Mental Health Act & MSE Flashcards
What is a section 2?
- Lasts up to 28 days
- Assessment and treatment of mental health disorders
- Should be used if no previous admission to hospital, no treatment plans in place and period of assessment is required, if it is unclear if the patient would accept admission or medication voluntarily
What is the process for a section 2?
- Application by AMHP (approved mental health practitioner) or nearest relative
- 2 recommendations required from doctor’s (one section 12 approved, one should know the patient, both should personally examine the patient)
- Patient can apply for mental health review tribunal (MHRT) within first 14 days of section
- Nearest relative can apply for discharge with 72hrs notice (could be blocked by responsible clinician)
- At the end of 28 days, the patient must be discharged or detained under section 3 for treatment
What is a section 3?
- Lasts for up to 6 months (then renew/discharge, renew for further 6 months then on yearly basis)
- For treatment of mental health disorders
What is the process for a section 3?
- AMHP cannot act if nearest relative objects
- Nearest relative can be displaced by courts
- Patient can apply for MHRT during each section period
- Nearest relative can apply for discharge with 72hrs notice, can be blocked by responsible clinician
What are section 36 and 37?
Section 36
• Similar to a section 3 but for a person awaiting trial
Section 37
• Similar to section 3 but for a convicted criminal
• Responsible clinician can discharge
What is a section 4?
- Lasts for 72 hrs
* For detention and assessment ONLY (no treatment)
What is the process for a section 4?
- AMHP or nearest relative can make application
- For emergency situations with urgent clinical need, but 2nd medical opinion is not available and would delay assessment/detention of patient
- The second medical recommendation converts the section 4 to a section 2 and should occur ASAP
What is a section 5(2)?
- Dr can detain informal patient already admitted to hospital
- Lasts for up to 72 hrs
- Section ends when patient is assessed for a section 2 or 3, or if no MHA assessment is necessary
What is a section 5(4)?
- Psychiatric nurse can detain informal patient already admitted to hospital
- Lasts for up to 6hrs
- Section ends when patient is assessed for a section 2 or 3, or no MHA is necessary
What is a section 135?
- Police section
- To remove a person from his/her premises to a place of safety
- For up to 72 hrs
- Requires a warrant
What is a section 136?
• Lasts for up to 72 hrs
• Is a police detention order
• For a person in a public place in immediate need of care and control who appears to be suffering from a mental health disorder
• Detained for their own safety or for the protection of others
Used in A&E
Who is the nearest relative?
Rank as follows: • Husband/wife/civil partner/lived with patient for over 6 months • Eldest child • Eldest sibling • Eldest grandparent • Eldest grandchild • Eldest aunt/uncle • Eldest niece/nephew • Someone who has resided with the patient for at least 5 yrs
What are the 11 parts of an MSE?
Appearance Behaviour Speech Mood & Affect Thought form Thought content Disorders of perception Cognitive state Insight Risk assessment
What do you take into consideration for Appearance?
- Dress (appropriate to situation and weather)
- Cleanliness and hygiene
- Self care and grooming (make-up, nail varnish, neglect)
- Smart/well-kempt
- Looks their age?
What do you take into consideration for Behaviour
- Facial expression
- Physical posture, eye contact
- Appropriateness
- Aggression/violence/demanding/suspicious/overactive
- Cooperative/calm/settled
- Withdrawn/tearful
- Gestures and mannerisms
- Involuntary movements/ticks?
What do you take into consideration for Speech?
- Rate (pressure of speech? Poverty of speech?)
- Rhythm
- Tone (monotonous?)
- Spontaneous
- Volume
What do you take into consideration for Mood?
Sustained state of emotion • Euthymic • Low • Anxious • Elated
What do you take into consideration for Affect?
Observable and objective emotion • Congruent with mood? Eg jovial patient who talks of suicide. • Reactive affect • Labile? • Agitation/irritable Blunted/unreactive Perplexed Suspicious
What do you take into consideration for Thought form?
- Ascertain thought form via speech.
- Disorganised? (quote word for word)
- Poverty of thought
- Flight of ideas
What do you take into consideration for Thought content?
What they say
• Main themes
• Preoccupations/worries/concerns/obsessions
• Phobias
• Ruminations
Depersonalisation
Abnormal beliefs (overvalued ideas, ideas of reference)
• Delusions?
• Suicide/homicideWhat do you take into consideration for Disorders of perception?
Hallucinations and illusions
• Visual/aural/tactile/olfactory/gustatory/somatic
• Depersonalisation/derealisation
What do you take into consideration for Cognitive state?
- Alertness
- Attention and concentration
- Orientation
- Memory
- Formal assessment? (MMSE/MOCA)
- Grossly intact?
What do you take into consideration for Insight?
- Understands illness/diagnosis/treatment/management
- ‘Do you think there is anything the matter with you?’
- ‘Are you willing to accept treatment?’
What do you take into consideration for Risk Assessment?
To self:
• Suicide/self harm
• Social isolation
• Alcohol dependence
• Wandering into community
To others:
• Carer for children
• Aggression to others? Threats?
Persecutory delusions/control or command hallucinations
From others:
• Getting into fights?
• Drug addiction/money issues
Self neglect
• Weight loss
• Nutrition
• Self care
• Homeless?
All risks will change with circumstances.Describe what is meant by flight of ideas
A disorder of thought form
Abnormal connection between statements based on a rhyme or pun rather than meaning
What is meant by loosening of associations?
A disorder of thought form
No discernible link between statements
How would you describe normal speech as a psychiatrist?
Spontaneous, logical, relevant and coherent
How do you elicit someone’s hallucinations?
“Have you seen or heard things that other people can’t see or hear?”
Define hallucination
Perceptions in the absence of and external stimulus, that are experienced as true and as coming from the outside world
Name 4 types of delusion
Persecutory Grandiose Of reference Thought insertion/withdrawal/broadcast Passivity
What psychiatric disorders increase the likelihood of crime?
Schizophrenia (esp if accompanied by substance misuse)
Mania (fraud, defaulted debt, shoplifting)
Alcohol and substance misuse
Dementia and learning disability (shoplifting, disinhibition and sexual offences)
Antisocial personality disorders
What is a CTO?
Community treatment order
Following detention under section 3 or 37
Require that the pt makes themselves available for medical examination
How do you section someone in A&E?
A&E is not hospital so not 5(2). 136 section is used.
What is a neologism?
Neologisms are invented words that have mean something specific to the person who is using them.
What are clang associations?
I like cats. Hats are pretty. My best friend is very witty.
