Low mood - mental health capacity

Question 1

What are the core principles of the mental health capacity Act 2005?

Answer 1

• Assume to have capacity
• not to be treated unstable to make a decision unless all practicable steps have been taken without success
• not to be treated as unstable to make decision just because they make an unwise decision
• for someone who lacks capacity, best interest should be made
• less restrictive of persons rights and freedom of action

Question 2

Who does the MCA act apply to?

Answer 2

• applies to adults who lack capacity
• for people 16+ must first presume capacity
• test a patients capacity

Question 3

When does a person lack capacity?

Answer 3

1. unable to make (or communicate) a decision
   - understand relevant info
   - retain relevant info
   - use or weigh info
   - communicate decision
2. inability is due to an impairment of or a disturbance in the functioning of, the mind or brain
3. recall capacity
   - decision specific and time specific
   - permanent or temporary
   - not assumed

Question 4

What do decisions about treatment depend on?

Answer 4

• advance decision to refuse treatment
• lasting power of attorney
• persons best interests

Question 5

What do decisions about the persons detention depend on?

Answer 5

whether the person is being deprived of their liberty

Question 6

What is ADRT?

Answer 6

Advance decision to refuse treatment

• made by 18+ must be respected if competent, valid and applicable
• must be written, signed and witnessed

Question 7

What is a LPA?

Answer 7

Lasting power of attorney

• if 18+ can consent to or refuse treatment on their behalf if person lacks capacity
• needs specific authorisation to decide about non(provision) of life sustaining treatment
• best interests

Question 8

What to do if patient lacks capacity and no ADRT or LPA?

Answer 8

• Decisions made in persons best interests
• regard for persons beliefs and values, past and present wishes and feelings
• balancing exercise to decide

Question 9

What is deprivation of liberty?

Answer 9

• involves 18+ person being required to remain for treatment against will
• permissible if it protects person from harm, is proportionate, no less restrictive alternatives, best interests
• there are safeguards to check hospitals and care homes

Question 10

Who are involved in decisions?

Answer 10

• doctors must consult:
• person (maximise autonomy)
• welfare attorney
• court appointed deputy
• anyone named by patient
• IMCA

Question 11

What do the IMCA do?

Answer 11

advise on the patients best interests if no one else available to do so

Question 12

What is the mental health act 1983?

Answer 12

• area complies with the European convention on human rights
• act supplemented by a code of practice

Question 13

To whom does the MHA apply?

Answer 13

• anyone and everyone
• children dealt with under Children Act 1989
• mental disorder
• pose a risk to themselves or others

Question 14

Who applies the MHA?

Answer 14

• Patients
• nurses (detain for 4hrs)
• doctors (detain for 72hrs)
• police ( 24hrs)
• nearest relative

Question 15

What does an AMHP do?

Answer 15

approved mental health practitioner

• applies to a hospital to accept a patient
• usually social worker with specific training
• two recommendations from doctors
• must know patient or have special training under MHA

Question 16

What is an S2 MHA 1983?

Answer 16

For assessment and treatment

• up to 28 days
• if patient has a mental disorder of a nature or degree that warrants detention in hospital for assessment
• detention is in the interests of own health or safety or to protect others

Question 17

What is a S3 MHA 1983?

Answer 17

for treatment

• up to 6 months
• if disorder means they should be detained in own or others interests
• treatment only possible if detained
• appropriate treatment is available

Question 18

What treatment does the MHA cover?

Answer 18

• basic nursing care
• some types of medication
• ECT (safeguards s583)
• psychotherapy

any treatment must be in order to treat cause or the sequala of the mental disorder

Question 19

What are the safeguards within the MHA?

Answer 19

S2 = person and their nearest relative is told how to appeal, legal advice provided, care team makes reports within 7 days, independent tribunal held within 7 days

S3 = same but within a month, hearing every 6 months, tribunal reviews annually

Question 20

Difference between focus of MHA 1983 and MCA 2005?

Answer 20

• people who have mental disorder and pose risk to themselves
• people who lack capacity due to an impairment

Question 21

Difference between treatment of MHA 1983 and MCA 2005?

Answer 21

• given involuntarily

- given in best interests

Question 22

Differences between detention/liberty in MHA 1983 and MCA 2005?

Answer 22

• Detention: required to prevent harm to person or others, required for treatment of mental disorder
• deprivation of liberty: persons best interests, not have to be specific treatment