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a Psychiatry > Lecture - Mental Health Act & Mental Capacity Act > Flashcards

Lecture - Mental Health Act & Mental Capacity Act Flashcards

1
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3
Q

Who makes the final decision in relation to the MHA?

A

Approved mental health professional (usually a social worker by trade)

The other people invovled are shown below. The doctors need to be Section 12 approved (2 day course at registrar level).

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4
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How do you assess risk?

A

Assessing risk:

  1. Risk to self
  2. Risk from others
  3. Risk to others
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5
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What principle are we violating when we detain someone agaisnt their will?

A

Human rights act

Article 5: right to liberty

MHA limits human right (article 5) to allow for assessment and treatment of mental disorder

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6
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An example of a medical recommendation:

A
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7
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What are the outcomes of MHA?

A

Detained under section 2 or 3

Not detained

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8
Q

What are the criteria for detention under MHA section 2?

A

Sufferring from a mental disorder

AND

It is of a nature or degree to warrant hospital detention for assessment or

AND

Ought to be detained for the person’s own safety or view to the protection of others

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9
Q

How long does MHA S2 last? What mental problems is it not used for?

A

28 days

Used for assessment only and not treatment

Not used for substance dependance

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10
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What are the criteria for detention under Section 3?

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11
Q

Can you detain someone under Section 3 if the wait for treatment is 3 months?

A

No - the appropriate treatment must be avaialble at the time

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12
Q

What is the purpose of MHA S3 over S2? How long is it valid?

A

Section 3 is used for treatment (should use this with well known patients, rarely is)

Lasts for 6 months

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13
Q

What if the patient still does not consent to the treatment being given after 3 months under Section 3? What is an advantage of Section 3?

A

Another doctor needs to approve treatment if not consenting after 3 months

This patient is then eligible for aftercare

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14
Q

What are the alternatives to sectioning?

A
  1. Agree to an informal admission if possible
  2. Try to predict potential problems that might make patient reluctant to come/stay in hospital (smokink breaks, leave, visitors etc) then seek solutions
  3. Always think about what you could do to deescalate the patient
  4. Don’t jump straight to medication and sectioning (remember this in PACES)
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15
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Judge and mother

Only the patient’s responsible clinician (RC) can discharge the patient and not any ST

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16
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What is a MH tribunal?

A

Nurse, social worker and doctors will write a report

Patient will be able to appeal their case

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17
Q

Who can discharge the patient from under section 2 and 3?

A

Discharge is via RC, tribunal, managers hearing, nearest relative

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18
Q

When can a patient get temporary leave from section 2 and 3?

A

If they have temporary leave under section 17 e.g. a 30min break to go to the shop.

If something happens the RC (responsible clinician) is responsible.

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19
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20
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Section 5(2) MHA : Doctor’s holding power

21
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When can you use section 5(2)? How long is it valid for?

A

ONLY for inpatients (not A&E)

Maximum of 72 hours

Acts as a trigger for MHA assessmnet

Completed by approved clinician or deptuty (i.e. F2 or above) - must have personally examined the patient yourself and state why you think informal admission is no longer applicable and why you think the patient has a mental disorder

Cannot be completed by any other team/doctor including Psychiatry liaison

22
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When can you not use 5(2)?

A

If you are not the clinician looking after the patient

Cannot be used for treatment

23
Q

When should you use Section 5(2)?

A
24
Q

Why can you not just section 2 someone and not 5(2)/5(4)?

A

Because it needs to be a section 12 approved doctor who does Section 2

In the Tom Jones case, this is also out of hours.

Section 2 may be the end result as you are triggering the

25
Q

What is the purpose of 5(4)?

A

Doesn’t need doctor approval and only needs to be done by 1 nurse.

BUT in practice this is rarely done as it is only valid for 6 hours and a doctor is usually available to do the one valid for 72 hours i.e. Section 5(2).

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27
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What is Section 136? How long is it valid for?

A

Emergency power that police have to remove a suspected mentally ill person from a public place to a place of safety for further assessment

Up to 24hours detention for assessment

28
Q

What criteria are required for Section 136?

