Legal Aspects of Psychiatry Flashcards
What is the Mental Health Act 2003?
It increases the rights and protection of individuals with mental disorders
What are the three types of mental health disorders? What section defines this?
Mental illness
Learning disability
Personality disorder
Section 328
Does the Mental Health Act define alcohol/substance misuse alone as a mental disorder?
No
Which age group does the Mental Health Act 2003 apply to?
It can be applied to individuals of all ages, including those under the age of 18
What are the three civil compulsory powers determined by the Mental Health Act 2003?
Detainment
Assessment
Treatment
What are the three types of detentions in the Mental Health Act 2003?
Emergency Detention
Short Term Detention
Compulsory Treatment Order
How long does an emergency detention certification (EDC) authorise detention for?
72 hours
Note: This does not include the time taken to travel to hospital
Who can conduct an emergency detention certificate (EDC)?
A registered Medical Practioner
Which section of the Mental Health Act 2003 states that detainment can be determined by an approved medical practitioner?
Section 22
Which five individuals are deemed as registered medical practitioners?
GP
Consultant psychiatrist
Dental practitioner
Optician
Registered nurse
Which individuals are not regarded as registered medical practitioners?
Foundation Year 1 Doctors
What are the five criteria that must be obtained for an emergency detention certificate (EDC)?
It is considered likely that the patient has a mental disorder
The patient’s decision making ability with regard to medical treatment for that mental disorder is significantly impaired
It must be 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 also be significant risk to the health, safety or welfare if the patient, or the safety of another person, if the patient were not detained
The granting of a short-term detention certificate would involve undesirable delay
Can treatment be given under the emergency detention certification (EDC)?
No
Do individuals have the right to appeal an emergency detention certification (EDC)? Why?
No
This process requires the patient to instruct their solicitor to lodge an appeal, which is not practicable within 72 hours
How long does a short term detention certificate (STDC) authorise detention for?
28 days
Who can conduct a short term detention certificate (STDC)?
Registered Medical Practitioner
AND
Mental Health Officer
What are the five criteria that must be obtained for a short term detention certificate (STDC)?
It is considered likely that the patient has a mental disorder
The patient’s decision making ability with regard to medical treatment for that mental disorder is significantly impaired
It must be necessary 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 also be significant risk to the health, safety or welfare if the patient, or the safety of another person, if the patient were not detained
The granting of a short-term detention certificate is necessary
How do we determine whether an individual has significant impairment of decision making ability about medical treatment for mental disorder?
We conduct a SIDMA test, which assesses for the following…
- Lack of insight
- Cognitive impairment
- Psychosis
- Severe depression
- Learning disability
Do individuals have the right to appeal a short term detention certification (STDC)?
Yes
How long does a compulsory order treatment certificate (COT) authorise detention for?
6 months
Who can conduct a compulsory treatment order certificate (COT)?
The application for this certification is conducted by a Mental Health Officer, supported by two approved Medical Practioners, to the Mental Health Tribunal
What are the five criteria that must be obtained for a compulsory treatment order certificate (COT)?
It is considered likely that the patient has a mental disorder
The patient’s decision making ability with regard to medical treatment for that mental disorder is significantly impaired
It must be necessary to detain the patient in hospital in order to determine what medical treatment should be provided to the patient for the suspected mental
There would also be significant risk to the health, safety or welfare if the patient, or the safety of another person, if the patient were not detained
The granting of a compulsory treatment order certificate is necessary
How regularly should compulsory treatment order certificates (COT) be reviewed?
Every 2 years
How long does a nurse holding power authorise detention for?
2 hours
When is a nurse holding power conducted?
It is used when detention in hospital is required until assessment from a doctor can be conducted
In general what are the five criteria of the Mental Health Act 2003?
Mental disorder is likely
They are not competent
Treatment is available
The patient is at risk to themselves or others
Hospitalisation is necessary
In what section of the Mental Health Act is medical treatment of mental disorders determined?
Section 16
Who authorises medical treatment of mental disorders after two months? What forms are used?
Patient (T2)
OR
Doctor from the Mental Welfare Commission (T3)
What are the rights of the Police under the Mental Health Act 2003?
They can remove individuals from a public place to a place safety,
They can detain patients in this safe place for up to 24 hours
This is to allow assessment and make arrangements for their care and treatment
What is the Adults with Incapacity Act 2000?
It provides a framework for protecting the welfare of adults (those who have attained the age of 16 years) who lack the capacity to make decisions for themselves, due to mental illness, learning disability or an inability to communicate
What are the four principles of the Adults with Incapacity Act 2000?
The intervention must benefit the adult
The intervention shall be the least restrictive in relation the freedom of the adult, consistent with the purpose of the intervention
There should be consideration of the adults past and present accounts
There should be consideration of the relatives, carers or relevant others (guardians, attorneys, etc) views
What section of the Adults of Incapacity Act 2000 states the four principles?
Section 2 - 4
What is the intervention order?
It authorises an individual to make a one-off decision on behalf of an adult with incapacity
What is the guardianship order?
It authorises an individual to make ongoing decisions on behalf of an adult with incapacity
Who can appoint a guardianship order?
