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Y3 - psychiatry > legal aspects of psychiatry > Flashcards

legal aspects of psychiatry Flashcards

1
Q

why do we have mental health law

A

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

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2
Q

mental health care and treatment act 2003 - principles

A 
non-discrimination
equality 
respect for diversity 
reciprocity 
informal care
participation
respect for carers
least restrictive alternative 
benefit 
child welfare
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3
Q

what is a mental disorder defined as but the MH(C+T) act 2003

A

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

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4
Q

who can be detained under the MH (C+T) act

A

> 18yrs

> 18yrs

  • can still be detained
  • need child/adolescent specialist
  • use specialist resources wherever possible
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5
Q

overview of key civil compulsory power

A

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

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6
Q

EDC - who can do it

A

registered medical practitioner

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7
Q

what must be considered likely to give an EDC

A

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

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8
Q

what must you also be satisfied that when giving an EDC

A

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

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9
Q

who can give a STDC

A

approved medical practitioner -someone who has special recognition under the law as a specialist e.g. consultant, specialty trainee etc

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10
Q

what must be considered likely when giving an STDC

A

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

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11
Q

getting a CTO

A

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

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12
Q

what must you be satisfied of when granting a CTO

A

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

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13
Q

criteria for detention

A

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

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14
Q

what is a named person

A

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

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15
Q

what is access to advocacy

A

right of every person with a mental disorder

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16
Q

what does incapable mean

A

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

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17
Q

principles of adults with incapacity act

A

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
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18
Q

when is capacity presumed present

A

capacity is presumed to be present unless proven otherwise

19
Q

capacity and situation

A

capacity depends on the situation

may have capacity for some decisions but not others

20
Q

decision specific capacity - 3 areas

A

property
welfare (medical)
financial

21
Q

what is an intervention order

A

one off power required

application to the court

22
Q

what is a guardianship order

A

someone else is appointed to make decisions on behalf of the adult - financial, welfare or both

23
Q

adults with incapacity - medical treatment

A
24
Q

exclusions to incapacity

A

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

25
Q

what powers do police have

A

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

26
Q

criminal responsibility and mental disorder

A

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

27
Q

when is a person unfit for trial

A

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

28
Q

disposal in case of insanity

A
29
Q

diminished responsibility

A

culpable homicide = manslaughter

30
Q

restricted pts

A

aka first minister pts

~1/2 aren’t managed by forensic psychiatrists

31
Q

orders that confer restricted status

A 
compulsion order and restriction order
assessment order
treatment order
interim compulsion order
transfer for treatment direction 
hospital direction
32
Q

what is the effect of being restricted

A

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

33
Q

assessment order

A

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
34
Q

treatment order

A

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)

35
Q

compulsion order

A

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

36
Q

restriction order

A

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

37
Q

effect of a restriction order

A

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

38
Q

what is a state hospital

A

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

39
Q

what is a medium secure unit

A

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

40
Q

what is a low security unit

A

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

41
Q

presence of mental illness in prison

A

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

42
Q

mental illness and violence

A

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

43
Q

what affects risk of violence in mental illness

A

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

44
Q

mental illness and violence - UK populaiton attributable risk

A

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%

Y3 - psychiatry (27 decks)

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