Legal Aspects of Psychiatry Flashcards
The nature of psychiatric disorders means patients may refuse treatment; state 3 domains under which we can treat patients without consent
- Treatment under Mental Capacity Act
- Treatment under Mental Health Act
- Treatment authorised by a court
Briefly outline the aim of the MCA
Identify people who lack capacity to refuse or consent to treatment and to protect them. Only applies to England & Wales.
Remind yourself of the two stage Mental Capacity Assessment
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?
State the 5 key principles of Mental Capacity Act (2005)
- 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
What is a lasting power of attorney?
State the 2 types
- 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..)
What is an advanced statement?
Is it legally binding?
- 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
What is an advance decision/directive?
- 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
State 3 options for advanced care planning
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?
- 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
What is an IMCA?
- 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
Define a mental disorder
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.
What is the MHA (1993, ammended in 2007)/what does it allow you to do?
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
What do we mean by formal & informal pts?
Formal= in hospital under MHA
Informal= in hospital voluntarily
AMHP (approved mental health professionals) can make an application for a pt to be sectioned; state some examples of AMHPs
- Nurses
- Social workers
- Psychologists
- OTs
NOT DOCTORS
When should you use MHA?
*HINT: Revise Our Mental Health Act
For a section 2 discuss:
- What it allows you to do
- Who can/which professionals can reccommend a section 2
- Appeals process
- 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)
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)
- 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
What is section 117 aftercare?
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..
There are 5 emergency sections; state these
- Section 4
- Section 5 (2)
- Section 5 (4)
- Section 135
- Section 136
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
- 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
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
*
- 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
For a section 5 (4) discuss:
- What it allows
- How long it lasts
- Who can do it
- Right to appeal
- 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
For a section 135, discuss:
- What it allows
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
For a section 136, dicuss:
- What it allows
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
