Mental Health And Law Flashcards
Why can’t people with mental disorders be treated under the Mental Capacity Act in their best interest?
Mental illness can affect people’s value
Even though their cognitive function may not be impaired, the process of decision making can be affected
Mental health act 1983
To ensure that people with serious mental disorders shchi threaten their health or safety of the public can be treated irrespective of their consent where it is necessary to prevent them from harming themselves or others
- only for mental health. Not physical illness
- detention/treatment without consent
- 3 professionals decisions
Section 2
Assessment order
Cannot institute long term treatment, but can give treatment as part of assessment process
Last up to 28 days
Two doctors must agree and one of them must be section 12 doctor
Section 3
Treatment order
Can initially last up to 6 months
Each subsequent order lasts up to 1 year
Cannot be detained under section 3 if Nearest Relative object
Most treatment can be given under section 3 including psychotropic medication (on psychiatric ward)
After 3 months of detention, either person has to consent to treatment or SOAD doctor must confirm treatment is in best interests
Safeguards for ECT
Two doctors have to agree
Renewable
ECT
A person must consent to ECT
Where they lack capacity, a second doctor must give authorization
Section 4
Emergency order -seldom used as good practice is to hold full MHA assessment and consider for 2 or 3
Allows emergency detainment for the purpose of assessment for a duration of up to 72 hours
The application can be made by the nearest relative or an Approved Mental Health Professional and must be supported by one doctor. The doctor must have examined the patient within the previous 24 hours
During the 72 hour period, second doctor has to review
Community treatment order
For patients on section 3
Enforce treatment in community
Power to bring patient back to hospital of does not comply with treatment plan
Section 5 (2)
•Doctor's holding power (72 hours) •When an informal inpatient tries to leave -any registered doctor -any ward (not A&E) •Further assessment must occur within 72 hours -can be released from 5(2) -MHA assessment >>discharge if not detainable or >>detention under section 2 or 3
S5(4)=Nurse’s holding power 6 hours
*must be a hospital inpatient
Section 135
Magistrate’s order
Applied for by AMHP where person refusing to allow mental health professionals into their residence
Gives police warrant to enter property and take person to “place of safety”
Section 136
Applies to person found in public place suspected by police of having mental disorder conferring an immediate risk
Taken to “place of safety”
Assessment by Duty psychiatrist
-discharge or
-MHA assessment
»admit under S2 or 3 or discharge of not detainable
Sarah -took overdose, history of physical and sexual abuse, history of depression.
refusal of treatment
Section 2 for assessment due to high risk of suicide, possible mental illness, refusal to engage
- Medics have to assess the capacity (understand,weight, retain and communicate)
- If no capacity, treat overdose under MCA
She might have BPD. Her refusal of treatment might be due to her ex showed up
She might be delirium due to the overdose
Chris -paranoid schizophrenia Become withdrawn after mother's death Disengage from mental health service Disturbing neighbours Religious delusion Threats to burn down his flat
Section 3 (treatment order) is appropriate.
He has an established diagnosis and recognized pattern of relapse. No further assessment is needed as we know what treatment he needs.
Chris-admitted to hospital
Develop gangrene in his leg
Surgeon advise an amputation
He refuse
Has to assess if Chris has capacity (understand, believe, weight, retain, communicate)
Just because he has paranoid schizophrenia, it doesn’t mean he doesn’t have capacity
Since gangrene is not the result of mental illness, it cannot be treated under the MHA.
49 yo man with severe autism, learning disability, mute
Increasingly agitated at day centre
Admitted informally for assessment
Carers not allowed to visit while he was being assessed
Detained in hospital under common law- he wasn’t refusing,but hadn’t actually consented
Common law based on case law-was how all cases of incapacitated persons were dealt with, based on doctrine of “best interests”
Common law based on precedent- no formal procedures or criteria; subjective, arbitrary,
Common law (informal, more arbitrary, based on precedence) vs statutory law (formal, by parliamentary act)
MCA’s deprivation of liberty safeguards (DoLS)
Provides legal safeguards for mental ill patients deprived of liberty when MHA not applicable
-amendment to the MHA which allows restraint and restriction to be used but only if they are in a person’s best interest
Not detainable under MHA
No acute deterioration - do not fulfil “degree” criteria
Deprivation necessary to reside in an institution to receive care, not assessment/ treatment
- -people with dementia living in a long stay institution
- -learning disability not detainable disorder under MHA
Who is covered by DoLS?
Adults (18+) in hospitals or care homes
Mental disorder/ disability not covered by MHA
Lack capacity to make decision on care/ placement
Deprivation of liberty is necessary to provide appropriate care (in their best interest)
If it’s long term-use DoLS (last1 year)
If assessment and treatment is needed- use MHA
MHA vs MCA
Authority granted when:
Person is mentally incapacitated due to disturbance of functioning of mind/brain rendering them unable to make a decision for themselves (MCA)
- physical disorders
- anyone can assess capacity
Patient is/could be suffered from mental disorder that is of a nature or degree that warrant assessment or treatment (MHA)
- mental disorders only
- 3 professionals’ decision
If psych patient detained under MHA needs treatment for physical disorder but is refusing and does not have capacity
Can either wait until regain capacity (with appropriate treatment for mental illness) and re-assess decision, or treat against their will under MCA if clinically urgent
Your client has just been admitted to hospital under section 2 of MHA. What would you tell the family?
section 2 is in the first place intended for assessment, but it also allows for treatment to be initiated if a conclusion is reached from the assessment
“No health without mental health: a cross government mental health outcome strategy for propel of all ages”
Who are responsible for mental health?
Families
Employers
Individual
Communities
Peter has an intellectual disability. He has turned 18 and is moving from family home to independent accommodation where he will be supported by daily visit from support worker. He wanna be in charge of his money but his family is worried.
The team should start from assumption that he is capable, but carry out an assessment of his capacity to make decision about expenditure in case some support is in his best interests
Who carry out duties under the Acts?
Approved mental health professionals (social worker, mental health nurse OT and psychologist who are approved by a local social service for five years)
Approved clinician
(Doctors, psychologist, mental health nurse etc who were trained and approved for five years to carry out certain duties under Act on behalf of the Secretary of State
Section 12 approved doctor
(Approved doctors are also approved under section 12 and they decide whether someone should be detained in hospital under section 2 and 3)
Nearest relative
1) Someone’s husband, wife, civil partner or unmarried partner (living more than 6 months)
2) Or children (over 18 years)
3) If not, their parent
4) brother or sister
5) grandparent, grandchild , uncle, aunt
6) not related but loving for more than 5 years
Nearest relative can ask manager to admit someone to hospital compulsorily for assessment (section 2) treatment (section 3) , emergency (section 4)
Section 35
Section 36
Section 37
Send an accused person on remand to hospital for report
Send an accused person on reman go hospital for treatment
Convicted person to be detained for treatment
Section 7
Guardianship
Section 17
When they are detained under section 2,3,37, they can leave under the permission
Global mental health
10% of the world population is affected by mental illness
22.8% in UK
(15%- cancers and cardiovascular )
Depression -No2 world wide for years lived with disability
Some major priorities for public mental health
Childhood
- half of mental disorder emerge before 14 yo (except dementia)
- 25% children show sign of MH problem
- parenting and school key
Public mental health -important example
Parenting
Attachment
Communication
Sensitivity to need containment
The public health consultant
Mixture of medical graduates & others with relevant work experience
4-5 years training
- assessing population needs and helping plan
- planning health promotion
- assessing impact on health of wider societal factor
- assessing and responding to outbreaks of communicable disease
Epidemiology and statistics
