Mental Health and the Law

Question 1

When do people not have the right to refuse healthcare?

Answer 1

harm to themselves and others

don’t have the ability to consent to the treatment

Question 2

What are the two key mental health laws in England and Wales?

Answer 2

Mental Health Act 1983, amended 2007

Mental Capacity Act 2005

Question 3

What is the MHA?

Answer 3

Overriding a person’s autonomy in people suffering from a ‘mental disorder’ (any disorder or disability of the mind), which poses a risk to their health, safety, or to others.

Question 4

MHA: duration

what do sections NOT cover?

Answer 4

Duration = maximum lengths of detention: person often discharged or the section rescinded before that time passes.

Sections = parts ofthe law for particular situations

• do not cover physical health problems unless they are directly causing or resulting from the mental disorder

Question 5

MHA: checks to prevent rights abuses (3)

Answer 5

3 independent assessors must all agree to S2/S3 (if one disagrees, there’s no section)

The person’s nearest relative can request their discharge from S2/S3 OR object to S3 (preventing it)

The person can appeal S2 and S2 with (free) representation by a solicitor, at an independent tribunal or hospital managers’ hearing

Question 6

What is mental capacity?

Answer 6

Ability to make decisions

• decision-specific = assessed separately for each decision
• all health professionals can assess capacity

Question 7

A person with capacity can: (4)

Answer 7

Understand information relevant to decision

Retain that information

Use or weigh that information to make their decision (e.g. risks vs benefits)

Communicate their decision (through speech/sign language/other means)

Question 8

What is the MCA?

Answer 8

Primarily for physical healthcare decisions, allowing professionals to act in the person’s best interests, e.g. giving abx when the person is too confused to consent

Question 9

What do best interests have to be under the MCA? (4)

Answer 9

Are the least restrictive of rights and freedoms

Allow as much participation as possible in decision-making (e.g. providing a specially trained, independent advocate)

Take the person’s beliefs (if known) into account

Consider the views of involved people (e.g. relatives)

Question 10

MCA: advance decisions

Answer 10

describes specific tx they wouldn’t want if they lacked capacity in the future

Question 11

DoLS

Answer 11

used to legally keep someone in hospital (or care hpme) for necessary care

LIKELY to be replaced by the Liberty Protection Safeguards

Question 12

Key MHA sections

Answer 12

Question 13

Mental Health Pathway

Answer 13

Pathway

EIS for first episode psychosis in under 35 y/o

Give them crisis number

“How do you feel about coming in to hospital?”

• It’s something you don’t have to think about now
• It would be beneficial to you
• I will discuss this with my seniors
• if pt says yes → informal admission
• if no → I would like to order a MHA assessment, 2 MH doctors and 1 social service worker trained

Question 14

Section 2

Answer 14

Suffering from mental disorder

and

nature or degree to warrant detention in hospital for assessment or assessment followed by tx

and

the person ought to be detained in the interests of their own health or safety or with a view of protection for others

CANNOT detain for substance dependance

Question 15

Section 3

Answer 15

same as 2

and

tx cannot be provided unless they are detained

and

appropriate medical tx is available for them

lasts 6 months, need 2nd doctor to approve tx if not consenting after 3 months, eligible for aftercare

Question 16

Who has final say, who can discharge

Answer 16

Final say is social worker (AMHP)

Discharge is by RC

Question 17

Both S2 and S3

Answer 17

right to appeal - MH tribunal

discharge by RC, tribunal, managers hearing, nearest relative

Temporary leave under section 17

Question 18

5(2)

Answer 18

CAN’T USE IN A+E

only for an inpatient

Question 19

CTO

Answer 19