Ethics and Law Flashcards
What is the MHA and what acts does it contain? Why is this a sensitive topic?
The Mental Health Act (1983)
- > Section 2
- > Section 3
- > Section 4
- > Section 136, [+ 135]
- > Section 5(2) [and 5(4)]
Ability to detain people goes against the Human Rights Act (article 5)
Who can use a Section 2 or 3? Who can use a section 5(2) and 5(4)?
Dr must be section 12 trained - Section 2 or 3
5(2) can be used by an F2 and above, 5(4) is the same but for nurses but less used as shorter so might as well use the 5(2)
What is a section 2 for? Who and what is required and who gets the final vote?
Section 2 = Detainment for the assessment of a patient (+/- treatment can be given in this time also) - [Max 28 days]
REQUIRES:
- > Pt to have a MH disorder
- > MH disorder is of a specific NATURE (e.g. Schizophrenia/Bipolar affective; not for substance or alcohol abuse!) and DEGREE to warrant detention in hospital for assessment (+/-Tx)
- > The person ought to be detained for their own safety/safety of others
Two Dr’s required - one S12-approved and second e.g. GP
BUT
Final vote by the approved mental health practitioner (usually a social worker) OR nearest relative
What is a section 3 for? Who and what is required? What is the patient eligible for after?
Section 3 = Detainment for the treatment of a patient - [Max 6 months] - usually used with well known patients
REQUIRES:
- > Pt to have a MH disorder
- > MH disorder is of a specific NATURE (e.g. Schizophrenia/Bipolar affective; not for substance or alcohol abuse!) and DEGREE to warrant detention in hospital for assessment (+/-Tx)
- > The person ought to be detained for their own safety/safety of others
- > Treatment must be available at the time of detention and can only be provided by detainment (e.g. not by crisis team)
Requires TWO doctors; one S12-approved and a second Dr who knows the patient in a professional capacity e.g. GP
–> AMP or nearest relative is necessarily to MAKE the decision
The patient can be forcibly medicated
–> Consent to Treatment provisions apply after 3 months of detention (if not consenting,
will need a Second Opinion Appointed Doctor (SOAD) Assessment)
After 6m, the patient is also eligible for aftercare (which is often beneficial)
Why is it beneficial to try and encourage informal admission, instead of formal admission?
Informal = patient consents Formal = sectioned/detained against will
Informal is better - if formal, then patients have to formally request leave for breaks using a section 17 form and also feels worse for patient
What is a section 5(2)? When would it be used?
Doctors holding power - for maximum 72h (nurses/5(4) is only 6h)
Can be used by F2 and above but only those who are directly overseeing that patients care - and only for inpatients (not A+E) and acts as a trigger to start the section 2/3 process
Used in emergency situations where you can’t wait for the section 2/3 act - either on a psychiatric ward or on a medical/surgical ward
Does NOT authorise treatment power during this time
What is a section 5(2)? When would it be used? What is required?
Doctors holding power - urgent detention of an inpatient on a ward for maximum 72h (nurses/5(4) is only 6h)
- Drs MUSTVE examined the patient themselves (if F1 then CT Dr should be told) –> pass form to hospital managers –> triggers MHAA
Can be used by F2 and above but only those who are directly overseeing that patients care - and only for inpatients (not A+E) and acts as a trigger to start the section 2/3 process
Used in emergency situations where you can’t wait for the section 2/3 act - either on a psychiatric ward or on a medical/surgical ward
Does NOT authorise treatment power during this time
What is section 4?
Urgent detention of a patient for max 72h - requires one Dr and one AMHP/NR
What is section 135 and 136?
Emergency power that the police have to detain someone who appears to be suffering from a MH disorder for 24h enabling assessment:
136 -> in a public place
135 -> in their own homes (this requires planning i.e. going to court and getting an order/warrant)
What is a CTO?
CTO = community treatment order
This is given by the responsible clinician i.e. consultant (for patients who are post-section 3)
- > ensures supervised treatment in the community for the patient with set conditions e.g. drug adherence/blood tests
- > 6 month renewal and can be appealed at tribunal
Why is the MHA different to the MCA?
MHA - used for detaining patients with MH disorders specifically
MCA - regards capacity, used for any patient
What is DOLS?
Deprivation of liberty safeguarding
- Safeguarding mechanism within the MCA
- Authorises the ongoing deprivation of liberty of a resident or patient who lacks capacity to consent to care/treatment
