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Year 3 Psychiatry > Legal and Ethical Frameworks in Psychiatry > Flashcards

Legal and Ethical Frameworks in Psychiatry Flashcards

1
Q

When does the MHA 2007 not apply?

A

In informal admissions - used when mental health P has capacity and gives consent to the admission.

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2
Q

When is the MHA utilised?

A

When P refuses to give consent to assessment or admission for tx in hospital for a mental health disorder. Must be risk to P’s health or safety and to the safety of others. Is an involuntary admission.

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3
Q

What are the guiding principles of the MHA?

A

Should be the least restrictive option
Views of patient and family should be considered
Should be clear therapeutic aims
Only used for as long as is necessary

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4
Q

What is not a mental disorder?

A

Learning disabilities (unless abnormally aggressive or seriously irresponsible conduct not attributable to an unmet health, social or emotional need)

Alcohol and drug dependency - unless associated with a mental disorder which falls within the act’s definition

Neither of these can be the sole basis for admitting someone.

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5
Q

How is capacity assessed?

A

Can they
- understand the relevant information
- retain the information long enough to make a decision
- weigh up the information
- communicate their decision

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6
Q

Which part of the MHA covers admission for assessment?

A

s.2

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7
Q

How long can a P be detained under s.2 MHA?

A

Up to 28 days

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8
Q

Who can apply for a s.2 order?

A

Nearest relative or Approved Mental Health Professional (AMHP) + supported by 2 Drs (1 x s.12).

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9
Q

Can s.2 be renewed?

A

No - needs to be transferred to s.3

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10
Q

What part of the MHA covers admission for treatment?

A

s.3

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11
Q

How long is the detention period under s.3?

A

6m, then a further 6m, then on a yearly basis.

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12
Q

Who can apply for a s.3 order?

A

Nearest relative or Approved Mental Health Professional (AMHP) + supported by 2 Drs (1 x s.12).

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13
Q

Can treatment be given under s.3 without consent?

A

Tx can be given without consent for up to 3m. At this point need a second opinion to confirm that Tx is still in P’s best interests.

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14
Q

Which s. of the MHA is used for emergency admissions?

A

s.4 - although rarely used

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15
Q

How long can a P be detained under s.4?

A

72 hours

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16
Q

Who can apply for an order under s.4?

A

1 doctor (not a specialist but ideally knows the P)

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17
Q

Can treatment be given under s.4 without consent?

A

NO TX can be given under s.4 without consent

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18
Q

Can Tx be given under s.2 MHA without consent

A

Treatment for the mental health disorder only can be given without consent during this period.

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19
Q

Which section of the MHA is known as the doctor’s holding power?

A

s.5(2) MHA

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20
Q

How long can doctors hold Ps for under s.5(2). What form needs to be done for this?

Can Tx be given without consent under this section?

A

72 hours

H1

No treatment can be given without consent

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21
Q

How long can Ps be held for under s.5(4).

Can treatment be given without consent?

A

Up to 6 hours

No treatment can be given without consent

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22
Q

When can police detain a P under s.136?
How long for?

A

If they are in a public place
Appear to have a mental disorder
AND
are in need of immediate care or control

Have to take to a place of safety.

Up to 24 hours but can be extended on medical grounds

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23
Q

What is the difference between s.135 and s.136

A

s.135 - allows police to enter private dwelling and remove person who is mentally unwell if unsafe to a place of safety.

s.136 = public place

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24
Q

What is a community treatment order?

A

It allows Ps to leave hospital provided they engage with Tx in the community as prescribed. Treatment can only be enforced if the P is recalled to hospital.

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25
Q

Which section of the MHA allows a P to go on leave during their stay if sufficiently well enough?

A

s.17

26
Q

How often can Ps appeal to the Mental Health Review Tribunal (MHRT)?

A

Once per detention period

27
Q

What are advocates for Patients with mental health issues called?

A

Independent Mental Health Advocates

28
Q

Can psychosurgery and ECT be given to a patient who refuses consent?

A
29
Q

What issues regard confidentiality of psychiatric Patients?

A

The stakes are higher than other patients
- Greater likelihood of confidence breaches
- Greater degree of subsequent harm from the disclosure

30
Q

What is the conflict between capacity and danger to others?

A
31
Q

What is the Szasz-Kendell debate?

A

About whether mental illness is a myth.

Szasz = mental illness is classified by deviation from psychosocial, ethical, legal norms rather than having a clearly identifiable cause in the body.

Kendell rebuts this = mental illness is not fundamentally different from physical illness - because it has a physical root (even if unknown) and also it implicates physical well being (inc mortality, dec fertility). Is not a myth.

Basically all boils down to how you define disease - by ramification or by cause.

32
Q

Which act covers deprivation of liberty?

A

Mental Capacity Act 2005

33
Q

What is mental disorder defined as under the MHA 2007?

A

Any disorder or disability of the mind.

Does not include learning disability (unless associated with abnormally aggressive or seriously irresponsible conduct) OR dependence on drugs or alcohol.

34
Q

What is a person who has undergone specific training in assessing and dealing with patients with mental disorder called?

A

Approved Mental Health Professional (AMHP)

35
Q

What is an approved clinician?

A

Mental health professional trained to carry out certain duties under the MHA.

36
Q

What is the responsible clinician?

A

Person with overall responsibility for the P’s care under the MHA.

37
Q

What is a doctor with special expertise in the diagnose and treatment of mental disorders known as?

A

s.12 Approved Doctor

38
Q
A
39
Q

Can s.2 be renewed?

