Mental Health Law Flashcards
When is involuntary treatment used?
Within mental illness:
- When someone poses a risk to themselves or others
- Severely unwell, lost touch with reality (psychotic)
How can involuntary treatment be approved?
There Mental Health Legislation which provides a legal mechanism
What criticism is there to involuntary treatment?
- Seen as ill-liberal
- Poorly compatible with international human rights norms
- Unnecessary for most patients
- Counterproductive to some patients
- Practical problems in administration
What ethical issues surround involuntary treatment?
- Non-maleficience
- Loss of autonomy
- Paternalism – > Hard = Ignores patients views
- Non-discrimination –> Physical versus mental illness e.g. diabetes
What ethical justifications surround involuntary treatment?
- Beneficence
- Autonomy –> May promote reasoned autonomy
- Right to treatment
- Paternalism –> Soft = Shaping
What legislations surround involuntary treatment in the UK
- Scotland = Mental Health (Care & Treatment) (Scotland) Act 2003, “MHA”
- England = Mental Health Act 1983 [Amended by Mental Health Act 2007]
- Northern Ireland = Mental Health (Northern Ireland) Order 1986
What legislations surround involuntary treatment in Scotland?
Scotland = Mental Health (Care & Treatment) (Scotland) Act 2003, “MHA”
What legislations surround involuntary treatment in England?
England = Mental Health Act 1983 [Amended by Mental Health Act 2007]
What legislations surround involuntary treatment in Northern Ireland?
Northern Ireland = Mental Health (Northern Ireland) Order 1986
What is the role of the mental health acts?
- Allows involuntary treatment
- Provide rights and safeguards
- Duties on NHS Boards and local authorities
What is the role of safeguards?
- Explicit criteria
- Multiple professional views
- Lay and career perspectives
- Legal oversights
- Right of appeal (Article 5 ECHR)
What are the Millan Principles?
- Non-discrimination
- Equality
- Respect for diversity
- Reciprocity
- Informal care
- Participation
- Respect for carers
- Least restrictive alternatives -
- Benefit
- Child welfare
What are the 5 criteria for MHA?
All must be met:
1) Mental disorder
2) Treatment available
3) Condition cause impaired ability to makes decisions about psychiatric treatments
4) Risk to self or others
5) Necessity
6) Least restrictive treatments
What is nurse holding power?
Authorises detention for 2 hours, fewer safeguards
What is emergency detention certificate?
Authorises detention for 72 hours, fewer safeguards
What is short-term detention certificate?
Authorises detention for 28 days
Requires 5 criteria, 1 doctor and 1 MHO
What is compulsory treatment order?
Authorises detention for up to 6 months, more safeguards
What is a mental health disorder?
Mental illness, personality disorder or learning disability
What exclusions are there in mental disorders?
- Sexual orientation
- Sexual deviancy
- Transsexualism
- Transvestism
- Dependance on, or use of, alcohol or drugs
- Behaviour that cause, or is likely to cause, harassment, alarm or distress to any other person
- Actin as no prudent person would
What differences are there in mental health laws in the UK?
Impaired decision making ability in Scotland
Versus
Need for hospitalisation in UK
Also procedural matters, durations etc
What is mental capacity?
Ability to make decisions about finances, welfare and medical treatments
What is required for mental capacity?
- Reason and deliberate
- Values and goals
- Appreciate one’s circumstances
- Understand information
- Communicate a choice
What is legal capacity?
- The ability to hold right and duties (legal standing) and to exercise these rights and duties (legal agency)
- Making legally-valid decisions
When is capacity assessed?
- Impaired mental capacity (Dementia, intellectual disability etc) –> May lead to loss of legal capacity
- Legal matter –> But relies on medical evidence
What is the legislation surrounding mental capacity in Scotland?
Adults with Incapacity Act (Scotland) Act 2000, AWIA
What is the legislation surrounding mental capacity in England and Wales?
Mental Capacity Act 2005 [Amended by Mental Health Act 2007]
What is the legislation surrounding mental capacity in Northern Ireland?
Mental Capacity Act (Northern Ireland) 2016
What is the role of the mental capacity legislation?
1) Allows legally-valid decisions to be made for those who lack mental capacity
2) Transfers decision-making right from impaired individual to another
Typical outcome AWIA = Guardianship
How can doctors shortcut the AWIA to attain guardianship for an individual with loss of capacity?
Certificate of Incapacity under Section 47 of the Adults with Incapacity (Scotland) Act 2000
How can social workers shortcut the AWIA to attain guardianship for an individual with loss of capacity?
Housing
What safeguards are in place in terms of capacity ?
- Multiple professionals
- Explicit criteria
- Procedures
- Legal oversight
What is the criteria for the Adults with Incapacity Act, Scotland, 2000 (AWIA)?
Needs only to have significant impairment in one area:
- Acting; or
- Making decision; or
- Communicating decisions; or
- Understanding decisions; or
- Retaining the memory o decisions
Differences between AWIA and MHA?
AWIA = Fiances, welfare treatment for physical conditions
MHA = Treatment for psychotic conditions
Which ethical issues surround capacity law?
Autonomy:
- In theory, promotes (principles)
- In practice, may diminish (Mechanisms)
Non-discrimination:
- Allows legally-valid decisions for disabled people
- Transfers powers away from disabled people
What is the Adult Support and Protection (Scotland) Act 2007?
- Defines “adults at risk”
- Risk of harm
- Harm includes
What is the Adult Support and Protection (Scotland) Act 2007 - in terms of adults art risk?
Defines “adults at risk” as:
1) Unable to safeguard their own well-being, property, rights or other interests;
2) At risk of harm; and
3) Because they affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable of being harmed than adults who are not so affected
What is the Adult Support and Protection (Scotland) Act 2007 - in terms of risk of harm?
Risk of harm:
- Another person’s conduct is causing (or is likely to cause) the adult to be harmed, or
- The adult is engaging (or is likely to engage) in conduct which causes (or is likely to cause) self-harm
What is the Adult Support and Protection (Scotland) Act 2007 - Harm includes?
Harm includes:
- Physical harm
- Psychological harm
- Unlawful conduct
- Self-harm
What should you do if you suspect an adult is at risk of harm?
- Discuss with a senior
- Document concerns
- Report to the relevant authority
