Mental Health Act and Capacity

Question 1

What is Capacity?

Answer 1

The ability to be in a state of mind to be able to make their own decisions about their care.
It can fluctuate and change

Question 2

What is an Advanced Directive?

Answer 2

A “living will” where someone can say what treatment they would NOT like to receive if they were in a situation where they would lack capacity, which they set in a legal document whilst they have capacity.

A DNAR is a type of advanced directive

They cannot OPT IN for treatment in an AD

Question 3

What is Power of Attorney?

Answer 3

When you give the power to decide on different things to a NoK or representitive.
It is a legal document
Can be done for medical treatment, handling of finances, property management etc

Must be in best interests (and if concerns then can be overridden)

Question 4

Why may someone lack capacity?

Answer 4

Severe mental illness - psychosis, depression
where they are not in a state of mind to be able to weigh up the risks/benefits

Dementia - unable to understand or retain

It can change, so if can put off treatment until gain capacity then you can do so

Question 5

What is treatment in the best interests?

Answer 5

When you give the ideal treatment for the patient at that time, in the best interests for their health and that has the optimum outcome for them.

Question 6

What is the Best Interests Commitee?

Answer 6

A team of people who judge how to treat the patient if they lack capacity and a suitable next of kin
They consult the family and doctors

Question 7

How do you assess capacity?

Answer 7

Are they:

1) Able to hear and understand the information given (in any format e.g. spoken, written, signed, translated)
3) Able to retain the information for a suitable amount of time
3) Able to weigh up the information and decide
4) Able to communicate that decision back to you

If lack ONE of these then they lack capacity

Question 8

What is the Mental Health Act?

Answer 8

An act which gives power to a medical provider to detain a patient against their will in order to assess or treat a mental health condition or if condition is DIRECTLY caused by it (e.g. overdose due to severe depression, but probably lack capacity at that point)

CANNOT be used for medical treatment, need to assess capacity for that

Question 9

What is Section 2?

Answer 9

RMO and other can detain for inpatient assessment of condition for up to 4 weeks

Can turn into section 3
Must be section 12(2) approved

Question 10

What is Section 3?

Answer 10

RMO and other can detain for inpatient treatment of condition for up to 6 months
Can be appealed twice
Can be discharged at any point felt able by the doctor in charge

Question 11

What is Section 5(2)?

Answer 11

RMO can detain for assessment for 72 hours if on medical ward
No appeal

Question 12

What is Section 5(4)?

Answer 12

Ability to detain by a registered mental health nurse/other staff on a medical ward, for assessment later by a doctor
For 6 hours

Question 13

What is Section 7?

Answer 13

Permitted leave if under section 2 or 3 and inpatient.

It has different levels e.g supervised, on the grounds, day leave to go home

Can be brought back still as still under section

Question 14

What is Section 17?

Answer 14

Aftercare if they were detained under section 3

Question 15

What is Section 136?

Answer 15

Section allows police to remove a person from a public space to a safe location for 72 hours for assessment under the MHA

Ideally not a police cell, there are specific centres for detention e.g. at the Bradgate Centre

Question 16

What is the Mental Capacity Act?

Answer 16

A set of laws which defines capacity and what to do if lack capacity.
It presumes capacity at all times and uses the 4 step process to assess capacity

Question 17

What is a community treatment order?

Answer 17

If well enough to be discharged but under section 3 can discharge to community and give rules of compliance with medications and follow up with out-patient centers.
If don’t then they can be brought back to hospital
Can appeal still (as under section 3)

Question 18

What is a community treatment order?

Answer 18

If well enough to be discharged but under section 3 can discharge to community and give rules of compliance with medications and follow up with out-patient centers.
If don’t then they can be brought back to hospital
Can appeal still (as under section 3)

Question 19

What are the criteria for the MHA?

Answer 19

Must be a risk to themselves or others
Must be a legally defined disorder
No alternative to admission
Must be of a certain severity

Question 20

What is liaison psychiatry?

Answer 20

An on-call psychiatrist who goes round medical wards/A&E and assesses patients for conditions
Can detain under the MHA