Legal aspects of MH Flashcards
what is the AIM of the Mental Capacity Act (MCA)?
Aim to identify those ppl who may LACK CAPACITY to consent to
or To REFUSE TX and protect them
Allows people with a ‘mental disorder’ to be sectioned, ex: admitted to hospital, detained and treatedW/OUT their consent either for their own health and safety, or for the protection of other people.
who is excluded from the MHA?
most common sections of the MHA that are used to admit people?
Pts who are only under the influence of alcohol or drugs
Sections 2 and 3 are the most common
When to use the Mental Health Act (MHA)?
Refusal of voluntary treatment.
Other options have been considered but are not appropriate.
Mental disorder: must be the result of a known or suspected mental disorder.
Harm (risk of ): ptx must be at significant risk of self-harm, self-neglect or harm to others.
Appropriate treatment: There must be an appropriate treatment option available to the patient
common Abrev.
what are the purposes of different sections of the MHA?
Section 2: admit for assessment at treatment for 28 days
Section 3: Keep in hospital for 6 months for Tx–>can be renewed a further 6 months and then further renewed for further periods of one year at a time.
both 2 and 3 must be reviewed by TWO approved clinicians + with at least one section 12 approved doctor
Section 4: Used as an emergency, when s2 would involve an unacceptable delay. Often changed to a section 2 upon arrival at hospital. It can be done by one doctor w/ an AMHP or nearest relative (NR)
Section 5 (2): done by DR, kept in for up to 72 hrs, them must be assess for S(2) or S(3), or discharge from s5(2) to become an informal patient.
Section 5 (4): done by NURSE–> Allows urgent detention for up to 6 hours of an inpatient already receiving treatment for a mental disorder in hospital.
Patient’s “rights” in the different sections of the MHA?
Section 2: patient can appeal w/in 14 days!
Section 3: patient can appeal only ONCE in the first 6 months, if the s3 is renewed, an appeal can be made once during the second 6 months. then an appeal can be made once during each one-year period.
Section 4: Cannot appeal!
Section 5 (2): cannot APPEAL!
Section 5 (4): Cannot APPEAL!
Section 135: cannot appeal
Section 136: cannot appeal
Under s2 and s3, patients CANNOT refuse treatment!!!
Under s3, ptx can be treated against their will for 3 months, but after this time they are seen by a second opinion appointed doctor (SOAD) if they lack capacity to consent or are refusing treatment. A SOAD carries out an assessment to see if they think that the treatment is needed.
what is Community treatment order ?
Allows patients on SECTION 3 who are well enough, to LEAVE the hospital for treatment in the community.
The decision is made by the responsible clinician (RC) with the agreement of the AMHP.
The patient can be recalled to hospital if they do not comply with treatment or attend appointments.
Once recalled they may be detained for up to 72 hours for assessment.
Deciding when to use the MHA.
What makes consent valid? (3)
Informed-appropriae level of info
Competent- capactiy to consent
Voluntary- not forced by relatives, medics, nurses etc.
What are the rules regarding consent?
· Can be implied (suggested but not directly expressed)
· Can be withdrawn
· Can be verbal, non-verbal or written
At what AGE are patients deemed to have capacity?
what do u do if theyre below that age?
16 and over
under age 16
- Parental consent (next of kin) required in ptx best interest
OR
- Gillick’s competence - may be competent so test for capacity. They have the ability to accept medical treatment but CANNOT REFUSE medical treatment!
The 5 key principles of the Mental Capacity Act (2005)?
Best Interests: Decisions made on behalf of the patient must be in their best interests.
Help to make decisions: People must be given all appropriate help before anyone
concludes that they cannot make their own decisions, e.g. use of interpreters and multiple times (as capacity may fluctuate).
Eccentric or unwise decisions are allowed: Capacity is determined by the way in which a decision is made and not the decision itself. Therefore, it does not matter how unwise the decision is.
Least restrictive intervention: Decisions made on the patient’s behalf should be the least restrictive option.
Presumption of capacity: Capacity is assumed to be present until proven otherwise.
what is Lasting power of attorney? types?
This allows a person with capacity to appoint an attorney (usually a relative or close friend) to make future decisions on their behalf if they lose capacity.
2 types:
- Property and affairs deals with property and financial affairs.
- Personal welfare deals with decisions about healthcare, living conditions and location.
What is capacity? When is someone deemed not to have capacity?
Ability to make a decision. Can involve personal welfare, healthcare and financial decisions.
if UNABLE to make a decision for himself in relation to the matter because of an impairment of, or disturbance in the functioning of the mind or brain, the person lacks capacity
Assessment of capacity?
1. He or she has an ‘impairment of, or disturbance in, the functioning of the mind or brain’ whether permanent or temporary
AND
2. Must be able to:
a. UNDERSTAND the info relevant to the decision
b. RETAIN that information
c. USE or WEIGH that info as part of the process of making the decision
d. COMMUNICATE the decision made by talking, sign language or other means
what is an Advanced decision?
what is included?
Advance decisions is a process that allows patients to make decisions about their future care in case they lost capacity later on.
