legal aspects of psychiatry Flashcards
why do we have mental health law
power to provide compulsory care and treatment for people w/ mental disorder
rights and safeguards to make sure those powers are used appropriately
duties on NHS boards and local authorities to provide a wide range of services for people w/ a mental disorder
mental health care and treatment act 2003 - principles
non-discrimination equality respect for diversity reciprocity informal care participation respect for carers least restrictive alternative benefit child welfare
what is a mental disorder defined as but the MH(C+T) act 2003
any mental illness, personality disorder or learning disability however caused or manifested
if it is only one of these things it is not a mental disorder:
- sexual orientation, sexual deviancy, transsexualism, transvestism, dependence on/use of drugs or alcohol; behaviour that causes/is likely to cause harassment/alarm/distress to any other person; acting as no prudent person would
who can be detained under the MH (C+T) act
> 18yrs
> 18yrs
- can still be detained
- need child/adolescent specialist
- use specialist resources wherever possible
overview of key civil compulsory power
emergency detention certificate (EDC) - detention for up to 72hrs
short term detention certificate (STDC) - detention for up to 28 days, has to be done by a specialist
compulsory treatment order (CTO) - detention for up to 6mths, renewable on an annual basis
nurses holding power - detention for up to 3hrs, allows holding until assessment by a doctor
EDC - who can do it
registered medical practitioner
what must be considered likely to give an EDC
the patient has a mental disorder, and
because of that mental disorder the patient’s decision making ability with regard to medical treatment for that mental disorder is significantly impaired
what must you also be satisfied that when giving an EDC
it is necessary as a matter of urgency to detain the patient in hospital in order to determine what medical treatment should be provided to the patient for the suspected mental disorder
there would be a significant risk to the health, safety or welfare of the patient or to the safety of another person if the patient were not detained in hospital and
making arrangements w/ a view to granting a short-term detention certificate would involve undesirable delay
who can give a STDC
approved medical practitioner -someone who has special recognition under the law as a specialist e.g. consultant, specialty trainee etc
what must be considered likely when giving an STDC
the patient has a mental disorder
because of that mental disorder, the patients ability to make decisions about the provision of medical treatment is significantly impaired
it is necessary to detain the patient in hospital for the purpose of determining what medical treatment should be given to the patient or giving medical treatment to the patient
if the patient were not detained in hospital there would be a significant risk to the health, safety or welfare of the patient or to the safety of any other person, and
the granting of a STDC is necessary
getting a CTO
applicatio to mental health tribunal made by mental health officer for the granting of a CTO
tribunal considers evidence and makes decision
mental health reports - GP and approved medical practitioner or 2 approved medical practitioners
what must you be satisfied of when granting a CTO
the patient has a mental disorder
medical treatment is available and would be likely to prevent deterioration or alleviate symptoms
w/o treatment there would be significant risk to health, safety or welfare of patient or safety of others
mental disorder significantly impairs decision making ability
making of compulsory treatment order is necessary
criteria for detention
some differences between the orders but overall:
mental disorder
significant impairment of decision making ability for medical treatment about mental disorder
significant risk to health, safety or welfare of the person or the safety of any other person
treatment available
order necessary
what is a named person
a right to be a party to proceedings
must be nominated by the patient and witnessed and the name person must have witnessed acceptance
patient thinks their opinion would be important to the tribunal and to the professionals looking after them
what is access to advocacy
right of every person with a mental disorder
what does incapable mean
the person is incapable of
acting or making decisions or communicating decisions or understanding decisions o r retaining the memory of decisions
- has to be by reason of mental disorder or an inability to physically communicate those decisions
adult - person who has attained the age of 16yrs
principles of adults with incapacity act
intervention must benefit the adult
any intervention shall be the least restrictive in relation to the freedom of the adult, consistent with the purpose of the intervention
account must be taken of the past and present wishes of the adult
where practicable, account should be taken of:
- views of relatives and carers
- views of relevant others - guardians, attorneys etc
when is capacity presumed present
capacity is presumed to be present unless proven otherwise
capacity and situation
capacity depends on the situation
may have capacity for some decisions but not others
decision specific capacity - 3 areas
property
welfare (medical)
financial
what is an intervention order
one off power required
application to the court
what is a guardianship order
someone else is appointed to make decisions on behalf of the adult - financial, welfare or both
adults with incapacity - medical treatment
exclusions to incapacity
use of force or detention, unless it is immediately necessary and only for so long as it is necessary in the circumstances
