detention - assessment 
AND 
Dangerous 
Application 1Dr 
72hours

Question 14

Admission for treatment s3

Answer 14

Grounds : mental disorder - nature which warrants treatment in hospital AND
Dangerous
AND
Mental illness is treatable = alleviate or prevent deterioration in mental illness
Treatment includes for the symptoms
Application similar to s2 where the SW names the application NR must be consulted
6months
Period is renewable
Cannot be used to enforce treatment on an outpatient basis

Question 15

Amendments to the 1983MHA -> MHA 2007

Answer 15

Removal of categories of mental disorder
Section 1 amends the wording of the definition in the 1983 from ‘mental illness, arrested or incomplete development or mind, psychopathic disorder and any other disorder or disability to
-> any disorder or disability of the mind
Section 4 replacement of treat ability and care tests with appropriate treatment put into

Question 16

Professional roles

Answer 16

Chapter 2 provides for roles which are central to the operation of the 1983 act potentially to be performed by a wider range of professionals than at present
In particular it replaces the role of the responsible medical officer with that of the responsible clinician and the role of the approved social worker with the approved mental health professional

Question 17

Safe guards for patients

Answer 17

Section 23 introduced a new right for a patient to apply for an order displacing the NR in the same grounds available to other applicants under the 1983 act as it stands and in the additional ground that the NR is unsuitable to act as such

Question 18

ECT

Answer 18

Section 27 inserts a new section 58A into the 1983 act. That new section provides that ECT and any other treatment provided for by regulations made under subsection 1b can inky be given the patient either gives concert or is incapable of giving consent

Question 19

Supervised community treatment

Answer 19

Allow some patients with a mental disorder to live in the community whilst being subject to powers under the 1983 act. Only those patients who are detained in hospital for treatment while be Elba lie to be considered for SCT
In order for a patient to be placed on SCT, various criteria need to be met

Question 20

Refusing treatment

Answer 20

Every competent adult has a legal right to refuse treatment even if it is life saving
They need not give any explanation rational or otherwise
This respects the individuals right to autonomy
Capacity should be assumed until proven otherwise by a functional assessment
Suicide is no longer a criminal act

Question 21

Common law principles

Answer 21

Allow treatment in an emergency, to prevent loss of life or deterioration of health in someone without capacity
Is is incorporated into the mental capacity act with guidance on substitute decision making
There may be a need for a mental health act assessment in arranging treatment for ongoing mental disorder

Question 22

Competence mental capacity act 2005

Answer 22

Take in and retain information
Understand that information in appropriate terms
Weigh up the information to arrive at a decision
Communicate that decision
Mental health act acknowledges that mental,disorders can impair capacity
However compulsory hospital admission and treatment are only for that mental disorder or physical illness contributing to that disorder or now physical consequences of the disorder
Appropriate treatment must be available

Question 23

Mental capacity act v mental health act

Answer 23

Dont know which one of use first in order to detain someone
Initial guidance was to use the MCA first asit was least restrictive option compared to MHA
Subsequent case law reverses the guidance
Where a patient met the criteria for detention under the MHA and lacked capacity the MHA had to used
However this has been complicated by other judgements

Question 24

Amending the MHA 1983

Answer 24

The Michael stone case
Review
- the treatsbility cluase
New diagnosis - dangerous, severe, personality disorder
Compulsory detention before criminal act
E.g. Autonomy v good of society
Widespread opposition from royal college of psychiatrists, mental health charities and service user groups
Medicalising antisocial behaviour
Using mental health legislation for social control

Question 25

What were the final amendments of the 1983 act

Answer 25

Broader definition of mental disorder Removal of exclusion Appropriate treatment test

Question 26

What must community treatment order be considered for

Answer 26

Any patient in. Section 3 who is going on 7 days of s17 leave or make