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YEAR 3 HEALTH AND SOCIETY > MCA, MHA, SECTIONING > Flashcards

MCA, MHA, SECTIONING Flashcards

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1
Q

What is the Mental Capacity Act 2005?

A

An act that provides a legal framework for acting and making decisions on behalf of adults who lack capacity to make particular decisions for themselves

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2
Q

What are the 5 statutory principles of the MCA?

A

A person must be assumed to have capacity unless its established that they do lack capacity
A person is not to be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success
A person is not to be treated as unable to make a decision merely because they make an unwise decision
An act done under this act on behalf of a person who lacks capacity must be done in their best interests
Any decisions made within this act must achieve the least restriction of the person’s rights and freedom of action

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3
Q

What is deprivation of liberty?

A

Where your liberty is taken away from you i.e. you are not free to leave and you are under continuous supervision and control
This should only be used if its the least restrictive way of keeping you safe or making sure you have the right medical treatment

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4
Q

Who does the MCA apply to?

A

Anyone 16 or over who may lack capacity to make decisions for themselves

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5
Q

What is an independant mental capacity advocate?

A

An advocate appointed to act on your behalf if you lack capacity to make certain decisions appointed to you by a local authority
They allow pt to express their views, defend their rights, accompany and support them in meetings. They dont advise but give objective information to facilitate them making a decision

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6
Q

What is a deputy?

A

A person appointed by the court of protection to make financial/property decisions for you once you have lost capacity
(I..e its like an attorney but its appointed to you by the court rather than you choosing an attorney when you still have capacity)

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7
Q

What do the court of protection do?

A

Make decisions and appoints deputies to act on your behalf if you are unable to make decisions about your personal health, finance or welfare

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8
Q

What is a lasting power of attorney?

A

a person over the age of 18 whom you have appointed to make decisions on your behalf about your welfare and/or your property and financial affairs. You need an attorney if you are unable to make such decisions yourself. If you do not have the capacity to appoint an attorney, the Court of Protection will appoint a deputy to perform this role.

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9
Q

What is a lasting power of attorney?

A

a legal document that lets you appoint an attorney to make decisions for you
The 2 types are: a health and welfare LPA or a property and financial affairs LPA

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10
Q

What is an advance statement?

A

A written documents that sets out your preferences (other than refusals of treatment)
It is not legally binding

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11
Q

What does it mean if a person lacks capacity?

A

They are unable to make decisions for themselves

They lack capacity if they are unable to do one or more of…
Understand information
Retain information
Use or weigh up that information
Communicate a decision

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12
Q

What is the two-stage functional test of capacity?

A

Stage 1 - is there an impairment in the functioning of a person’s mind/brain
Stage 2 - is the impairment sufficient enough that the person lacks the capacity to make a particular decision

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13
Q

What are the 2 types of advanced directives?

A

Advanced statement of wishes
Advanced directives

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14
Q

What are advanced statement of wishes?

A

A written statement of wishes
Not legally binding but should be taken into account

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15
Q

What are advanced directives?

A

Speicifc decision to refuse treatment. Note they cannot refuse basic personal care
Trumps best interest EVERY time as it is equal to consent
They are beneficial as they extend pt autonomy

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16
Q

What is Ulysses arrangement?

A

an agreement where a patient may arrange for psychiatric treatment or non-treatment to occur at a later stage when she expects to change her mind

Eg. In schizophrenia when they stop taking their meds

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17
Q

What is a second opinion appointed doctor?

A

Doctors that give supportive second opinions on treatment or sectioning - additional safegaurding measure

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18
Q

What is an approved mental health professional?

A

mental health professionals who have been approved by a local social services authority to carry out certain duties under the Mental Health Act. They are responsible for coordinating your assessment and admission to hospital if you are sectioned.

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19
Q

What is a section 12-approved doctor?

A

A doctor who has been approved under MHA for sectioning a pt as they have specific expertise for diagnosing and treating a mental health disorder

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20
Q

What is the mental health act?

