Mental health act, capacity and consent Flashcards
what is the role of the mental health act
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
what are the millan principles
- 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
what are the 5 criteria for detention under the mental health act IMPORTANT
- like mental disorder
- significant impaired decision making ability
- Determining treatment required (giving treatment – STD (short term detention) and CTO- compulsory treatment order)
- significant risk (health, safety or welfare of patient, safety of others)
- informal/ voluntary care not appropriate
give examples of things that are not mental disorders
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
are these things mental disorders:
Alzheimer’s, delirium, drug induced psychosis, antisocial personality disorder, postnatal depression (not post natal low mood), korsakoff’s
yes
how is significantly impaired decision making ability different from incapacity
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
what is classes as significant risk
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
what does detainment have to be
the least restrictive option:
Unable to be treated in the community due to level of risk
Community treatment failed
what are the features of an emergency treatment order
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)
what are the details of short term detention
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
what are the details of a compulsory treatment order
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
when can urgent treatment be given in emergency detention
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
when should a T4 certificate be completed
after (7 days) of emergency treatment
does emergency detention authorise treatment
no
what duration of treatment can be given under a short term detention/ CTO
2 months
what treatments are not allowed during short term detention/ CTO
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)
what are advanced statements
- 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)
what is a named person
- Patient chooses someone to support them and protect their interests
- Same rights to be notified of, attend and be represented at tribunal hearings
does every person with a mental illness have the right of access to independent advocacy
yes
what do mental health tribunals do
- Decide on CTO applications/ appeals
- Panel= psychiatrist, convener (solicitor), third person with experience
- Take place in hospital
what is nurse holding power
- 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
what power do police have in the mental health act
- 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
what does the mental welfare commission do
- Encourages best practise
- Publishing information and guidance
- Carrying out visits to patients
- Investigations
- Medical examination
- Inspect patient records
what qualifies as a mental disorder
mental illness
learning disability
personality disorder
what qualifies of valid consent
given freely without duress or coercion legally capable of consenting cover the intervention/ procedure informed enduring
what should you consider when obtaining someones consent
treatment details benefits/ risks and SEs written/ visual aids translators friends/ relatives time to reflect
what is capacity
the ability to make a decision
does capacity for one decision mean capacity for all
no
to have capacity someone must be able to do what?
understand and retain relevant information
use and weigh that information to make a decision
communicate that decision
when is someone considered incapable of making a decision (under adults with incapacity act)
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
what needs to be understood by patient to consent
what the intervention is, its nature and purpose and why it is being proposed
main benefits/ risks/ alternatives
consequences of not receiving intervention
should capacity or incapacity by assumed until proven otherwise
capacity
what are the principles of the adults with incapacity act
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
what is the AWI section 47 certificate
Authorises practitioner to provide reasonable interventions related to the treatment
what does the AWI section 47 certificate not authorise
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
what does the adults with incapacity act do
authorise treatment of a physical disorder in someone without capacity to consent to that treatment
what is a power of attorney
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
what is gaurdianship
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
what are the powers of a welfare guardian
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.
what does the mental health care act authorise
Allows for treatment of mental disorder or physical consequences of mental disorder in someone without capacity to consent to treatment
if someone is actively resisting treatment for a mental disorder which act should you use
mental health act rather than AWI as patient will get more protection
what certificates are included in the mental health act
Emergency detention certificate
Short term detention certificate
Compulsory treatment order
what are the criteria for mental detention
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)
what are the criteria for short term delay
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
when is a young person presumed to have capacity
16
is parental involvement encouraged in capacity for young people
yes
what should you do if a young person lacks capacity
the children act
ask one parent for consent
if parents disagree seek legal advice
is there a lower age limit for the mental health act
no
when should you consider using the mental health act rather than parental consent in a child lacking capacity
if:
Use of force
Use of intramuscular medication
Certain treatments e.g. nasogastric feeding, ECT
Detrimental impact on relationship with carer
who can give advice on breaking confidentialty
medical defence union
can FY1s use the mental health act
no
can you detain someone for intoxication/ withdrawal symptoms
no
when detained, can you take a patients blood without consent under mental health act
no