action which would be inconsistent with any decision by a competent court
placing an adult in hospital for the treatment of a mental disorder against his will - has to be properly done under mental health act
what powers do police have
removal from a public place
appears to be in immediate need to care or treatment to a place of safety
detain for up to 24hrs
purpose to allow assessment and make arrangements for their care and treatment
criminal responsibility and mental disorder
a person isn’t criminally responsible for conduct resulting in an offence if they were at the time of the offence unable by reason of mental disorder to appreciate the nature or wrongfulness of the conduct and should be acquitted of the offence
they don’t lack responsibility for such conduct if the mental disorder is only a personality disorder which is characterised only/mainly by abnormally aggressive or seriously irresponsible conduct
when is a person unfit for trial
if they are incapable by reason of physical/mental illness to participate effectively in the trial
consider the ability of the person to
- understand the nature of the charge
- understand the requirement to tender a plea to the charge and the effect of such a plea
- understand the purpose of, and follow the course of the trial
understand the evidence that may be given against the person
- instruct and otherwise communicate w/ the person’s legal representative
disposal in case of insanity
diminished responsibility
culpable homicide = manslaughter
restricted pts
aka first minister pts
~1/2 aren’t managed by forensic psychiatrists
orders that confer restricted status
compulsion order and restriction order assessment order treatment order interim compulsion order transfer for treatment direction hospital direction
what is the effect of being restricted
you are subject to special restrictions
special provisions for leave - MAPPA, SGMHD
oversight by scottish ministers
duties on ministers and RMO to review at certain points
specific functions for the tribunal
assessment order
court satisfied that there are reasonable grounds (one registered medical practitioner)- mental disorder, detention in hospital is necessary, civil risk criterion met, treatment, suitable bed available within 7 days, assessment could not be undertaken if not in hospital
court also has to consider
- all the circumstances incl. offence
- any alternative means of dealing w/ the person
treatment order
lasts until final disposal or another order is granted
court satisfied on the basis of evidence from 2 RMP (one must be approved) - mental disorder, treatable, civil risk
suitable bed available within 7 days
- reasonable alternative? necessity
need to consider all of above
treatment may be given (under STD but not ECD)
compulsion order
court satisfied on the basis of evidence from 2 RMP (one must be approved) - mental disorder, availability of medical treatment, significant risk, necessary to be in hospital
need to consider the level of scrutiny
need to consider if a restriction order is necessary
restriction order
court must hear ORAL evidence from at least one medical practitioner
court must be satisfied that the criteria are met
- having regard to the nature of the offence of which he is charged
- the antecedents of the person
- the risk that as a result of his mental disorder he would commit offences if set at large
that it is necessary for the protection of the public from serious harm
person shall be subject to the special restrictions w/o limit of time
effect of a restriction order
w/o limit of time cf 6mths
RMO must review annually
MWC can initiate a review
scottish ministers have a duty to review
patient and named person can make an application for a review by a tribunal
automatic hearing if no hearing in last 2yrs
MHO has responsibilities as CO and are set out in MOP
what is a state hospital
for people subject to detention under the criminal procedure act or the mental health (C+T) act who require treatment under conditions of special security on account of their dangerous, violent or criminal propensities
1 in scotland - high secure care for scotland and NI; rigorous physical, relational and procedural security
what is a medium secure unit
step down from high security or step up from low security
3 in scotland, all function slightly differently
less security that the state hospital but maintains a higher degree of procedural, relational and physical security than low secure units
what is a low security unit
lower level of security
pts in general will have more access to the community
relatively lower level offenders or step down through the pathways of care
transferred prisoners
not NO security
presence of mental illness in prison
4% M and W - psychotic illness
10% M, 14% W - major depression
18-30% M, 10-24% W - alcohol misuse
10-48% M, 30-60% W - drug misuse
mental illness and violence
people w/ severe mental illness more likely to have a hx of violence
severe mental illness not at higher risk of serious violence (deadly weapons, forced sexual acts etc), also not more likely to be bizarre
US pop survey - 75% viewed those w/ mental illness as dangerous, 60% believed people w/ sz were likely to commit violent acts
what affects risk of violence in mental illness
risk of violence will fluctuate depending on contextual factors
dynamic factors may be an intervention target - work, diagnosis, marital conflict, anxiety management to combat stress
mental illness and violence - UK populaiton attributable risk
the reduction in frequency of people committing 5 or more violent incidents in 5yrs that would occur if the risk factor in question was removed entirely from the population
psychosis - 2% ASPD - 20% personality disorder - 33% hazardous drinking - 55% drug dependence - 21%