A

The law in England and wales which tells people with mental health problems what their rights are regarding assessment and treatment in hospital, treatment in the community and pathways into hospital

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21
Q

Why was the mental health act introduced?

A

Prior to the introduction of the Mental Health Act, people with mental illnesses could be detained in institutions without due process or legal protections. The Mental Health Act established clear procedures for detention, assessment, and treatment, and provided safeguards to protect the rights of people with mental disorders.

The Act also established the role of the approved mental health professional, who is responsible for making sure that the rights of people with mental disorders are protected and that they receive appropriate care and treatment. Additionally, it created the Mental Health Tribunal

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22
Q

What is a mental health tribunal?

A

A panel made up of a judge, medical member and lay member that you can apply to for discharge from tour section. They will gather information to decide if you still fit the conditions for being sectioned

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23
Q

Who cannot apply to the tribunal?

A

If you’re under section 5, 135, 136 or a section that has been ordered by a court and you are currently on remand

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24
Q

What does it mean to be on remand?

A

That you will go to prison until you go to court to have your case considered

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25
Q

What is a community treatment order?

A

Supervised treatment in the community as ordered by your responsible clinician
Your responsible clinician can return you to hopsital and give you immediate treatment if necessary
It comes with some certain conditions you have to follow e.g. going to treatment appointments or living in a certain place

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26
Q

How long does a CTO last?

A

6 months from the date of order
It can be renewed by your responsible clinician

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27
Q

What is section 117 aftercare?

A

People who have been kept in hospital under the MHA can get free help and support after they leave hospital
E.g. healthcare, social care, employment services, supported accommodation, services to meet social/cultural/spiritual needs

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28
Q

Who can get section 117 aftercare?

A

If you have had:
Treatment under section 3
Under a hospital order under section 37
Following transfer from prison under section 47 or 48
Under a hospital direction under section 45A

In addition:
Discharged into a CTO for the entire period of your CTO
If you are a restricted patient on a conditional discharge

29
Q

Who is responsible for providing section 117 aftercare?

A

It’s the duty of the integrated care board and local social services authority

30
Q

When can you apply for a mental health tribunal?

A

Under section 2 you must apply within the first 14 days after sectioning
Under section3. You can apply once at any time in the first 6 months (if sectioning extended you can apply once in the next 6 months and then once every 12 month period)
If on CTO you can apply once at any time in the first 6 months (if sectioning extended you can apply once in the next 6 months and then once every 12 month period)
Under section 37 you or your nearest relative can apply one in the second month period and then once after every 12 months

31
Q

What happens under section 37 hopsital order if you do not apply for a tribunal hearing after 3 years?

A

You will be referred to the tribunal after 3 years

32
Q

Who can represent you at a tribunal?

A

A mental health accredited solicitor
Someone you trust e.g. advocate or family member (this must be approved by the tribunal)
Yourself

33
Q

What are the rights of a CTO?

A

Right to informed consent
Right to legal representation
Right to appeal
Right to confidentiality
Right to adequate treatment
Right to review of their CTO regularly to ensure its still necessary and appropriate for their needs

34
Q

Where can a pt under the MHA get legal support?

A

Local law centre
Civil Legal Advice
Citizens advice England
Private solicit
Mind’s legal Line

35
Q

Where are independant mental health advocates and how are they different to independant mental capacity advocates?

A

Specially trained advocates who can support pt under the MHA i.e. detained in hopsital or subject to a CTO.
IMCAs support people who lack capacity to make certain decisions whereas IMHA provide info and advice to support a pt and help them understand their rights so they can make informed decisions about their care and treatment

36
Q

When are you detained under section 2?

A

you have a mental disorder
you need to be detained for a short time for assessment and possibly medical treatment, and
it is necessary for your own health or safety or for the protection of other people.

37
Q

How long can you be detained under section 2?

A

Up to 28 days

38
Q

Can section 2 be extended or renewed?

