mental health act 2001

Question 1

what is mental illness ?

Answer 1

• “mental illness” means a state of mind of a person
• which affects the persons thinking, perceiving, emotion or judgement and..
• which severely impairs the mental function of the person
• to the extent that he or she requires care or medical treatment in his or her own interest or in the interest of other persons

Question 2

types of mental disorder

Answer 2

1. mental illness
2. severe dementia
3. significant intellectual disability

Question 3

define severe dementia

Answer 3

• “severe dementia” means a deterioration of the brain of a person
• which significantly impairs intellectual function of the person
• thereby affecting thought, comprehension, and memory or
• which includes severe psychiatric or behavioural symptoms such as physical aggression

Question 4

what is the mental health act 2001

Answer 4

• a modern legislative frame-work for the:
  1. admission AND
  2. detention
  3. treatment of people with a mental disorder in compliance with international standards and obligations
• mainly deals with involuntary admissions
• ## the best interests of the person are paramount

Question 5

define significant intellectual disability

Answer 5

• means a state of arrested or incomplete development of mind of a person
• which includes impairment of intelligence and social functioning
• and abnormally aggressive or seriously irresponsible conduct on the part of the person

Question 6

Involuntary admission criteria

Answer 6

1. Because of the illness, disability, or dementia, there is serious liklihood of the person concerned causing immediate and serious harm to himself or to other person

OR

2. (i) because of the severity of the illness, disability or dementia, the judgement of the person concerned is so impaired that failure to admit the person to an approved centre would likely to lead to a serious deterioration in his or her condition or would prevent the administration of appropriate treatment that could be given only by such admission

AND

ii) the reception, detention and treatment of the person concerned in an approved centre would be likely to benefit or alleviate the condition of that person to a material extent

Question 7

exclusions to the mental health act

Answer 7

1. substance misuse
2. personality disorders
3. Social deviance

Question 8

practical steps for mental health act 2001

Answer 8

1. application - can be made by:
   - spouse/ civil partner / family member
   - authorized Officer
   - a Garda Siochana
   - member of the public
   **must be made within 48 hours of seeing patient
2. Recommendation
   - Fully registered medical practitioner
   - within 24 hours of application being made
   - form 5
3. Recommendation is reviewed by Consultant within 24 hours
   - confirm/ revoke application for detention
4. Order affirmed
   - complete form 6
   - patient notification of rights
   - initial admission is for 21 days
   - will be seen by second opinion psychiatrist
5. Tribunal within 21 days of admission
6. Consultant Psychiatrist may extend detention for up to 3 months if remains unwell
7. Tribunal convened within 21 days of extension of detention
8. Further periods of detention - 6 months, 1 year

Question 9

discuss mental health tribunal

Answer 9

• run by Mental health commission
• independent review of detention process
• comprised of:
  1. independent consultant psychiatrist
  2. Barrister
  3. Lay person
• who else attends:
  1. responsible consultant psychiatrist
  2. Patient
  3. patients solicitor

Question 10

other applications of the mental health act

Answer 10

1. governance regarding seclusion and restraint
2. governance regarding mental health committee and tribunals
3. transfer of a patient to the central mental hospital
4. Administration of PO/IM/IV psychotropic medication without consent
   - consent means patients understand nature, purpose, and likely effects; given freely and without threats or inducements
   - reviewed every 3 months
5. ECT without consent
   - second opinion required from independent consultant psychiatrist

Question 11

children and the mental health act 2001

Answer 11

• parenteral consent required for psychiatric examination
• <18 years old, can be admitted without consent if parents agree
• if parents and child refuse, process goes to the district court
• HSE makes application to the courts requesting authorization of a detention order
• evidence is examined by the courts, and can order detention of the child for up to 21 days
• no tribunals
• treatment without consent requires a second opinion

Question 12

a common misunderstanding of the MHA

Answer 12

• commonly may receive request to detain a patient using MHA to facilitate admission for treatment of a physical illness – ILLEGAL
• mental health act only be used to detain a person suffering with a mental disorder, in need of treatment for their mental disorder - not any other condition

Question 13

capacity

Answer 13

• a persons ability to make a legally enforceable decision for themselves
• if a patient is refusing a treatment for their physical illness - capacity should be assessed
• assessment of capacity
  1. understand
  2. retain
  3. appreciate
  4. Reason
  5. Communicate decision