Medicolegal - MCA and MHA

Question 1

Outline the 4 step capacity test

Answer 1

Patient must be able to:

1. Understand information relevant to decision
2. Retain the info long enough to make decision
3. Weigh up info
4. Communicate decision

Question 2

What are the 3 features of consent which make it valid?

Answer 2

• Informed - enough info to weigh up pros and cons
• Competent - patient has capacity
• Voluntary - no coercion

Question 3

How may consent be indicated?

Answer 3

Implied - no objection and full cooperation

Expressed - verbal/written

Question 4

What is the legal age of capacity?

Answer 4

16

Question 5

Can children under 16 make decisions about their health?

What is this called?

Answer 5

Yes - if deemed to have capacity. This is Gillick competence

Question 6

What is special about 16 and 17 year olds with regards to consent?

Answer 6

They can consent to treatment, but cannot refuse life-saving treatment

Question 7

What is an advanced directive?

Answer 7

Document which allows adults over 18 with capacity to make medical decisions in advance of becoming incapacitated

Question 8

Can an advanced directive be used to demand treatment?

Answer 8

No - only to refuse it

Question 9

Can advanced directives be used to make decisions about housing, finances etc…?

Answer 9

No - only medical decisions

Question 10

What is DOLS?

Answer 10

Deprivation of Liberty Safeguarding - part of MCA which deprives people without capacity of their liberty in order to keep them safe.
“Lesser version” of sectioning
Care homes or hospitals
Renewed annually

Question 11

If there are no ADs or LPA, how should decisions be made about someone who lacks capacity?

Answer 11

In their best interests

Question 12

What is the MHA used for?
Exceptions?
What can’t it be used for?

Answer 12

To enforce treatments for mental health conditions only
The only “physical” treatment allowed is force-feeding in EDs
Cannot be used for substance/alcohol abuse

Question 13

What are the 3 criteria for implementation of the MHA?

Answer 13

1. Must be judged to have a mental disorder as defined by law
2. Nature or degree of disorder is severe enough to warrant hospitalisation
3. No alternative to hospital admission to contain risks

Question 14

Outline the key features of section 2

Answer 14

• Primary purpose = assessment
• 28 days
• Application by AMHP, recommendation by 2 doctors, 1 of whom must be section 12 approved (i.e. psychiatrist)
• Appeals only within first 14 days

Question 15

Outline the key features of section 3

Answer 15

• Primary purpose = treatment
• Up to 6 months (can be renewed)
• Application by AMHP, recommendation by 2 doctors, 1 of whom must be section 12 approved
• NoK must be consulted
• 1 appeal at any time

Question 16

Outline the key features of section 5(4)

Answer 16

• Allows RMNs to detain psychiatric inpatient for further assessment by doctor
• 6 hours

Question 17

Outline the key features of section 5(2)

Answer 17

• Allows consultant or his deputy to detain inpatient (any ward except A+E)
• 72 hours
• No appeals

Question 18

Outline sections 136/135

Answer 18

136: Allows police officer to remove person from public place to place of safety (not police station)
24 hours for assessment

135: same, but from private place - requires magistrate’s warrant

Question 19

Outline section 17

Answer 19

Allows patients on section 2/3 to have leave - set out by consultant

Question 20

Outline section 117

Answer 20

Entitles patients on section 3 to aftercare following discharge, paid for by local authority (i.e. social services)

Question 21

Can treatment be given without consent if a patient is under section 5(4) or 5(2)?

Answer 21

No - assessment only

Question 22

Can medication be given without consent if a patient is under section 2 or 3?

Answer 22

Yes, for first 3 months

After that, patient must consent if they have capacity, otherwise opinion of SOAD must be sought

Question 23

What is a community treatment order (CTO)?

Answer 23

Legislative order which may be applied to patients who were on section 3 in order to ensure compliance after discharge
Lasts up to 6 months