A

Appears to be sufferring from a mental disorder

Individual is in a place to which the public have access e.g. front garden, A&E, carpark, street

Taken to ‘place of safety’ - S136 suite

For the protection of that person and others

29
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What is the difference between S135 and S136?

A

S135 allows the police to break into someone’s home - triggers MHAA

30
Q

What are CTOs? What are the conditions for this?

A

Community treatment order (CTO)

  • Order made by clinician (consultant) to give patient supervised tretament in the community, after they have been in hospital.
  • Must have been on a Section 3.
  • Set conditions e.g. regular assessments, medication adherence (depot), blood tests (clozapine)
  • If conditions breached allows the patient to be recalled to hospital for up to 72 hours for assessment
  • Requires 6 month renewal and can be appealed at tribunal.
  • Less restrictive than admission
31
Q

What framework should we use to treat him?

  1. Section 2
  2. Section 5(2)
  3. Section 3
  4. MCA
  5. Gillick competence
A

Mental capacity act

32
Q

Is the MCA used for all decision making?

A

No

Identifies how best interests are determined

Decision specific e.g. you can decide which food you want but not which medication etc.

33
Q

What are the 5 principles of the MCA?

A
34
Q

When is the MHA vs MCA used?

A

MHA - for MENTAL things
Limited to treatment for mental disorder

v

MCA - for PHYSICAL things
Applied to any situation whereby a person aged 16 or above with a disorder of mind/brain ‘lacks’ the mental capacity to make a decision.
Applies to any decision.
[MCA can be used to treat physical health for someone who is detained under MHA]

Anorexia is used under MHA

35
Q

What must you always assume in terms of MCA before assessment?

A

Person should be always be assumed competent

36
Q

What is the first step of MCA assessment?

A

Is there an organic problem like stroke, dementia etc.

37
Q

What is the second step of MCA assessment?

A
  1. Does the disorder of mind/brain make the person unable to make the decision?
  2. Understand the information relevant to that decision
  3. Retain the information
  4. Use or weigh up that information
  5. Communicate their decision.
38
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A
39
Q

What is DOLs?

A

Deprivation of liberty safeguarding (DOLs)

Safeguarding mechanism within the MCA

Authorises the ongoing deprivation of liberty of a resident or patient who lacks capacity to consent to care/treatment

Specifically re: liberties, usually whether people can leave, but any form of restraint/deprivation

Widely used in care homes

Used in many hospital settings; e.g. delirium, dementia, brain surgery, stroke, neuro

Urgent authorisation can be given by hospital and application should be made ASAP by the treating team.

40
Q

What is the name of DOLs changing to?

A

Liberty Protection Safeguards to supersede in 2022

41
Q

Who may need DOLS?

A

A person is being deprived of their liberty if they:

  • lack capacity AND are:
  • under constant control and supervision of the hospital
  • not free to leave

This could include if decisions made for them or on their behalf

If there are limitations on where they are allowed to go

Or if their routine decided for them

This also includes using medication (e.g. sedation) and physical restraints to prevent people from leaving or in managing their everyday life

Usually used in geriatrics. You do not need to do sectioning forms.

42
Q

What are the components important in the CAMHS capacity assessment?

A

Parental responsibility: A ‘person with parental responsibility’ can consent to medical treatment for their child, up to the age of 18 years old.

16-18yrs old: As per Mental capacity act (Parental responsibility should not be relied upon when a child has capacity)

Under 16yrs old; ‘Gillick competence’. No right to make an unwise decision and need to have reached a certain degree of wisdom, maturity and free will

43
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A

Green - looks like he has psychotic depression

Not 14yo as she has agreed and consented

44
Q
A

correct order

  • ask ward CT to carry out the assessment
  • ensure face to face assessment is carried out
  • reassure patient
  • discuss risk assessment with nurses on the ward
  • document clearly in section 5(2) form
45
Q
A

Psychiatry ward

a Psychiatry (50 decks)

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