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Psychiatry > Laws > Flashcards

Laws Flashcards

1
Q
  • What is Section 5(2)?
    1. Type of order
    2. How long it lasts
    3. Staff required

[This is the only section you need to be able to recall from memory]

A

Section 5(2) is a doctor’s “Holding Power”.

Type of Order: Emergency
How long it lasts: Up to 72 hours
Staff required: 1 Doctor

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2
Q

What is Section 2?

  1. Type of order
  2. How long it lasts
  3. Staff required
A

It is to be used when there is no clear psychiatric diagnosis at the given time. It allows you to hold and treat someone against their will for up to 28 days. After this time, a decision needs to be made as to whether a Section 3 order needs to be implemented or whether you are to begin treating the patient informally.

You cannot implement two Section 2 orders back-to-back

Type of Order: Assessment
How long it lasts: Up to 28 days
Staff required: 2 Doctors and an AMHP

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3
Q

What is Section 3?

  1. Type of order
  2. How long it lasts
  3. Staff required
A

It is used when there is a definitive psychiatric diagnosis or prognosis. It allows you to hold and treat someone against their will for up to 6 months. If the section is renewed it lasts a further 6 months, and any further renewal from then on lasts for 1 year.

Type of Order: Treatment
How long it lasts: Up to 6 months
Staff required: 2 Doctors and an AMHP

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4
Q

What is Section 4?

  1. Type of order
  2. How long it lasts
  3. Staff required
A

Type of Order: Emergency
How long it lasts: Up to 72 hours
Staff required: 1 Doctor and an AMHP

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5
Q

What is Section 5(4)?

  1. Type of order
  2. How long it lasts
  3. Staff required
A

Type of Order: Emergency
How long it lasts: Up to 6 hours
Staff required: 1 Registered Mental Health Nurse

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6
Q

What is Section 135?

  1. Type of order
  2. How long it lasts
  3. Staff required
A

Type of Order: Power of entry & removal to Place of Safety
How long it lasts: Up to 72 hours
Staff required: Magistrate

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7
Q

*What is Section 136?

  1. Type of order
  2. How long it lasts
  3. Staff required
A

It is an order which gives the police power to remove a person who they consider to have a mental disorder to a “Place of Safety”. This particular order can last up to 72 hours. A “Place of Safety” is a place which is locally agreed upon, and is usually a special 136 suite, but can include either a Police station or A&E. Once the person has been taken to a “Place of Safety” under Section 136 they can be assessed, and a Section 2 or a Section 3 order can be implemented.

Type of Order: Place of Safety
How long it lasts: Up to 72 hours
Staff required: Police Officer

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8
Q

What are 4 types of patients can receive a Section 5(2)?

A
  1. If the patient is an in-patient with a mental illness
  2. If the patient is at risk
  3. If informal admission is no longer appropriate, i.e. the patient wants to leave
  4. If the patient needs an assessment for Section 2 or 3
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9
Q

What can or cannot be done under Section 5(2)?
1 Can
6 Cannot

A

Can:
Hold the patient for Mental Health Act assessment.

Cannot:

  1. Cannot give treatment
  2. Cannot do another 5(2) back-to-back
  3. Cannot let it lapse
  4. Cannot use in A&E or Outpatients - only in-patients in general hospital
  5. Cannot have leave
  6. Cannot get into trouble for doing it in good faith.
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10
Q

What is the most important thing when applying Section 5(2)?

A

Keeping patient alive, so prioritise treatment

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11
Q

Who can apply a Section 5(2)?

A
  1. In a General Hospital it is done by the physicians/surgeons - Not the psychiatrist!
  2. It is good practice to get the most senior member of the team present in the hospital to sign the form.
  3. Only a fully registered medical practitioner can sign the form so a Pre-registration house officer, such as an F1, can NOT do it.
  4. If the physician does report the patient under Section 5(2) then the psychiatrist should see the patient as soon as possible.
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12
Q

What is the acronym for dealing with a Section 5(2)?

A 
C = Calm - keep calm
A = Assistance - call for assistance (security/police) if necessary
R = Responsible - The medical team are responsible and need to complete and sign the section. practitioner can sign the form
R = Read the form
O = Only a full registered medical practitioner can sign the form, preferably the most senior member of the team
T = Tell an Approved Mental Health Professional or Specialist Registrar Psychiatrist that a section 5(2) has been done.
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13
Q

What should you do if the situation is immediately dangerous and the patient is uncontrollable?

