Mental Health Act Flashcards
When is compulsory hospitalisation indicated?
People taking action without a patient’s consent must attempt to keep to a minimum the restrictions they impose on the patient’s liberty, having regard to the purpose for which the restrictions are imposed.
The patient must have a mental disorder, i.e. any disorder or disability of mind but alcohol or drug addiction are insufficient on their own to detain a person under the Mental Health Act.
The patient’s mental disorder must require hospital detention for assessment or treatment and the detention must be necessary in the interests of the patient’s health or safety, or with a view to the protection of others.
Which act allows the non-consensual detention of patients in the hospital?
The Mental Health Act 1983 gives a statutory framework for the non-consensual detention of patients in the hospital. The 1983 Mental Health Act has been amended by The Mental Health Act 2007. It applies to people in England and Wales.
What is section 2 of the MHA?
Admission for assessment.
The period of assessment (and treatment) lasts for up to 28 days and is not renewable.
Patients’ appeals must be sent within 14 days to the mental health tribunal (composed of a doctor, lay person and lawyer).
An AMHP or the NR makes the application on the recommendation of two doctors, one of whom is ‘approved’ under Section 12(2) of the Act (in practice a consultant psychiatrist or a specialist registrar of sufficient experience). The second medical recommendation is given by a doctor who knows the patient personally in a professional capacity. If this is not possible, the Code of Practice recommends that the second doctor should be an ‘approved’ doctor.
What is section 3 of the MHA act?
Admission for treatment (up to 6 months)
The exact mental disorder must be stated. Detention is renewable for a further six months (annually thereafter).
Two doctors must sign the appropriate forms and know why treatment in the community is contra-indicated. They must have seen the patient within 24 hours and there may not be more than five clear days between the time the first doctor saw the patient and the time when the second doctor saw them.
They must state that treatment is likely to benefit the patient, or prevent deterioration; or, that it is necessary for the health or safety of the patient or the protection of others.
The AMHP has 14 days after the second doctor has signed their recommendation to make an application to the hospital.
What is section 4 of the MHA?
Emergency treatment (for up to 72 hours)
The admission to hospital must be an urgent necessity. May be used if admission under Section 2 would cause undesirable delay (admission must follow the recommendation rapidly).
An AMHP or, very rarely, the NR makes the application after recommendation from one doctor (e.g., the GP). The GP should keep a supply of the relevant forms, as the AMHP may be unobtainable.
It is usually converted to a Section 2 on arrival in hospital, following the recommendation of the duty psychiatrist. If the second recommendation is not completed, the patient should be discharged as soon as the decision not to convert to Section 2 is made. The Section should not be allowed to lapse.
What is section 5(2) of the MHA?
Detention of a patient already in hospital (up to 72 hours)
The doctor in charge (or, in the case of a consultant psychiatrist, his or her deputy) applies to the hospital managers, day or night, so it is often helpful to obtain early joint care for these patients with a consultant psychiatrist. The duty AMHP should be informed as soon as a 5(2) is applied, because they have the responsibility for coordinating the full Mental Health Act Assessment which should follow.
A patient in an Accident and Emergency department is not an inpatient, so cannot be detained under this Section. Restraint permitted by The Mental Capacity Act or Common Law is all that is available to provide temporary restraint for individuals who are a manifest danger either to themselves or to others while awaiting assessment by a psychiatrist.
Plan, where the patient is to go before the 72 hours, have elapsed - eg, by liaising with psychiatrists for admission under Section 2.
What is section 5(4) of the MHA?
Nurses’ holding powers (for up to six hours)
Any authorised psychiatric nurse may use force to detain a voluntary ‘mental’ patient who is taking their own discharge against medical advice if such a discharge would be likely to involve serious harm to the patient (eg, suicide) or to others.
During the six hours, the nurse must find the necessary personnel to sign a Section 5(2) application or allow the patient’s discharge.
What is section 7 of the MHA?
Application for guardianship
This enables patients to receive community care where it cannot be provided without the use of compulsory powers.
Application is made by an AMHP or, very rarely, the NR and also needs two medical recommendations.
The guardian, usually a social worker, can require the patient to live in a specified place, to attend at specified places for treatment and to allow authorised persons access.
What is section 17a of the MHA?
Supervised community treatment (SCT)
To be eligible for SCT, a patient must be liable to be detained under Section 3 or subject to certain specified provisions under Part III Mental Health Act (ie a hospital order, a hospital direction or a transfer direction without restrictions).
A community treatment order (CTO) cannot be made unless the RC is of the opinion that the ‘relevant criteria’ are met and an AMHP states in writing their agreement with this opinion and that it is appropriate to make a CTO.
When is a SCT considered in a patient?
The Mental Health Act 2007 states that SCT should be considered when:
- The patient is suffering from a mental disorder of a nature or degree which makes it appropriate for them to receive medical treatment.
- It is necessary for their health or safety or for the protection of other persons that they should receive such treatment.
- Such treatment can be provided without them continuing to be detained in a hospital.
- Appropriate medical treatment is available for the patient.
- It is necessary for their health or safety or for the protection of other persons that the RC should be able to exercise the power to recall the patient to the hospital.
What is section 20(4) of MHA?
Renewal of compulsory detention in hospital
The patient continues to suffer from a mental disorder and would benefit from continued hospital treatment.
Further admission is needed for the health or safety of the patient - which cannot be achieved except by forced detention.
What is section 136 of MHA?
Allows police to arrest a person ‘in a place to which the public has access ‘ and who is believed to be suffering from a mental disorder.
The patient must be conveyed to a ‘place of safety ‘ (usually a designated Accident and Emergency department) for assessment by a doctor (usually a psychiatrist) and an approved social worker.
The patient must be discharged after assessment or detained under Section 2 or 3. The patient may also accept the offer of a voluntary admission into the hospital.
What is section 135 of the MHA?
This empowers an AMHP who believes that someone is being ill-treated or is self-neglecting to apply to a magistrate for a warrant to search for and remove such patients to a place of safety in order to carry out a Mental Health Act assessment.
The AMHP or a registered medical practitioner must accompany the police.
