L12 - Ethical & Legal Issues in Psychiatry Flashcards
What is competency according to the Mental Capacity Act of 2005?
The cognitive ability to understand and weigh up the key issues relevant to a decision
How might mental illness affect the process of decision other than by affecting cognition (as would be seen with, e.g. Alzheimer’s)?
By altering values, e.g. people with depression still have good cognitive values
List 2 justifications for overruling refusal of treatment for mental health conditions.
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
What requirements are in place for clinicians to assess the capacity of patients detained under the Mental Health Act?
A person detained under the Mental Health Act can be treated for a mental disorder without reference to their capacity / competence
List 2 ethical problems with the approach to treating patients detained under the Mental Health Act.
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
Why might it be inappropriate to use criminal law in the case of mentally ill patients?
- 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
List the criteria necessary for a patient to be detained under section 2 (admission for assessment) of the Mental Health Act.
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 whom must be a psychiatrist
And either of:
- The patient’s nearest relative
- An approved mental health professional
Lasts for 28 days
List the criteria necessary for a patient to be detained under section 4 (emergency assessment) of the Mental Health Act.
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)
Lasts for 72 hours
List the criteria necessary for a patient to be detained under section 3 (admission for treatment) of the Mental Health Act.
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 whom 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
Lasts up to 6 months (period renewable)
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?
- 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
In 2007, how was section 4 of the Mental Health Act of 1983 amended?
- Introduced new “appropriate medical treatment test” into criteria for detention
- Criteria can’t be met unless medical treatment available to patient takes into account the nature & degree of patient’s mental disorder & all other circumstances
What is the law regarding the use of electroconvulsive therapy for treating patients that are detained under the Mental Health Act of 1983?
ECT & any other treatment provided for by regulations made under subsection 1b can only be given when patient either gives consent or is incapable of consenting
What is supervised community treatment?
- Provisions that allow some to live in community whilst being subject to powers under MHA
- Only those detained in hospital eligible to be considered for SCT with various criteria to be met
