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Psychiatry > Mental health act, capacity and consent > Flashcards

Mental health act, capacity and consent Flashcards

1
Q

what is the role of the mental health act

A

protects people with a mental disorder, ensures they get effective care and treatment
Overrides an individuals right to self determination for their benefit in certain well defined circumstances

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2
Q

what are the millan principles

A
  • Non discrimination
  • Equality
  • Respect for diversity
  • Reciprocity – giving something in return for taking freedom
  • Informal care
  • Participation
  • Respect for carers and their views
  • Least restrictive
  • Benefit
  • Child welfare
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3
Q

what are the 5 criteria for detention under the mental health act IMPORTANT

A
  1. like mental disorder
  2. significant impaired decision making ability
  3. Determining treatment required (giving treatment – STD (short term detention) and CTO- compulsory treatment order)
  4. significant risk (health, safety or welfare of patient, safety of others)
  5. informal/ voluntary care not appropriate
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4
Q

give examples of things that are not mental disorders

A

sexuality, sexual deviancy, transsexualism, transvestism, substance abuse, behaviour that causes or is likely to cause harassment, alarm or distress to others, acting as no other prudent person would act

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5
Q

are these things mental disorders:
Alzheimer’s, delirium, drug induced psychosis, antisocial personality disorder, postnatal depression (not post natal low mood), korsakoff’s

A

yes

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6
Q

how is significantly impaired decision making ability different from incapacity

A

SIDMA= As a result of mental illness patients ability to make decisions about medical treatment is significantly impaired (Affects ability to believe, understand and retain information and communicate effectively)

Incapacity also includes disease of the brain, physical disability, impaired cognition, SIDMA is mental disorder alone

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7
Q

what is classes as significant risk

A

to patient:

  • Suicide
  • Self harm
  • Wandering (dementia)
  • Vulnerability
  • Deterioration in mental state
  • Physical health (starvation, dehydration)
  • Poor self care
  • Retaliation from others due to aggressive behaviours

to others

  • Aggression
  • Violence
  • Sexual assault
  • Intimidation
  • Arson
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8
Q

what does detainment have to be

A

the least restrictive option:
Unable to be treated in the community due to level of risk
Community treatment failed

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9
Q

what are the features of an emergency treatment order

A

72 hours of assessment
doesn’t authorise treatment
needs fully registered doctor (FY2 and above) to complete, where possible a mental health officer should also agree
patient must have likely mental disorder
there is no right of appeal (as patient would be able to do this within 72 hours)

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10
Q

what are the details of short term detention

A

up to 28 days or assessment/ treatment
done by approved mental practitioner PLUS a mental health officer
patient must have likely mental disorder
patient has right of appeal (patient or named person)
can be extended by 3 days if extra time need to submit for a compulsory treatment order/ 5 extra days once CTO submitted

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11
Q

what are the details of a compulsory treatment order

A

initially up to 6 months
Approved medical practitioner plus mental health officer
Mental disorder present
Reports from 2 independent doctors (2 AMPs or AMP + GP) a care plan and MHO report
MHO makes the application to the tribunal service
Mandatory tribunal
Treatment authorised for up to 2 months of detention
Reviewed at 6 months then yearly

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12
Q

when can urgent treatment be given in emergency detention

A

o To save patient life
o Prevent serious deterioration in patient condition
o Alleviate serious suffering
o Prevent to patient from being a danger to themselves or others

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13
Q

when should a T4 certificate be completed

A

after (7 days) of emergency treatment

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14
Q

does emergency detention authorise treatment

A

no

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15
Q

what duration of treatment can be given under a short term detention/ CTO

A

2 months

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16
Q

what treatments are not allowed during short term detention/ CTO

A

o ECT
o Nutrition by artificial means
o Vagus nerve stimulation
o Transcranial magnetic stimulation
o Any medicine given for the purpose of reducing sex drive
o Neurosurgery (with patient consent or additional protections)

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17
Q

what are advanced statements

A
  • Written statement
  • Signed when patient is well
  • How they would want/ not be treated if they became ill
  • Witnessed and dated
  • Tribunal and medical practitioner must regard this
  • It can be overruled (advisory)
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18
Q

what is a named person

A
  • Patient chooses someone to support them and protect their interests
  • Same rights to be notified of, attend and be represented at tribunal hearings
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19
Q

does every person with a mental illness have the right of access to independent advocacy

