Mental health acts + mental capacity act

Question 1

How is the MCA different from the MHA?

Answer 1

MHA = regulates assessment and treatment of mental illness and allows for compulsory detention and treatment

MCA = is the law for decision making on behalf of adults who lack mental capacity to make their own decisions

Question 2

Who can the mental health acts apply to?

Answer 2

children and adults

Question 3

What are the 5 guiding principles under the mental health acts?

Answer 3

least restrictive option and maximising independence
empowerment and involvement
respect and dignity
purpose and effectiveness
efficiency and equity

Question 4

How are patients detained/treated under the MHA?

Answer 4

patients with a mental disorder are admitted to hospital in 2 ways:
- informally
- compulsory detention (‘sectioned’)

detention or treatment under the MHA cannot be used for treating physical health problems

Question 5

What section of the mental health act applies to informal admissions and what applies under this?

Answer 5

section 131
patient must have capacity
patient must consent + not resist admission
free to leave at any time
90% of all admissions

Question 6

What is covered under section 2 of the MHA?

Answer 6

person can be detained for assessment under section 2 only if both following criteria apply:
- suffering from a mental disorder which warrants their detention in hospital for assessment
- and the person ought to be detained in the interests of their own health or safety or with a view to the protection of others

Question 7

Describe a section 2 under the MHA

Answer 7

compulsory admission for up to 28 days
cannot be renewed
application made by AMHP or patient’s nearest relative
application must be supported by 2 medical recommendations
for assessment

Question 8

What is covered under section 3 MHA?

Answer 8

person can be detained for treatment if all the following criteria apply:
- suffering from mental disorder of a nature or degree which makes it appropriate for them to receive treatment in a hospital
- necessary for the health or safety of the person or for the protection of others that they should receive such treatment and cannot be provided unless the person is under this section
- appropriate medical treatment is available

Question 9

What factors would ‘count’ to detain a person under the MHA for their health and safety?

Answer 9

self harm
suicide
self neglect
suffering an accident due to their own recklessness

Question 10

What factors should be considered when detaining someone under the MHA for the protection of others?

Answer 10

nature of the risk to others arising from the patient’s mental disorder
the likelihood harm will result
the severity of any potential harm

Question 11

What is a section 4 under the MHA?

Answer 11

compulsory admission on an emergency basis for assessment
up to 72h only
only 1 doctor required
must explain and justify the emergency

Question 12

What is a section 5(2) under the MHA?

Answer 12

doctors compulsory holding power of voluntary inpatients
up to 72h only
must be an inpatient
cannot be extended
not an independent power for short term detention

Question 13

What sections of the MHA are police powers?

Answer 13

s136
s135

Question 14

What is a section 136 under the MHA?

Answer 14

police can remove a person who is found in a place which the public have access who appears to be suffering from mental disorder and in need of care or control
transfer to place of safety for up to 72h

Question 15

What is a section 135 under the MHA?

Answer 15

allows police to enter private property to remove a patient

Question 16

What are the 5 core principles of the MCA?

Answer 16

a presumption of capacity
individuals being supported to make their own decisions
unwise decisions
best interests
least restrictive option

Question 17

What is the 2 stage test of the mental capacity act?

Answer 17

is there an impairment of, or disturbance in, the functioning of the person’s mind or brain?
is the person unable to make the decision? (after appropriate help and support)

Question 18

What is the statutory test for capacity under the MCA?

Answer 18

S.3(1) MCA 2005
a person is unable to make a decision for himself if he is unable to:
a) understand the information relevant to the decision
b) retain that information
c) use or weight that information as part of the process of making the decision
d) communicate the decision

Question 19

What is the name of the person who makes decisions in someone’s best interests?

Answer 19

decision maker

Question 20

What is best interests?

Answer 20

encourage participation
identify all relevant circumstances
find out the patient’s views
avoid discrimination
assess whether the patient might regain capacity
consult other
avoid restricting the person’s rights
if decision concerns life-sustaining treatment - do not be motivated by a desire to bring about the patient’s death

Question 21

What are the 2 types of lasting power of attorney?

Answer 21

health + welfare - cannot be used if the person has the capacity to make the decision

property + financial affairs - can be used even if the person has capacity to make the decision, unless they have stated otherwise in the LPA

Question 22

Who are independent mental capacity advocates (IMCAs) used for?

Answer 22

for people who lack capacity who are ‘unbefriended’ (no one willing to be consulted)

NHS must involve IMCA when the decision is with regards to providing, withholding or stopping serious medical treatment

can also be used if someone has representatives but there is a dispute

Question 23

What is the court of protection used for?

Answer 23

when there is dispute over whether someone has mental capacity to make a specific decision
makes declarations on best interests on financial and welfare matters