Lecture 5.1 - Ethical and Legal Framework Flashcards

1
Q

Concerning psychiatric legal requirements, the law seeks to find a balance between:

A

The right to autonomy, self-determination, care and treatment - and the safety of the public.

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2
Q

What is the mental health act? What are its purposes?

A

Originally written in 1967, last revisions made in 1990. It is a law that gives certain power and sets of conditions for those powers, to stipulated health care professionals and institutions regarding admission and treatment of individuals with mental disorders

Purpose it to protect and health and rights of persons with mental illness, and also the rights of the community

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3
Q

What is an informal admission?

A

A person found incapable and admitted to a hospital with the consent of the person authorized to make his or her treatment decisions.

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4
Q

What are the three ways in which a person is admitted involuntarily to a hospital?

A

Under the Involuntary Mental Health Evaluations and Admissions (forms 1-5), Informal admission, and under the criminal code

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5
Q

What is form 1? Who signs it?

A

Signed by a physician who has examined the person for the involuntary admission (and police detaining) of a person for up to 72 hours at a psychiatric facility for the purpose of assessment. Expires after 7 days.

Form 42 must be provided to the patient. Without form 42, 1 is invalid.

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6
Q

What is form 42?

A

A notice to the patient that form 1 was enacted - is signed by physician.

Informs that patient that there is no right to appeal.

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7
Q

What is the nurse’s role when a form 1 + 42 have been signed in a facility?

A

To help the patient cope and support them emotionally, and to explain what the forms mean.

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8
Q

What is form 2?

A

A request for psychiatric assessment that can be filled out by anyone and needs to be signed by a justice of the peace, does not allow for any hold. Also expires after 7 days.

If the physician determines that the person requires further assessment, a form 1 is then signed.

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9
Q

What is form 2 section 17?

A

Allows police to detain an individual and bring them to the ER to be assessed by a physician at the officer’s discretion

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10
Q

What is form 3? Who signs it? How long it is valid? What must it be given with?

A

A certificate of involuntary admission filled out by a different physician than the one who completed form 1. It must be completed 72 hours from the start of the detention period under form 1.
Given with notice in form 30

Valid 2 weeks from and including the date it was signed.

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11
Q

What is a form 4? What must it be given with?

A

A certificate of renewal for involuntary admission after initial 2 week hold.

1st - valid 30 days
2nd - valid 60 days
3rd - valid 90 days
Every time it is renewed it can be appealed.

Must be given with a form 30

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12
Q

What is form 30?

A

A notice to patient letting them know who will visit, the situation, and their right to appeal and obtain legal services alongside an involuntary admission (3 +4)

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13
Q

What is a form 5?

A

Initiated by attending physician to change from an involuntary to informal or voluntary admission. No expiration or renewal.

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14
Q

What are the three kinds of involuntary assessments of individuals accused of criminal acts? How long are they?

A

Psychiatric Assessment: when a judge believes a person that has committed a criminal act suffers from a psychiatric disorder. Involves section 22 + 21.

Under Criminal Code:
Fitness assessment: Judge believes a person may be unfit to stand trial (5 day hold)

Criminal Responsibility Assessment: Judge believes a person may or may not be criminally responsible on account of mental disorder for criminal acts committed (30-60 day)

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15
Q

What are sections 22 + 21 of a psychiatric assessment?

A

22: order for inpatient assessment
21: order for outpatient assessment

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16
Q

What is an order for return?

A

Form 9
–> Initiated by the officer of charge of a psychiatric facility when the absence of a person who is subject to involuntary admission becomes known.

Expired 1 month after the absence becomes known.

17
Q

Can you subject someone to involuntary treatment?

A

No, not inpatient.

Consent must be informed, voluntary, and must not be given through misrepresentation or fraud.
The patient must be able to understand the information and express their opinion.

18
Q

Under what section allows a person to have an appointed representative for consent and capacity board?

A

Section 33

19
Q

In what order are substitute decision makers chosen when a person is deemed incapable of consent?

A

Guardian, POA, appointed representative, spouse/partner, child/parent, sibling, other relative, public guardian and trustee.

20
Q

How did Brian’s law change the mental health act?

A

Brian’s law introduced community treatment orders and new criteria for involuntary commitment to psychiatric facilities.

21
Q

What is form 45?

A

A community treatment order for those that require psychiatric treatment for serious recurring mental illness.
–> Involves comprehensive plan of community-based treatment or care and supervision that is less restrictive than being detained. Expires 6 months after the day they are made and are terminated unless renewed.

22
Q

When is a patient’s right to confidentiality excepted?

A

When children or elders is care facilities are at risk.

The duty to warn an identified victim in the imminent threat of harm or death, may also report to the police.

23
Q

What are the three kinds of restraints?

A

–> Physical
–> Environmental
–> Chemical

24
Q

What kinds of things are considered environmental restraints?

A

Seclusion room, secure unit, security 1:1

25
Q

What is the goal of employing restraints?

A

Prevent harm towards the self or others

Their use must be minimal and exceptional

26
Q

Does the MHA authorize restraints for voluntary or informal patients?

A

No. Involuntary patients only.

27
Q

What must be documented is a restraint is implemented?

A
  1. Understanding the person’s behaviour
  2. Developing an individualized plan of care to meet the person’s needs
  3. Collaborating with the interprofessional team
  4. Evaluating the plan of care and making changes PRN
  5. Using least restrictive restraints
  6. Discussing with the person or (SDM) to ensure informed decisions (about use of restraints in past - what scared the patient - de-escalation techniques that worked
  7. Being aware of agency policies
  8. Monitoring and reviewing the continued use of restraints
  9. Being aware that restraint use is an emergency temporary intervention
  10. Documentation