A

Let the patient leave and call the police

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14
Q

What is a Community treatment order?

A

A person may be treated under the Mental Health Act and still live in the community on what is known as a Community Treatment Order.

This particular order only relates to the patient’s psychiatric care, and if the said person was to seek healthcare services, that person’s healthcare should be given as normal and their psychiatric condition does not necessarily need discussion. All treatment should be consensually given according to the Mental Capacity Act.

However, if the cirumstances to which a person is required to seek medical advice is in direct consequence of their mental illness, then psychiatric care must be given.

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15
Q

What does the Mental Capacity Act state?

A

The Act assumes that all adults have capacity unless proven otherwise, so it does not apply to those with capacity.
All practicable steps need to be taken to help the person to have capacity before a person is deemed to not have capacity.

If a person makes an unwise decision, that does not necessarily mean he/she lacks capacity (that would need to be assessed).

An act done or decision made under the MCA needs to be in the person’s best interests and needs to be least restrictive of the person’s rights.

Capacity is time- and decision-specific.

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16
Q

What are 4 components to the process of capacity?

A
  1. Understand - Understand the information relevant to the decision
  2. Retain - Retain that information for long enough to make the decision
  3. Deliberate - Deliberate that information as part of the process of making the decision
  4. Communicate - Communicate the decision (whether by talking, using sign language or any other means)
17
Q

What test is used to assess capacity?

A

2 stage test

18
Q

What is Stage 1 of the 2 stage test?

A

Stage 1: a person lacks capacity if he/she is unable to make a specific decision due to a disturbance in the functioning of the mind or brain.

There needs to be evidence that the person has a disturbance of their mind or brain which is affecting the functioning of their mind or brain. This may be a temporary or permanent disturbance due to physical or psychological or other reasons

19
Q

What is Stage 2 of the 2 stage test?

A

Stage 2: a person is unable to make a decision if they are unable to:

Understand
Retain
Deliberate
Communicate

20
Q

What is the capacity flowchart for the 2 stage test?

A

Stage 1: If there is no disturbance of the mind/brain that affects ability to make decision then - >they have capacity

If there is a disturbance -> Stage 2
Is the person able to URDC?
-> yes -> Capacity
-> No -> No capacity

21
Q

Why does a particular diagnosis not immediately mean someone lacks all capacity?

A

Capacity is time and decision specific e.g. if a person has acute schizophrenia, lacks insight into his condition and requirement for antipsychotics, he lacks capacity to decide about antipsychotic treatment, but if he also has diabetes his schizophrenia may not be affecting his decision making in relation to his treatment of his diabetes

22
Q

After establishing that a patient lacks capacity in a specific situation, the doctor must act in the best interests of the patient under the MCA. What must you consider when acting in the best interests of a patient (6)?

A
  1. What would this patient in this situation want given their upbringing, background, beliefs and expressed wishes?
  2. Is the person likely to regain capacity & when?
  3. Maximise the person’s participation in process
  4. Past and present wishes of person
  5. Their beliefs, values and other factors
  6. Views of carers and other nominated or appointed persons
23
Q

What criteria allow you to restrain a patient?

A
  1. Can restrain under MCA as long as they lack capacity
  2. If the restraint is required to protect the individual in question from harm
  3. Restraint needs to be proportionate to the situation
24
Q

What is lasting power of attorney (LPA)?

A

a legal mechanism that allows someone to specify another adult to look after their affairs - financial and/or medical should they lack capacity in the future. This is done by going to a solicitor and making certain declarations.

25
Q

What is an advance directive/decision?

A

Advance decisions are made by a patient when he/she has capacity, come into effect when the patient no longer has capacity and are able to state what treatment a patient wants to refuse in a specific situation. If the treatment being refused would be life-saving the advance directive needs to be in written form, signed by the patient and witnessed. It also needs to say that the person realises refusal of this treatment may result in his/her death.

If in doubt keep the patient alive and seek legal advice immediately via NHS solicitors having first discussed with senior colleagues.

26
Q

What is Deprivation of liberty safeguards (DoLS)?

A

Under article 5(1) of the human rights act everyone has a right to liberty, except in specific circumstances (e.g. detained under Mental Health Act (1983) or sent by a court of law to prison).

DoLS created by the MCA and apply to people being deprived of their liberty in hospital or care homes when the person lacks capacity in this matter. When relevant, an application needs to be made to a supervisory body for authorisation.

Psychiatry (16 decks)

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