Mental Capacity concerns

Question 1

What does the Mental Health Act 2007 cover

Answer 1

Compulsory admission and treatment of mental illness
Limited to treatment of mental disorder

Question 2

What does the Mental Capacity Act 2005 cover

Answer 2

Consent and capacity for those >16yo
Even if they have a mental illness, any physical condition can only be treated under MCA if they lack capacity not MHA
+ advance decisions, LPAs (health & welfare, finance)

Note: MHA can overrule advance decisions

Question 3

What is an approved mental health professional (AMPH)

Answer 3

95% social workers
Approved by local social services authorities to carry out duties under the MENTAL HEALTH ACT
Responsible for coordinating the assessment/admission of a patient to hospital if sectioned

Question 4

What is an independent mental health advocate (IMHA)

Answer 4

Advocates trained to help the patient understand their rights under the MHA and provide support

Patients have a right to an IMHA if:
- Under a section that is NOT 4, 5, 135 and 136
- Under MHA guardianship, conditional discharge and CTO
- Discussing treatments such as ECT

Question 5

What are the 5 principles of the mental capacity act

Answer 5

Assumption of capacity
Assist with decision-making process
Unwise decisions
Best interests
Least restrictive alternative

Question 6

How do you assess capacity

Answer 6

Understand the risks, benefits and alternatives related to their decision
Retain that information long enough to make the decision
Weigh up that information
Communicate the decision through any means

Question 7

What is Section 135

Answer 7

Allows police to bring a person from their place of residence to a place of safety
- AMPH applies to Magistrates Court for warrant to gain access to property to look for and remove an ill patient to a ‘place of safety’ (usually a hospital
- Executed by the police who must be accompanied by an AMHP and a doctor.
- Can result in 24 hour admission for assessment

Question 8

What is section 136

Answer 8

Allows police to bring a suspected mentally ill person from a public place to a place of safety for further assessment
- Individual is in a place to which public has access to (Starts from outside of your front gate)
- Police need to be able to justify it
- Can result in 24 hour admission for assessment (can be extended, e.g., if pt has been asleep for most of those 24 hours)

Question 9

What is section 2

Answer 9

Power to detain a patient for 28 days of assessment ± treatment

Usually occurs following a MHAA for first admission
Cannot be renewed
Must be seen within 14 days of the date of application
The person is suffering from a mental disorder - it is of a nature or degree to warrant detention in hospital for assessment and detained in the interest of their own health/safety with a view to protect others
Can’t use for substance dependence - so must rule out intoxication at the time
Responsible clinician (RC) is a consultant - ST can’t discharge

Question 10

What is needed for discharge from section 2

Answer 10

One application by the nearest relative can be made to the Mental Health Review Tribunal within the first 14 days of detention
A responsible clinician can discharge at any time
Social worker has nothing to do with discharge

Question 11

What is section 3

Answer 11

Power to detain patient in hospital for 6 months for treatment with diagnosis stated

The person is suffering from a mental disorder - it is of a nature or degree to warrant detention in hospital for assessment and detained in the interest of their own health/safety with a view to protect others, and treatment is available and can’t be provided unless they are detained
Can recommend if section 2 is about to expire and still not any better
Consent to treatment provisions apply after 3 months of detention
If not consenting to treatment, you will need a second opinion appointed doctor (SOAD) assessment i.e. a doctor not from the same hospital that agrees with the plan
Are eligible for 117 aftercare if detained under section 3 (but not under section 2)

Question 12

Can section 3 be renewed/extended

Answer 12

May be extended
- First renewal: 6 months
- Second renewal and onwards: 12 months

Question 13

What is needed for discharge from section 3

Answer 13

Can apply to the Mental Health Review Tribunal at any time (MHRT aims to hold a hearing within 5 weeks)
Leave can be granted under Section 17
Nearest relative can apply for discharge to the hospital i.e. not the MHRT, but it can be barred by the responsible clinician

Question 14

What is section 4

Answer 14

Admission for assessment in cases of emergency, where a second doctor is not available and waiting for a second doc would cause undesirable delay

i.e. done instead of section 2 in emergency
Needs 1 doc (section 12 approved) and AMHP
Lasts for 72 hrs –> then usually altered to section 2/3

