Law And Mental Health Flashcards
Mental Capacity act 2005 covers
Consent and capacity
Mental health act 2007 covers
Compulsory admission and treatment of mental illness
Mental health act is concerned with those who…
Are considered to be a risk to themselves or others
And suffer from a ‘mental disorder’
MHA defines ‘mental disorder’ as
Any disorder or disability of the mind
Quite broad
MHA key points
Can only be detained if appropriate medical treatment available
Do not apply for treating physical illness
Those under sections 2&3 can appeal against decisions
How many inpatients in mental health units are admitted under MHA?
10-15%
Section 2
Admission for assessment
Max 28 days
Need 2 Drs to recommend - one section 12 approved
Section 3
Admission for treatment
Maximum 6 months
2 Drs, at least one section 12 approved
Section 5(2)
Holding order for patient already on ward
Maximum 72 hours
One doctor to recomend
Section 136
Police can remove person appearing to suffer from ‘mental disorder’ from public place to ‘place of safety’
Capacity
Ability to make decisions
Presumed intact
Related to specific decisions
To have capacity must be able to…
Understand the relevant information
Retain that information
Use that information to make decision
Communicate that decision
If a person lacks capacity..
Steps may be taken in their best interests
Least restrictive, allow maximum participation in decision
Take into account personal beliefs
To give valid consent one needs
Mental capacity
Sufficient information
Lack of coercion
Mental capacity act - 2 stage test for capacity
- Impairment/disturbance in functioning of mind/brain
2. Does this mean they are unable to make a specific decision when they need to?
Capacity of patients admitted acutely to general medical beds:
40% lack capacity for treatment decisions if subjected to detailed assessment
Most go along with treatment and understand they are in hospital
Key cause of mental incapacity is:
Cognitive impairment
What percentage of patients without capacity are recognised as such?
25%
Psychiatric patients and capacity
60% acute inpatients lack capacity
25% lack capacity and NOT under MHA
Main reason is major disorder - mania/schizophrenia
If lacking capacity, consider…
Advance decision
Lasting power of Attorney / Court Deputy
Independent mental capacity advocate
Physical illness can only be treated on MHA when…
Mental disorder is caused by physical illness
Physical illness is direct result of mental disorder (eg overdose)
Detention under Mental Health Act ends when…
Patient/family can apply to tribunal to review Section
Pt/family can apply to court
Responsible clinician can end Section
Time lapse
Section 5.4
Register nurse can detain a patient for 6 hours
In hospital
If considering section 2 or 3
Section 135
Police can enter someone’s house and bring them to a place of safety
For 72 hours, for assessment
Need to apply to a magistrate
Section 17
Can give patients leave from the ward
Subject to conditions deemed necessary
No limit of duration
Consequences of being ‘sectioned’
Under section 3 - get section 117 aftercare
May need to declare on visa applications
Equality act so should not be discriminated against regarding work
MHA or capacity act - which takes precedence?
Mental health act.
Risk before best interests
Young people in forensic mental health
50% of all offenders are under 21, and 90% of 16-20yrs in prison have some mental health issue and 10% had functional psychosis
Section 117 of the MHA
doctors have a duty of aftercare for patients discharged from section 3
Section 7 of the MHA
Guardianship – requires the patient to live at a place decided by the guardian and attend for treatment. Access is given to a responsible clinician
Advance directives
To be valid needs to be made by a person over 18, with capacity, specific situations where it applies and not have been modified.
In order to refuse life saving treatment an advance directive must
Be in writing
Be signed and witnessed
Include the statement that the decision stands even if life is at risk
Advance directives cannot
Ask for life to be ended
Force doctors to act against their better judgement
Be used to deny treatment for a mental disorder
To make a will a person must be
Aware of the nature and effect of a will
Aware of the extent of their estate
The claims of those included and excluded
Have no mental disorder or be lacking in capacity or be under undue influence by third parties
Driving
If the patient has a condition which impacts their ability to drive they must inform the DVLA – if they refuse the doctor must be only after having informed the patient