A

yes

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20
Q

what do mental health tribunals do

A
  • Decide on CTO applications/ appeals
  • Panel= psychiatrist, convener (solicitor), third person with experience
  • Take place in hospital
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21
Q

what is nurse holding power

A
  • Registered mental health nurse/ intellectual disability nurse can detain patient for up to 3 hours
  • Patient must be in hospital and receiving treatment
  • Necessary for health, safety or welfare of patient or safety of others
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22
Q

what power do police have in the mental health act

A
  • Removal to a place of safety
  • From a public place
  • Appears to have a mental disorder and is n need of care and treatment
  • Up to 24 hours to allow assessment to be carried out
23
Q

what does the mental welfare commission do

A
  • Encourages best practise
  • Publishing information and guidance
  • Carrying out visits to patients
  • Investigations
  • Medical examination
  • Inspect patient records
24
Q

what qualifies as a mental disorder

A

mental illness
learning disability
personality disorder

25
Q

what qualifies of valid consent

A 
given freely without duress or coercion 
legally capable of consenting 
cover the intervention/ procedure 
informed 
enduring
26
Q

what should you consider when obtaining someones consent

A 
treatment details 
benefits/ risks and SEs
written/ visual aids 
translators 
friends/ relatives 
time to reflect
27
Q

what is capacity

A

the ability to make a decision

28
Q

does capacity for one decision mean capacity for all

A

no

29
Q

to have capacity someone must be able to do what?

A

understand and retain relevant information
use and weigh that information to make a decision
communicate that decision

30
Q

when is someone considered incapable of making a decision (under adults with incapacity act)

A

if unable to

  • act or make decisions
  • communicate decisions
  • understand decisions
  • retain memory of decisions

unable to do this due to mental disorder or of inability to communicate because of physical disability

31
Q

what needs to be understood by patient to consent

A

what the intervention is, its nature and purpose and why it is being proposed
main benefits/ risks/ alternatives
consequences of not receiving intervention

32
Q

should capacity or incapacity by assumed until proven otherwise

A

capacity

33
Q

what are the principles of the adults with incapacity act

A

1) Intervention must benefit the adult
2) Such benefit cannot reasonably be achieved without the intervention
3) Take account of past and present wishes
4) Consult with other relevant persons
5) Encourage the adult to use residual capacity

34
Q

what is the AWI section 47 certificate

A

Authorises practitioner to provide reasonable interventions related to the treatment

35
Q

what does the AWI section 47 certificate not authorise

A

Does not authorise force unless immediately necessary and only for as long as is necessary
Does not specifically authorise the transport of the adult to the place of treatment

36
Q

what does the adults with incapacity act do

A

authorise treatment of a physical disorder in someone without capacity to consent to that treatment

37
Q

what is a power of attorney

A

Granted whilst patient have capacity
Powers to act as their continuing (financial) and/or welfare attorney
In case capacity is lost at some future point
can be one or more persons

38
Q

what is gaurdianship

A

Applied for by one or more individuals / local authority
Granted by the sheriff
Welfare and/or financial
Person requires someone to make specific decisions on their behalf over the long term

39
Q

what are the powers of a welfare guardian

A

Cannot place the adult in hospital for treatment of mental disorder against their will
If the adult does not comply with the wishes of a welfare guardian, there is a mechanism for the Sheriff to issue a compliance order.

40
Q

what does the mental health care act authorise

A

Allows for treatment of mental disorder or physical consequences of mental disorder in someone without capacity to consent to treatment

41
Q

if someone is actively resisting treatment for a mental disorder which act should you use

A

mental health act rather than AWI as patient will get more protection

42
Q

what certificates are included in the mental health act

A

Emergency detention certificate
Short term detention certificate
Compulsory treatment order

43
Q

what are the criteria for mental detention

A

1) Likely to have a mental disorder
2) Significantly impaired decision-making ability regarding treatment, due to mental disorder
3) Detention in hospital is necessary as a matter of urgency to determine what treatment is needed
4) Risk to health, safety or welfare of the person, or safety of others
5) Making arrangements for s44 would involve undesirable delay (short term detention)

44
Q

what are the criteria for short term delay

A

1) Likely to have a mental disorder
2) Significantly impaired decision-making ability regarding treatment, due to mental disorder
3) Detention in hospital is necessary for assessment or treatment
4) Risk to health, safety or welfare of the person, or safety of others
5) Cannot be treated voluntarily

45
Q

when is a young person presumed to have capacity

A

16

46
Q

is parental involvement encouraged in capacity for young people

A

yes

47
Q

what should you do if a young person lacks capacity

A

the children act
ask one parent for consent
if parents disagree seek legal advice

48
Q

is there a lower age limit for the mental health act

A

no

49
Q

when should you consider using the mental health act rather than parental consent in a child lacking capacity

A

if:
Use of force
Use of intramuscular medication
Certain treatments e.g. nasogastric feeding, ECT
Detrimental impact on relationship with carer

50
Q

who can give advice on breaking confidentialty

A

medical defence union

51
Q

can FY1s use the mental health act

A

no

52
Q

can you detain someone for intoxication/ withdrawal symptoms

A

no

53
Q

when detained, can you take a patients blood without consent under mental health act

A

no

Psychiatry (27 decks)

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