Question 15

What is section 5(2), how long does it last for and what is required

Answer 15

Power to detain an inpatient on any general ward (except A&E or outpatient department) if patient is suspected to be suffering from a mental disorder

72 hours to allow time for MHAA (followed by section 2/3)
Requires a doctor of level F2 or above

Question 16

What is section 5(4), how long does it last for and what is required

Answer 16

5(4) = power to detain an inpatient on any general ward (except A&E or outpatient department) if patient is suspected to be suffering from any mental disorder if a doctor is not available

6 hours
Requires a registered mental health nurse
Can’t be completed by any other team/ doc inc. psych liaison
Doesn’t authorise treatment for mental health disorder (i.e., cannot give sertraline unless pt agrees) - for treatment must use MCA

Question 17

When would section 5(2) be used

Answer 17

On psychiatry: emergency, not possible or safe to wait for MHA assessment completion

Medical/surgical wards: patients who are trying to leave but showing signs of significant mental health illness which would need psychiatric admission (psychiatry team cannot initiate on behalf of the hospital, responsibility on consultant physician)
OR informal psychiatric patients who were transferred to physical health wards for temporary treatment (responsibility with psychiatrist here)

Question 18

What is section 17

Answer 18

Allows admitted patients to leave ward temporarily for a specified period of time e.g. to
have a cigarette, collect clothes

Consultant fills in the form and will be able to leave
Informal pts don’t need this but sectioned pts need to get permission from the consultant
Must meet certain conditions e.g. return at certain time

Question 19

What is section 117

Answer 19

Aftercare
Duty of getting follow-up care after leaving section 3 admission and ensure that they have their needs met to reduce chance of condition getting worse e.g. housing, medication

Question 20

What is a community treatment order (CTO)

Answer 20

Allows being discharge from a previous section but on the agreement that certain conditions are met e.g. living in a certain place, going somewhere for medical treatment

Can be used once a patient is discharged from a section 3
Gives the Responsible Clinician power to recall the patient back to hospital
Can’t be used to compel a patient with capacity take treatment
Lasts for 6 months, renewed for 6/12, then yearly
If breached → return to old section (CTO recall)
Other set conditions may be things like reg assessments, med adherence, blood tests

Question 21

What is Deprivation of liberty safeguarding (DOLS)

Answer 21

Authorises the ongoing deprivation of liberty of a resident or patient who lacks capacity to consent to care/treatment - widely used in care homes/ stroke wards/ pts with delirium, dementia, etc.
Patient must be in a place where the DOLS can be given e.g. carehome
Cannot be done if already under MHA

Includes making decisions for them, limiting where they can go, or deciding their routine for them
e.g. locking patients in rooms to prevent them from wandering

Question 22

Who is required for a mental health act assessment (MHAA)

Answer 22

1. The patient
2. Nearest relative of the patient (involved but does not have to be present) - Legally the AMHP has to call the nearest relative and get input, but doesn’t need to necessarily listen to them
   - Spouse -> Oldest parent -> oldest sibling -> etc. (section 26)
   - Can change nearest relative, e.g., if fallen out with nearest relative, you can displace them
   - Can get IMHA (independent mental health advocate) if no nearest relative found
3. Approved mental health professional (AMHP)
4. Doctor 1 - Section 12 approved and/or know the patient in professional capacity (F2 and above)
5. Doctor 2 - Section 12 approved and/or know the patient in professional capacity (F2 and above)

Question 23

Who has the final decision on the outcome of the MHAA

Answer 23

Social worker/ AMHP

Question 24

What are the following for:
Section 35
Section 37
Section 41
Section 47
Section 48

Answer 24

Forensive sections
35: Magistrates Course can remand you in hospital if one doctor has evidence that you may have
a mental health disorder
37: Admission for medical treatment in a patient who has committed a crime
41: Restriction order - affect leave of absence, discharge and transfer between hospitals
47: Transfer serving prisoner to hospital
48: Transfer unsentenced prisoner to hospital