The application for this certification is conducted by a Mental Health Officer, supported by two approved Medical Practioners, to the Mental Health Tribunal
Which individuals can act as a welfare guardian?
It might be a relative, friend or a carer
The court can also appoint the chief social work officer of a local authority to be a person’s welfare guardian
What is a power of attorney (POA)?
It is authority given by an individual with capacity, known as the Granter, to make decisions on their behalf
What is a named person?
It is an individual that the patient can nominate to look after their interests when treated under mental health legislation
They can apply and appeal to the Tribunal and can appear and be represented at the Tribunal hearings
Does the Adult of Incapacity Act enable placement of an adult in hospital for the treatment of mental disorder against his will? Why?
No
This would need to be under the Mental Health Act
In cases where individuals have both mental and physical disorders, what Act do we apply to conduct treatment against the patient’s will?
It is determined by the treatment being conducted - if psychiatric then we use the Mental Health Act 2003 and if physical then we use the Adults of Incapacity Act 2000
What is the Criminal Procedure Act 1995?
It includes provisions for individuals who are accused of a criminal act and who may have a mental disorder
What are the two considerations used to determine if an individual is criminally responsible?
The individual is not criminally responsible for conduct of an offence, and is to be acquitted of this offence, if the person was at the time of conduct unable by reason of mental disorder to appreciate the nature or wrongfulness of the conduct.
However, the individual doesn’t lack criminal responsibility for such conduct if the mental disorder in question consists only of a personality disorder, which is characterised solely or principally by abnormally aggressive or seriously irresponsible conduct.
What are the five considerations used to determine an individual’s fitness for trial?
The individual’s ability to understand the nature of the charge
The individual’s ability to understand the purpose of the trial
The individual’s ability to understand the requirement to accept a plea to the charge and the effect of this
The individual’s ability to understand the evidence that may be given against the person
The individual’s ability to instruct and otherwise communicate with the person’s legal representative
Can an individual be deemed unfit for trial by reason of their inability to recall whether the event which forms the basis of the charge occurred in the manner described in the charge?
No
What is another term for restricted patients?
First minister patients
What are restricted patients?
They are mentally disordered offenders who are detained in hospital for treatment
These patients are subjected to controls overseen by Scottish Ministers and Responsible Medical Officer (RMO), including permission for community leave, transfer to another hospital, discharge and recall to hospital
What are the four orders which can be applied to restricted patients?
Assessment Order
Treatment Order
Compulsion Order
Restriction Order
What are the five criteria used to obtain restricted patient orders?
It is likely that the patient has a mental disorder
The assessment couldn’t be undertaken if not in hospital
There must be a suitable bed available within seven days
There would also be significant risk to the health, safety or welfare if the patient, or the safety of another person, if the patient were not detained
It must be necessary to detain the patient in hospital in order to determine what medical treatment should be provided to the patient for the suspected mental disorder
How long does an assessment authorise detention for?
28 days
When is the assessment order applied?
When the individual is assessed for mental disorders prior to court trial
Who can conduct an assessment order?
A registered medical practitioner
When is the treatment order applied?
It authorises detention in hospital for treatment, whilst the individual waits for court trial
It lasts until the court decide to convict or acquit the patient
Who can conduct a treatment order?
2 Medical Practitioners
1 of whom must be approved
When is the compulsion order applied?
It authorises detention in hospital for treatment, whilst the individual either waits for court trial or has been convicted
How long does a compulsion authorise detention for?
6 months
Who can conduct a compulsion order?
2 Medical Practitioners
1 of whom must be approved
When is the restriction order applied?
It can be added to compulsion orders
It results in approval from Scottish Ministers prior to individuals being moved to a different hospital or community leave
How long does a restriction order last?
It is without limit of time, despite being applied to the six month compulsion order
Who reviews compulsion orders annually?
Responsible Medical Officer (RMO)
What is the The Criminal Justice & Licensing Act 2010?
It includes provisions for individuals who are accused of a charge of murder and who may have a mental disorder
What is diminished responsibility?
It results in in a charge of culpable homicide rather than murder
What are the two criteria of diminished responsibility?
The individual’s ability to determine or control conduct, for which the person would otherwise be convicted of murder was, at the time of conduct, substantially impaired by reason of abnormality of the mind. This includes mental disorders
The individual doesn’t deem diminished responsibility if under the influence of alcohol, drugs or any other substance at the time of the conduct
What is the Adult Support & Protection Act 2007?
It includes provisions that dictate and influence responses in situations where it is suspected, or known, that certain adults are experiencing harm or abuse
It deals with harm inflicted by others, self-harm and neglect
How does the Adult Support & Protection Act 2007 define adults at risk?
Those that are unable to safeguard their own well-being, property, rights or other interests
Those that are at risk of harm and because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected
What should clinicians do if they suspect an adult is at risk of harm?
They should discuss their concerns with a senior
They should document their concerns
They should report to the relevant local authority
What should the local authority do once a clinical reports an adult who is at risk of harm?
They should make inquiries to establish whether it is known or believed that an adult is at risk of harm and whether intervention may be necessary to protect the adult
They may apply to the sheriff for the grant of a protection order. This may be an assessment order, removal order or a banning order (this requires consent from the vulnerable adult)
