Mental Health Act Flashcards
- Definition of mental disorder
- Definition of learning disability
- Definition of mental disorder
‘Any disorder or disability of the mind’ - Definition of learning disability
‘a state of arrested or incomplete development of the mind which includes significant impairment of intelligence and social functioning’
Professionals involved in the MHA
- Section 12 Approved Doctor: approved doctor with experience in diagnosis or treatment of mental disorder
- Approved Clinician: a mental health professional approved to act for the purpose of the Act
- Responsible Clinician: the AC with overall responsibility for a patient’s case*
- Approved Mental Health Professional (AMHP)- a social worker or other professional approved by the local authority to carry out a variety of functions under the Act.
*most likely a consultant psychiatrist, but could also be a trained nurse/OT/social worker/psychologist
Nearest relative vs next of kin
- Nearest relative: A family member who has certain responsibilities and powers if a patient is detained under MHA; to ensure that the patient’s rights are protected. Eg. NR can apply or object to detention or apply for discharge to a tribunal
- NR hierarchy: husband/wife/civil partner > son/daughter > father/mother > brother/sister > grandparent > grandchild > uncle/aunt > nephew/ niece.
- Next of kin is chosen by pt and does not make decisions for them
Section 5(4)
Section 5(4 )- Nurses’ holding power (must be trained - either mental health or learning disability nurse) Must be an informal inpatient (voluntary) that is not accepting treatment any longer Duration: up to 6hrs
Section 5(2)
Section 5(2)- Doctors’ holding power
Registered Medical Practitioner or Approved Clinician in charge of the patient or their nominated deputy
Duration: 72 hours or as soon as has been assessed for detention under S2 or 3
Grounds: the doctor believes there are grounds for detention under S2/3
Must be informal inpatient like in 5(4)
Section 136
Enables a police officer to remove a person found in a public place to a ‘place of safety’
Duration: 24 hours or can be extended up to 36 hours until assessed by an RMP (doctor) AND AMHP
The patient may move from one place of safety to another in this time.
Purpose: ‘to permit assessment’
Section 135
To provide police officers with a power of entry to private premises to remove them to a place of safety
An AMHP needs to apply for a Section 135 warrant in court and a Magistrate has be satisfied
Duration: up to 36 hourse
The police officer must be accompanied by an AMHP and a doctor.
An ambulance or other transport should be available to take the person to a place of safety
Two types:
- 135(1): patient previously at home
- 135(2): patient already liable to be detained (eg inpatient gone AWOL and thought to be at home)
Section 2
Section 2 - admission for assessment
Requires:
- Two RMPs, one Section 12 approved and the other should ideally have prior knowledge of the patient
- an AMHP*
Duration: 28 days or earlier if discharged; cannot be renewed
Grounds: mental disorder associated with some risk that cannot be managed or assessed in the community and there is a refusal to accept informal admission
*or in rare cases a Nearest Relative
Section 3
Section 3 - admission for treatment
Requires: as in Section 2 & NR must not object to the application
Duration: 6 months and can be renewed for another 6 months initially and then annually
Grounds: same as S2
Section 17
Leave of absence - applied to pts on S2 or S3
- ONLY pt’s RC can authorise this
- they must state conditions of leave eg. timescale, if escorted or not etc.
- exception: patients on forensic sections
Section 4
- Emergency admission for assessment
- very rarely used
- usually during Christmas or bank holiday etc, when a section 2 would involve an unacceptable delay
- a GP and an AMHP or NR
- Only need 1 medical practitioner for recommendation
- Duration: up to 72 hours
- often changed to a section 2 upon arrival at hospital
Section 18
Section 19
Section 18
- used to retake pts who are already liable to be detained or subject to guardianship*
- usually patients who are AWOL and found in a public place (not at home –> section 135(2))
Section 19
- used to transfer detained pts or on guardianship from one trust to another
Guardianship: people with legal powers to make some decisions on behalf of a pt with a mental disorder. The choice of Guardianship would be made instead of being detained in hospital. Could be the NR, IMHA, AMHP
Community treatment order - CTO
A CTO (section 17A) is used to continue to receive treatment after their discharge from hospital
Application: RC and AMHP
Useful where the RC needs to be able to recall the patient to hospital if necessary.
Duration: up to 6 month, renewable for another 6 months then annually (with AMHP approval)
Conditions:
- they make themselves available for examination by the RC or SOAD (Second Opinion Approved Doctor) if they are required to take medication
- they make themselves available for examination by RC for renewal of the CTO.
Other conditions may be added e.g. where they live , supervision , medication etc. as long as they do not constitute a Deprivation Of Liberty
CTO - recall
If there is evidence of risk to pt (eg relapse) or if patient is not complying, they can be recalled to hospital for further assessment
Two options:
1. CTO is revoked –> section 3 is reinstalled and begins for up to 6 months
2. Pt sent back home still under CTO
Consent to treatment - principle
First determine if the patient has the capacity to consent to treatment. If he/she has the capacity, the professional cannot treat against the patient’s wishes, even if the professional does not agree with the patient’s decision
- For patients who lack capacity, the MCA must be used for making treatment and care decisions.
- For patients detained under the MHA , appropriate medical treatment (for mental disorder) can be given to patients against their wishes if it is in their best interest ; but consent should be sought nonetheless at every opportunity.
