Lecture - Mental Health Act & Mental Capacity Act Flashcards
Who makes the final decision in relation to the MHA?
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).
How do you assess risk?
Assessing risk:
- Risk to self
- Risk from others
- Risk to others
What principle are we violating when we detain someone agaisnt their will?
Human rights act
Article 5: right to liberty
MHA limits human right (article 5) to allow for assessment and treatment of mental disorder
An example of a medical recommendation:
What are the outcomes of MHA?
Detained under section 2 or 3
Not detained
What are the criteria for detention under MHA section 2?
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
How long does MHA S2 last? What mental problems is it not used for?
28 days
Used for assessment only and not treatment
Not used for substance dependance
What are the criteria for detention under Section 3?
Can you detain someone under Section 3 if the wait for treatment is 3 months?
No - the appropriate treatment must be avaialble at the time
What is the purpose of MHA S3 over S2? How long is it valid?
Section 3 is used for treatment (should use this with well known patients, rarely is)
Lasts for 6 months
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?
Another doctor needs to approve treatment if not consenting after 3 months
This patient is then eligible for aftercare
What are the alternatives to sectioning?
- Agree to an informal admission if possible
- Try to predict potential problems that might make patient reluctant to come/stay in hospital (smokink breaks, leave, visitors etc) then seek solutions
- Always think about what you could do to deescalate the patient
- Don’t jump straight to medication and sectioning (remember this in PACES)
Judge and mother
Only the patient’s responsible clinician (RC) can discharge the patient and not any ST
What is a MH tribunal?
Nurse, social worker and doctors will write a report
Patient will be able to appeal their case
Who can discharge the patient from under section 2 and 3?
Discharge is via RC, tribunal, managers hearing, nearest relative
When can a patient get temporary leave from section 2 and 3?
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.
Section 5(2) MHA : Doctor’s holding power
When can you use section 5(2)? How long is it valid for?
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
When can you not use 5(2)?
If you are not the clinician looking after the patient
Cannot be used for treatment
When should you use Section 5(2)?
Why can you not just section 2 someone and not 5(2)/5(4)?
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
What is the purpose of 5(4)?
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).
What is Section 136? How long is it valid for?
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
What criteria are required for Section 136?
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
What is the difference between S135 and S136?
S135 allows the police to break into someone’s home - triggers MHAA
What are CTOs? What are the conditions for this?
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
What framework should we use to treat him?
- Section 2
- Section 5(2)
- Section 3
- MCA
- Gillick competence
Mental capacity act
Is the MCA used for all decision making?
No
Identifies how best interests are determined
Decision specific e.g. you can decide which food you want but not which medication etc.
What are the 5 principles of the MCA?
When is the MHA vs MCA used?
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
What must you always assume in terms of MCA before assessment?
Person should be always be assumed competent
What is the first step of MCA assessment?
Is there an organic problem like stroke, dementia etc.
What is the second step of MCA assessment?
- Does the disorder of mind/brain make the person unable to make the decision?
- Understand the information relevant to that decision
- Retain the information
- Use or weigh up that information
- Communicate their decision.
What is DOLs?
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.
What is the name of DOLs changing to?
Liberty Protection Safeguards to supersede in 2022
Who may need DOLS?
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.
What are the components important in the CAMHS capacity assessment?
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
Green - looks like he has psychotic depression
Not 14yo as she has agreed and consented
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
Psychiatry ward
