Mental Health Act and Health Care Law/History

Question 1

What is an asylum?

Answer 1

Retreats from society designed with the hope that, with early intervention and several months of rest, people with mental illness could be cured.

Question 2

Where were the first asylums established?

Answer 2

Middle East, Baghdad and Cairo

Question 3

Which physician began to advocate for more humane treatment of people with mental illness along with other humanitarians in the 1700s?

Answer 3

Philippe Pinel

Question 4

What terminology did Philippe Pinel and William Tuke use to describe care of the mentally ill with calmerenvironments?

Answer 4

Described the use of social and psychological approaches to treatment as “moral treatment”.

Question 5

Define “moral treatment”.

Answer 5

Social and psychological approaches to treatment that included retreats from society, calm environments, and several months of rest.

Question 6

What approaches did Indigenous peoples in Canada use for mental illness?

Answer 6

Most were holistic - treating mind, body, and soul - and included sweat lodges, animistic charms, potlatch, and Sundance

Question 7

How were people with mental illness treated in the 1700s and early 1800s?

Answer 7

Housed in jails or similar workhouse situations

Question 8

When and where was the first psychiatric hospital in Canada?

Answer 8

mid-1800s, in Quebec (Beauport). Focus initially was on treatment and rehabilitation.

Question 9

What shift in the treatment of people with mental illness occured around the late 1800s and early 1900s?

Answer 9

Treatment focus was lost and the function of “housing” persons in an institution became the norm. Treatment was largely custodial.

Question 10

Who was Dorothy Dix?

Answer 10

A passionate social reformer, she advocated for improved treatment and public care of people with mental illness and was influential in lobbying for the first public mental hospital in the United States and for reform in institutions in Britain and Canada.

Question 11

What change occured in the 1960s in Canada relative to the treatment of persons with mental illness?

Answer 11

A move towards community treatment was underway. This movement followed the wave of psychopharmacology treatments that began with chlorpromazine in the 1950s

Question 12

What is deinstitutionalization?

Answer 12

The shift from caring for people with mental illness in institutions to caring for them in communities.

Question 13

What were some of the early psychiatric treatments?

Answer 13

• leeching
• spinning
• hydrotherapy
• insulin shock theray
• ECT
• lobotomies

Question 14

When did nursing within asymlums begin?

Answer 14

• Nursing within asylums began in the late nineteenth century as a result of the increased medicalization of psychiatry

Question 15

What was a key step in the professionalization of nursing and in the transition of nursing education from medical dominance to nursing-led knowledge development?

Answer 15

The development of university-based programs in nursing in the 1920s was a key step in the professionalization of nursing and in the transition of nursing education from medical dominance to nursing-led knowledge development.

Question 16

What are key elements of bioethics?

Answer 16

• Respect for autonomy
• Nonmaleficience
• Beneficience
• Justice

Question 17

There are 12 different Mental Health Acts across the provinces and territories. What are the differences across the Acts?

Answer 17

• Involuntary admission criteria
• The right to refuse treatment
• Who has the authority to authorize treatment

Question 18

What is the definition of “mental disorder”?

Answer 18

“Mental disorder” means a substantial disorder of thought, mood, perception, orientation, or memory that grossly impairs:
* judgment
* behaviour
* capacity to recognize reality
* ability to meet the ordinary demands of life

Question 19

What are the criteria for a community treatment order (CTO)?

Answer 19

1. Suffering from a mental disorder
2. One or more of conditions a, b, or c apply
   a) Have been a formal patient, in a designated facility at least 2 times for at least 30 days
   b) And/or have been on a CTO in the past 3 years at least once
   c) Both doctors believe you have a pattern of repetitive/recurring behaviour when living in the community, which shows you are likely to cause harm to yourself or others or significantly become impaired if you don’t get continuing treatment or care in the community
3. Both doctors (nneds 2) believe you are likely to harm yourself or others or will become significantly more impaired if you do not get continuous treatment and support in the community.
4. The Doctors believe you are able to follow the treatment and care plan as laid out in the CTO,

Question 20

What are the nurse’s responsivilities regarding the Mental Health Act on the unit?