A

No - must be changed to s.3 or P released

40
Q

What is the criteria for a s.2 hold?

A

P must be suffering from a mental disorder of a nature or degree that warrants their detention in hospital for assessment AND the person ought to be detained in the interests of their own health and safety or with a view to the protection of others.

41
Q

How can s.3 be renewed?

A

Up to 6m, then renewed for another 6m, thereafter 1yr at a time. If well enough can be discharged at any time. 2 doctors must have seen the P in the past 24 hours. Same criteria as s.2 - but - needs to also be appropriate mental tx available for the disorder from which the P is suffering.

42
Q

Which section of the MHA 2007 covers guardianship?

A

s.7

43
Q

Which section of the MHA 2007 details Compulsory Treatment Order powers?

A

s.17 A-G

44
Q

All Ps detained on long term sections need to be provided with formal aftercare, including an agreed care plan, allocated health are worker and regular progress reviews. Which section of the MHA 2007 covers this?

A

s.117

45
Q

What must occur within the first 24 hours of a detention under s.135 or s.136 of the MHA?

A

Needs to be a mental health assessment of the P.

46
Q

What are the guiding principles of the MHA?

A

Least restrictive option
Empowerment and involvement
Respect and dignity
Purpose and effectiveness
Efficiency and equality

47
Q

When can Ps appeal against their detention?

A

If under s.2, s.3 or CTO - Ps must have a Mental Health Review Tribunal within 6m of initial application at the latest. Can also ask for hearing at any time. 1 hearing per detention period.

48
Q

Who sits on a Mental health Review Tribunal?

A

Legal member
Doctor
Lay member

49
Q

Which act states that an independent advocate should be provided to patients detained involuntarily?

A

MHA 2007
Is for the local authority to provide

50
Q

Where does the legal authority to give treatment without the patient’s consent arise from?

A

s.3 MHA 2007 allows you to give medications against a Ps wishes for 3 months. After this you need consent from the P or an independent doctor to confirm that the treatment is still within the patient’s best interests.

51
Q

What are the exceptions to treating a patient without consent?

A

ECT - if a P has capacity and refuses - cannot be given. Can only be given to an incapacitated P if it doesn’t confict with an advance directive, decision of the nearest relative or a decision of the courts.

In emergencies - RC can authorise up to 2x ECT tx for Ps detained under s.3.

Physical Illness - MHA relates only to mental disorder - does not permit the Tx of any physical co-morbidity with 2 exceptions
- Enforced refeeding of severely emaciated anorexia P
- Tx of physical sequalae of attempted suicide which was a direct result of an underlying mental disorder.

Ps with comorbid physical conditions - who do not have capacity - can be treated under the Mental Capacity Act 2005.

52
Q

If consent is not obtained from a person who doesn’t qualify for coerced treatment under MHA or MCA - what crime will have been committed?

A

Assault +/- battery

53
Q

What age does the Mental Capacity Act apply to?

A

Above 16

If below 16 consent can be given by the parents

54
Q

What are the 5 principles of the Mental Capacity Act?

A
  • Assumed to have capacity unless established they don’t
  • Person is not treated as lacking capacity unless all practicable steps to help them have been taken
  • A person is not without capacity just because they make an unwise decision
  • Anything done must be in the P’s best interests
  • Anything done must be the least restrictive option with respect for the P’s basic rights and freedoms
55
Q

What does a P need to be able to do in order to be deemed to have capacity?

A
  • Understand the information relevant to the decision
    • Retain that information
    • Use or weigh up the information in order to make a decision
    • Be able to communicate their decision to others

If a P does not have capacity - everything done for the P must be in their best interests.

56
Q

Which act covers DoLS?

What does DoLS do?

A

Mental Capacity Act

Ensures that Ps lacking capacity that are being deprived of their freedom in order to provide safe care are appropriately protected. Need to apply to the court of protection for permission under DoLS legislation to determine whether the deprivation is in the P’s best interests and a reasonable response to the situation.

57
Q

What are the four ethical pillars of medicine?

A

Respect autonomy, maximise welfare (beneficence), minimise harm (non-maleficence) and respect justice principles

58
Q

Re C [1994] involved what?

A

Paranoid schizophrenia - detained under s.3 - gangrene foot - refused amputation (delusion of being a great surgeon) - Drs disagreed - Mr C sought injunction to prevent amputation without his written consent.
Judge - granted the injunction - general capacity was impaired by schizophrenia - however the P had understood and retained the information regarding his Tx and has capacity to make his decision.

59
Q

RM v St Andrew’s Healthcare [2010] involved what?

A

RM v St Andrew’s Healthcare [2010] - Mr M = organic delusional disorder and epilepsy - detained under s.3. Hostile and violent - was covertly medicated. He found out at his first tribunal - became upset and refused to take any medication, became suspicious of food and drink. Mental state deteriorated - more freq seizures and became more violent - requiring physical constraint and periods of seclusion. Covert medication resumed and he improved. Mr M - aware that he had improved - applied for discharge from hospital on the grounds that he did not have a mental illness that needed Tx as it was clear he was doing well without it.
Hospital asked to keep the covert medication hidden from the P during the court case - his lawyers took the hospital to court.
Judge - Mr M was entitled to challenge his detention effectively and could not do so if he did not know that he was being treated covertly. Disclosure would cause short term harm to the therapeutic alliance - but hard to justify preventing Ps access to justice.

60
Q
A

Year 3 Psychiatry (11 decks)

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