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Yr4: Psychiatry > Legal Aspects of Psychiatry > Flashcards

Legal Aspects of Psychiatry Flashcards

1
Q

The nature of psychiatric disorders means patients may refuse treatment; state 3 domains under which we can treat patients without consent

A
  • Treatment under Mental Capacity Act
  • Treatment under Mental Health Act
  • Treatment authorised by a court
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2
Q

Briefly outline the aim of the MCA

A

Identify people who lack capacity to refuse or consent to treatment and to protect them. Only applies to England & Wales.

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3
Q

Remind yourself of the two stage Mental Capacity Assessment

A

Stage 1 is looking at if there is an impairment of or disturbance of function in a person’s mind or brain?

Stage 2 is looking at if the impairment is sufficient to constitute a loss of capacity; four components:

  • Understand information?
  • Retain information long enough to make decision?
  • Can they weigh up/use that information in process of decision making?
  • Communicate decision?
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4
Q

State the 5 key principles of Mental Capacity Act (2005)

A
  • Decisions on behalf of patients must be made in their best interests
  • People must be given all appropriate help to make decisions before you decided they do not have capacity e.g. interpreters, multiple attempts (as capacity can fluctuate)
  • Unwise decisions are allowed and do not mean patient doesn’t have capacity
  • Least restrictive option should be chosen
  • Capacity is assumed until proven otherwise
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5
Q

What is a lasting power of attorney?

State the 2 types

A
  • A person, appointed by patient, who can make future decisions on their behalf if they lose capacity
  • Two types:
    • Property & affairs (property & finance)
    • Personal welfare (healthcare, living conditions etc..)
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6
Q

What is an advanced statement?

Is it legally binding?

A
  • When a patient states their wishes and preferences for the future- either verbally or written- if they were to lose capacity
  • NOT legally binding

*Must have capacity at time of writing

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7
Q

What is an advance decision/directive?

A
  • Legal document in which a pt can refuse specific treatment(s) in a pre-defined future situation (e.g. loss of capacity). Can only refuse treatment not demand it. Do not allow pts to refuse basic care needs e.g. food, drink, hygiene.
  • Legally binding (signed & witnessed)

*Must have capacity at time of writing

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8
Q

State 3 options for advanced care planning

A
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9
Q

For Deprivation of Liberty Safeguard (DoLS), discuss:

  • The aim
  • If it is part of MCA
  • Which countries it applies in
  • Who it applies to
  • How you get a DoLS?
A
  • Ensures people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty. A deprivation of liberty occurs when: ‘The person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements.
  • Part of MCA
  • England & Wales
  • Pts in hospitals and care homes only
  • Must apply for authorisation of deprivation of liberty
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10
Q

What is an IMCA?

A
  • Indepedent Mental Capacity Advocate
  • Person appointed to support a person who lacks capacity but has no one to speak on their behalf (e.g. no NOK, power of attorney). Help with decisions such as where to live & serious medical treatment options.
  • Gather as much information about pt as possibe, raise any concerns and produce report representing pt
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11
Q

Define a mental disorder

A

Any disorder or disability of the mind; it includes mental illness, personality disorder, learning disabilities, disorders of sexual preference (e.g. paedophilia) but NOT dependence on drugs or alcohol.

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12
Q

What is the MHA (1993, ammended in 2007)/what does it allow you to do?

A

Allows people with a mental disorder to be sectioned, detained & treated (for their mental disorder) without their consent either for their own health & safety or for the protection of others.

Used for people who:

  • Will not consent to admission & treatment voluntarily
  • Lack capacity to consent to admission & treatment

**Applies in England & Wales only

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13
Q

What do we mean by formal & informal pts?

A

Formal= in hospital under MHA

Informal= in hospital voluntarily

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14
Q

AMHP (approved mental health professionals) can make an application for a pt to be sectioned; state some examples of AMHPs

A
  • Nurses
  • Social workers
  • Psychologists
  • OTs

NOT DOCTORS

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15
Q

When should you use MHA?

*HINT: Revise Our Mental Health Act

A
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16
Q

For a section 2 discuss:

  • What it allows you to do
  • Who can/which professionals can reccommend a section 2
  • Appeals process
A
  • Allows you to admit & then detain pt for 28 days to allow for assessment & response to treatment
  • An AMHP makes the application on the recommendation of two doctors with at least one section 12 approved doctor
  • Can appeal to a tribunal during first 14 days (and to hospital managers at any time)
17
Q

For a section 3 discuss:

  • What it allows you to do
  • Who can/which professionals can reccommend a section 3
  • Renewal
  • Appeals process
  • When they have to be seen by a SOAD (second opinion appointed doctor)
A
  • Allows you to admit and detain a pt for up to 6 months (but may be discharged before this). Can be detained under S3 if known to mental health services/have mental disorder or following admission under S2
  • An AMHP makes the application on the recommendation of two approved clinicians (doctors registrar level & above) with at least one section 12 approved doctor
  • Can be renewed for further 6 months. After that renew for periods of one year.
  • Can appeal to a tribunal ONCE during first 6 months. If S3 renewed then can appeal once during second 6 months. then appeal can be made once during each year. Can appeal to MHA managers at any time.
  • Can be treated against their will for 3 months but after this time must be seen by SOAD if still refusing treatment or lack capacity to see if treatment is needed
18
Q

What is section 117 aftercare?