Answer 20

• Document they are admitted under formal status. Your notes will also refer to patient as formal or informal throughout admission.
• Shortly after formal admission (or when reasonable) you will document that the patient has been asked if they would like the patient advocate and if they do you will fax admission forms (each unit will have their own process) to patient advocate. The patient advocate will contact the patient.
• Formal Patients receive an information package. Document they have received it.
• Formal patients must have a treatment plan on their chart within one month.
• Interdisciplinary work, nurses are key. Most responsible practitioner (Dr.) presents to patient.

Each unit will have their process, learn your unit.

Question 21

According to Barbara Carper (with one addition by Chin & Kramer), what are the nursing ‘ways of knowing’?

Answer 21

• Empirical (evidence-informed) care
• Aesthetics
• Ethics
• Personal Evidence
• Emancipatory

Question 22

Define the empirical (evidence-informed) way of knowing.

Answer 22

Our nursing care must be informed by evidence (verifiable, objective, factural & research based)

Question 23

What is involved in the aesthetic nursing way of knowing?

Answer 23

• We know through intuition; tacit knowledge and skill
• How we read our patients & families
• Clinical judgment based on the experience & intuition of an experienced nurse
• Brings in EQ (emotional intelligence)
• Is subjective, individual and unique

Question 24

What is involved in the personal ethics nursing way of knowing?

Answer 24

• My awareness of myself and how I relate to others; my own history and experiences, my personal awareness and empathy
• My ability to self-reflect builds my personal ways of knowing
• How I use myself in the interpersonal relationship
• Each relationship builds my own capacity

Question 25

What is involved in the emancipatory nursing way of knowing?

Answer 25

We recognize systems and traditions are not always fair. Some groups are disadvantaged and this accounts for poor health, poor social standing.

Examples
Racism, discrimination based on gender, sexuality, diagnosis.

Question 26

What are significant aspects of the MHA to reflect on as a nurse?

Answer 26

• Understand the significance of removing a person’s rights
• Your responsibility to ensure the person is fully informed
• Maintain a therapeutic relationship in the context of a formal setting

Question 27

Who started the original American Psychiatric Association?

Answer 27

Dorothea Dix

Question 28

What does custodial care involve?

Answer 28

Bathing, toileting, etc.

Question 29

What was a faulty belief related to deinstitutionalization?

Answer 29

With the instroduction of Largactil (chlorpromazine), that the medication would just cure everyone. It did not.

Question 30

Which policy was one of the greatest failed policies, from the late 5-s and early 60s?

Answer 30

Deinstitutionalization

Question 31

Why was deinstitutionalion a failure?

Answer 31

• More than meds needed
• Root causes deeper and broder treatments needed
• Abuses in institutions affected people
• Custodial care; fewer skills and coping abilities to prepare them to live outside of the institution

Question 32

What kind of facility can accept patients under the Mental Health Act?

Answer 32

A designated hospital.

Question 33

What are the two admission statuses associated with psychatric patients?

Answer 33

Formal: involuntary admission
Informal: voluntary admission

Question 34

True or false: The MHA seeks to maximize patient choice?

Answer 34

True, though it may not seem like it at times.

Question 35

What is required for admission under the MHA?

Answer 35

When a qualified health professional examines a person and is
of the opinion that the person
(a) is suffering from mental disorder,
(b) has the potential to benefit from treatment for the mental
disorder,
(c) is, within a reasonable time, likely to cause harm to others
or to suffer negative effects, including substantial mental or
physical deterioration or serious physical impairment, as a
result of or related to the mental disorder, and
(d) is unsuitable for admission to a facility other than as a
formal patient,

the qualified health professional may, not later than 24 hours after
the examination, issue an admission certificate in the prescribed
form with respect to the person

Question 36

What is a difference between a CTO and an admission order?

Answer 36

Length of time is different (6 months versus 30 days)

Question 37

What is a Form 1?

Answer 37

Admission certificate

Question 38

What is a Form 2?

Answer 38

Renewal certificate

Question 39

What is a Form 3?

Answer 39

Order to Return a Formal Patient to a Facility

Question 40

What is a Form 8?

Answer 40

Warrant

Question 41

What is a Form 9?

Answer 41

Extension of warrant

Question 42

What is Form 19?

Answer 42

Issuance of Community Treatment Order

Question 43

What is a Form 23?

Answer 43

Community Treatment Order Apprehension Order