A

No but you may be assessed before the end of the 28 days to see if sectioning under section 3 is needed

39
Q

When can you be detained under section 3?

A

you have a mental disorder
you need to be detained for your own health or safety or for the protection of other people, and
treatment can’t be given unless you are detained in hospital.
Doctors agree that appropriate treatment is available for you

40
Q

How long can you be detained for under section 3?

A

Up to 6 months

41
Q

Can section 3 be extended or renewed?

A

Yes by your responsible clinician:
For 6 months the first time, 6 months the second time and after that for 12 month periods
There is no limit to the number of times the clinician can renew it

42
Q

What is section 5(2)?

A

This applies to you if you are a voluntary patient or inpatient

A doctor or other approved clinician in charge of your treatment needs to report to the hospital managers that an application to keep you in hospital (a detention section) ‘ought to be made’.

43
Q

How long can you be detained under section 5(2)?

A

Up to 72 hours

44
Q

What is section 5(4)?

A

This applies if you are a voluntary pt recieving treatment for a mental disorder as an inpatient
A nurse specially qualified/trained to work with mental health problems or learning disabilities can detain you if they think your mental health problem is so serious that you need to be kept in hospital immediately for your health/safety or protection of others, and its so urgent that its not practicable to get a practitioner or clinician to provide a report to the hospital managers

45
Q

How long can you be detained under section 5(4) for?

A

Up to 6 hours, or until a doctor or clinician with authority to detain you arrives
Whichever is earlier

46
Q

What is section 4?

A

You need to be detained under section 4 if:
you have a mental disorder
it is urgently necessary for you to be admitted to hospital and detained, and
waiting for a second doctor to confirm that you need to be admitted to hospital on a section 2 would cause “undesirable delay”.

You can be sectioned by 1 doctor and an approved mental health professional and can be taken to hospital in an emergency and assessed there

Different from section 2 in that there is an urgent need for treatment and person is not able to consent to treatment and the delay involved in obtaining an assessment under section 2 would have a negative impact on the person’s health or safety
Also only needs 1 doctor as Appleseed to section 2
For 72 hours

47
Q

What is section 7?

A

Guardianship
instead of being sectioned you are appointed a guardian who has the power to make certain decisions about you
They last for 6 months and scan be renewed

48
Q

What is section 135?

A

You can be placed under this section if there is reasonable cause to suspect that you have a mental disorder and you are:

being ill-treated or neglected or not kept under proper control, or
unable to care for yourself and live alone.
A magistrate can issue a warrant authorising a police officer (with a doctor and an approved mental health professional) to enter any premises where you are believed to be and take you to a place of safety.
You can be kept in hospital for up to 24 hours (may be extended yp to 36 hours in some circumstances)

49
Q

What is section 136?

A

If it appears to a police officer that you have a mental disorder and are “in need of immediate care or control” on a public place, they can take you to (or keep you at) a place of safety. You will be kept in the place of safety you were taken to so that you can be examined by a doctor and interviewed by an approved mental health professional, and any necessary arrangements can be made for your treatment or care.

You can be kept under this section for up to 24 hours (this can be extended up to 36 hours in some circumstances).

50
Q

What is an informal patient?

A

people who are staying in a psychiatric hospital but are not detained under the Mental Health Act. If you are a voluntary patient, you should be able to come and go from the hospital within reason and discharge yourself if you decide to go home.

51
Q

What is the Human Rights Act 1998?

A

The law that protects the human rights

52
Q

Why is the human rights act important?

A

It sets out a minimum standard of how the government should treat you
Parliament must think about whether a new law follows the HRA before it comes into force

53
Q

Who doesnt need to follow the humans right act?

A

Individual people
Private companies

54
Q

What are articles 2,3,5 and 6 under the human right act?

A

2- right to life
3 - prohibition of torture
5 - right to liberty and security
6 - right to a fair trial

55
Q

What is article 2: the right to life?

