Ethical and Legal Issues in Psychiatry

Question 1

What is competency according to the Mental Capacity Act of 2005?

Answer 1

The cognitive ability to understand and weigh up the key issues relevant to a decision.

Question 2

How might mental illness affect the process of decision other than by affecting cognition (as would be seen with, e.g. Alzheimer’s)?

Answer 2

By altering values, e.g. people with depression still have good cognitive values.

Question 3

List 2 justifications for overruling refusal of treatment for mental health conditions.

Answer 3

1 - The illness interferes with their normal values, and respecting the patient’s autonomy is to respect what that person would want when free from depressive illness.

2 - It is in the patient’s best interests.

Question 4

In which year was the Mental Health Act introduced?

When was it amended?

Answer 4

• The Mental Health Act was introduced in 1983.

- The Mental Health Act was amended in 2007.

Question 5

What requirements are in place for clinicians to assess the capacity of patients detained under the Mental Health Act?

Answer 5

A person detained under the Mental Health Act can be treated for a mental disorder without reference to their capacity / competence.

Question 6

List 2 ethical problems with the approach to treating patients detained under the Mental Health Act.

Answer 6

Overriding a competent patient’s refusal either:

1 - Assumes that the presence of a mental illness automatically renders someone incompetent (false).

2 - Discriminates between the physically and mentally ill, as it gives society much wider powers to forcibly restrain mentally ill people for the protection of others.

Question 7

Why might it be inappropriate to use criminal law in the case of mentally ill patients?

Answer 7

• The central issue in the case of dangerousness is responsibility.
• It can be argued that those who are mentally ill are not responsible for their dangerous acts.

Question 8

List the criteria for a patient to be detained under the Mental Health Act of 1983.

Answer 8

1 - The patient must have a mental disorder.

2 - The mental disorder must be of a nature so as to warrant them being detained and receiving treatment in hospital.

3 - They must be dangerous to themselves or to other people.

Question 9

List the purposes of section 2, 3 and 4 of the Mental Health Act of 1983.

Answer 9

1 - Section 2 governs admission for assessment.

2 - Section 3 governs admission for treatment.

3 - Section 4 governs emergency assessment.

Question 10

List the criteria necessary for a patient to be detained under section 2 of the Mental Health Act of 1983.

Answer 10

1 - There must be a mental disorder that is of a nature so as to warrant them being detained for assessment in hospital.

2 - The patient must be dangerous the themselves or to other people.

3 - There must be an application sent to the hospital that is supported by:

• 2 doctors, one of which must be a psychiatrist.

And either of:

• The patient’s nearest relative.
• An approved mental health professional.

Question 11

How long can a patient be detained under section 2 of the Mental Health Act of 1983?

Answer 11

28 days.

Question 12

List the criteria necessary for a patient to be detained under section 4 of the Mental Health Act of 1983.

Answer 12

1 - There must be a mental disorder that is of a nature so as to warrant them being detained for assessment in hospital.

2 - The patient must be dangerous the themselves or to other people.

3 - There must be an application sent to the hospital that is supported by 1 doctor (this is suitable in emergency situations, e.g. where another doctor cannot be reached without leaving the patient alone).

Question 13

How long can a patient be detained under section 4 of the Mental Health Act of 1983?

Answer 13

72 hours (because the application is only supported by 1 doctor).

Question 14

List the criteria necessary for a patient to be detained under section 3 of the Mental Health Act of 1983.

Answer 14

1 - There must be a mental disorder that is of a nature so as to warrant them being detained for assessment in hospital.

2 - The patient must be dangerous the themselves or to other people.

3 - There must be an application sent to the hospital that is supported by:

• 2 doctors, one of which must be a psychiatrist.

And either of:

• The patient’s nearest relative.
• An approved mental health professional, as long as the nearest relative is consulted.

4 - The diagnosis is known and the mental illness is treatable, such that treatment can either:

• Alleviate the mental illness.
• Prevent deterioration in mental illness.

Question 15

How long can a patient be detained under section 3 of the Mental Health Act of 1983?

Answer 15

6 months.

Question 16

What is the purpose of section 1 of the Mental Health Act of 1983?

In 2007, how was section 1 of the Mental Health Act of 1983 amended?

Answer 16

• To define mental illness.
• In 2007, the definition of mental illness was changed to ‘any disorder or disability of the mind. This gave psychiatrists more control over determining whether a patient is mentally ill.

Question 17

In 2007, how was section 4 of the Mental Health Act of 1983 amended?

Answer 17

• Previously, treatability was one criteria of all detainment under the Mental Health Act of 1983.
• Section 4 was changed so that treatability was no longer a criteria for detainment. This was in response to the 1996 case of Michael Stone.

Question 18

What amendments were made to the Mental Health Act of 1983 regarding the involvement of a nearest relative?

Answer 18

The right for a patient to apply for an order replacing the predefined nearest relative with another relative was introduced.

Question 19

What is the law regarding the use of electroconvulsive therapy for treating patients that are detained under the Mental Health Act of 1983?

Answer 19

Electroconvulsive therapy can only be given when the patient either gives consent or is incapable of giving consent.

*NB if the patient is already detained, they are deemed incapable of giving consent, so they can only overrule this treatment if they give an advance notice when they are not mentally ill.

Question 20

What is supervised community treatment?

Answer 20

Treatment that allows patients with a mental disorder to live in the community whilst still being subject to powers under the 1983 act.

Question 21

What legislation governs decision making for people over the age of 16 who lack capacity?

Answer 21

The Mental Capacity Act of 2005.

*There is often difficulty choosing between this act and the Mental Health Act of 1983, because there can be conflicting guidance between them.

Question 22

If a patient meets the criteria for detention under the Mental Health Act of 1983, but is able to demonstrate capacity under the Mental Capacity Act of 2005, can they be forcibly admitted to hospital for treatment?

Answer 22

Yes, but only if :

1 - Treatment is available.

2 - Admission to hospital is for treatment of any of the following:

• That mental disorder.
• A physical illness contributing to that mental disorder.
• Now physical consequences of that mental disorder.

Question 23

What is the purpose of section 37 of the Mental Health Act of 1983?

Answer 23

It is the same as section 3, but it is put in place by the courts rather than clinicians.

Question 24

What is the purpose of section 17 of the Mental Health Act of 1983?

Answer 24

It is concerned with the provision of home leaves whilst still under detention of the Mental Health Act of 1983.