A

Section 117 aftercare is a legal duty that is placed on health and social services to provide after care services for individuals who have been detained under section 3, 37, 47, 48 and 45A.

This may involve support with healthcare, supported accomodation, employment etc..

19
Q

There are 5 emergency sections; state these

A
  • Section 4
  • Section 5 (2)
  • Section 5 (4)
  • Section 135
  • Section 136
20
Q

For a section 4, discuss:

  • When it is used
  • What it allows you to do
  • How long it lasts
  • Who it requires
  • Whether you can appeal
  • What usually happens following S4
A
  • Allows emergency admission of pts not already in hospital when waiting for personnel or paperwork to complete S2 would cause dangerous delay
  • Allows you to detain pt but NOT treat
  • 72hrs
  • Only requires one doctor (who doesn’t need to be section 12 approved- it is often GP). Application made by NR or AMHP
  • No right to appeal
  • Usually converted into S2 upon arrival
21
Q

For a section 5(2) discuss:

  • Why & where it can be used
  • What it allows you to do
  • How long it lasts for
  • Who it requires
  • What should happen in that time
  • Right to appeal
    *
A
  • Urgent detention of pts on any ward (excluding A&E).
  • Does not allow you to treat only detain
  • 72hrs
  • Doctor (does not need to be section 12 approved but has to be the consultant or nominated deputy- in most psych wards this is core psychiatric trainee on call)
  • Assessed for a S2, S3 or discharge from 5 (2) to become informal
  • No right to appeal
22
Q

For a section 5 (4) discuss:

  • What it allows
  • How long it lasts
  • Who can do it
  • Right to appeal
A
  • Urgent detention of an inpatient already receiving treatment for a mental disorder, as an informal pt, in hospital
  • Up to 6hrs
  • Registered mental health nurse when doctor unable to attend immediately
  • No right to appeal
23
Q

For a section 135, discuss:

  • What it allows
A

Allows a police officer or authorised person with a magistrates warrant to enter a person’s premises, who is suspected to be suffering from a mental disorder, and remove them to a place of safety

24
Q

For a section 136, dicuss:

  • What it allows
A

Allows a police officer to remove an individual who appears to suffer from a mental disorder from a public place to a place of safety for assessment

25
Q

State 3 places of safety

A
  • Police station
  • A&E
  • Place of safety at mental health unit
26
Q

Briefly summarise some of the other following sections:

  • Section 17
  • Section 35-38
  • Section 7 (guardianship)
  • Section 62
A
  • Section 17= allows pts udner S3 to go on leave from hospital
  • Section 35-38= used by a court to send offenders to hospital for psychiatric assessment
  • Section 7 (guardianship)= gives power to specifiy where a pt lives and requires them to give professionals involved in their care access to their home
  • Section 62= urgent treatments such as ECT for life threatening depression
27
Q

What is a CTO?

A
  • Community treatment order
  • Can be used for pts who were on S3 when they leave hospital
  • Under a CTO pt can be recalled back to hospital if they don’t comply with treatment or attend appointments
  • Once recalled they can be detained for up to 72hrs for assessment
28
Q

You cannot use a section 5(2) or 5(4) in A&E as not classed as inpatient; hence, what could you do if you cannot let them leave?

A

Call security and not let them leave until…?CHECK

29
Q

Summary of main civil sections

A
30
Q

State some psychiatric conditions which are associated with crime

A
31
Q

Mens rea is when a person fully intended to commit the act/crime and was aware of the ramifications. There are some circumstances in which individuals may lack mens rea; state some examples

A
  • Age: children under 10yrs deemed incapable of criminal intent. Between 10-14yrs not criminally responsible unless prosecution can prove otherwise. Over 14yrs they are legally responsible.
  • Diminished responsibility: only applies in relation to murders. Murder charge will be changed to manslaughter if defendant has abnormality of mind e.g. if schizophrenic pt commits murder as a direct result of mental health problems
  • Automatism: act committed without presence of mind e.g. sleep walking
32
Q

Another legal aspect of psychiatry is safeguarding. Make sure up to date with safeguarding training. Look back over GP notes.

Remember that children always come first. Report if someone at risk.

A
33
Q

Discuss the difference between MHA and DoLS

A
  • ?????? medication
    *
34
Q
A

Yr4: Psychiatry (17 decks)

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