A

The European court has held that the article requires hospitals to take measures to ensure steps are in place to secure an individual’s right to life = mostly relevant with regards to suicide e.g. ensure no areas in a pt room which could easily support a noose, windows are secured etc or giving a pt home leave when a pt is still unwell and they end their life

56
Q

What is article 3: prohibition of torture and inhuman or degrading treatment?

A

This is relevant to justifying medical treatment which could be classified as torture e.g. strapping a pt to a wheelchair to prevent them wandering off and leaving hospital could be seen as degrading treatment or giving a pt a cheaper drug with worse side effects

57
Q

What is article 5: right to liberty and security?

A

This is a limited right i.e. you have the right to move around as you want and not be locked in a room but this can sometimes be limited by the law e.g. if a person is arrested or sectioned
Having your rights of liberty removed must be done lawfully and there must be safegaurds so you cna challenge whether it is lawful e.g. applying to mental health tribunal

58
Q

What is article 6: the right to a fair trial?

A

The concept that everyone sectioned has the right to a mental health review tribunal hearing

To be fair a hearing should be…
independent and impartial - fair and free from bias
Pt must be given notice
Taken place as soon as it proactively
Representation
Right to see all documents in proceedings
The right to be given reasons for a decision so you can understand why the decision is made

Example - Jean was transferred to a psychiatric home and the Local Authority went to the Court of Protection for an order to keep her there without consulting her or her family. This could be a breach of Article 6: Right to a fair trial.

59
Q

What is a limited right?

A

This means they can only be restricted in specific situations set out in the Human Rights Act. For example, article 5 says it’s not a breach of your right to personal freedom if you’re detained following a criminal conviction or under mental health legislation and the correct procedure was followed.

60
Q

What is a qualified right?

A

A public authority can sometimes interfere with your rights if it’s in the interest of the wider community or to protect other people’s rights
E.g. article 9 - freedom to manifest you r religion or beliefs

61
Q

What are absolute rights?

A

Rights that can never be restricted
E.g. right not to be tortured or treated in an inhuman or degrading way

62
Q

What are the criteria for consenting to treatment?

A

you need to meet all of the following criteria:
You have capacity to make the decision
You are at least 16 years old
You have enough information about the treatment to make your decision.
You are giving your consent freely – in other words, you do not feel pressured or threatened into a certain decision.

63
Q

When is consent not always required?

A

In emergencies
Immediately needs an additional emergency procedure during an operation
Severe mental health condition and lacks the capacity - MHA
Is severely ill and living in unhygienic conditions - national assistance act 1948
Infectious disease - Public Health (control of disease) Act 1984

64
Q

What is confidentiality?

A

The principle of not divulging or disclosing information about patients to others

65
Q

Why is confidentiality important?

A

Legal requirement
Autonomy & trust for patient
Prevent harm to patient – non-maleficence

66
Q

When can you break confidentiality?

A

Life-threatening situations - self-harm, suicide, DVLA
Demanded by court statute, CQC, NHS fraud, GMC, parliament
When discoloured is in the public’s best interest to prevent harm e.g. communicable diseases, terrorism prevention, knife or gun wounds must be reported to police, preventing trafficking, protecting children
When pt lacks capacity and disclosure is in their best interest
An anonymous e.g. statistics for research
If decreased - unless pt explicitly requested complete confidentiality up in death

67
Q

What is the equality act 2010?

A

the law that protects you from discrimination and gives you the right to challenge it. You are protected by the Equality Act if you have certain protected characteristics:
Age
Disability (including mental health problems)
Gender reassignment
Marriage and civil partnership
Pregnancy and maternity
Race
Religion and belief
Sex
Sexual orientation

68
Q

How does the equality act define disability?

A

if you have a physical or mental impairment that has a substantial, adverse, and long-term effect on your ability to carry out normal day-to-day activities.

69
Q

What is section 19?

A

The appointment of a deputy by the court of protection or person themselves if they still have capacity

YEAR 3 HEALTH AND SOCIETY (14 decks)

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