Mental Health Legislation Flashcards
What are the main laws of mental health legislation?
- Mental Health (Care and Treatment)(Scotland) Act 2003
- Adults with Incapacity (Scotland) Act 2000
Why would involuntary treatment occur?
- Treatment of small group of patients
- Severely unwell, lost touch with reality (psychotic)
- Risk to self or others
How is involuntary treatment allowed?
Normally, involuntary treatment would constitute assault and breach laws of consent, mental health legislation provides a legal mechanism
What are some critisisms of involuntary treatment?
- General
- Ill-liberal
- Poorly compatible with human rights normal
- Practical problems with administering treatments
- Ethical
- Non-maleficence
- Autonomy
- Paternalism (ignores patients views)
- Non-discrimination (physical vs mental illness)
What are the ethical justifications for involuntary treatment?
- Beneficence
- Autonomy (may promote reasoned autonomy)
- Right to treatment
- Paternalism
What is the mental health legislation in: Scotland, England and Wales, and Northern Ireland?
Scotland:
- Mental Health (Care and Treatment)(Scotland) Act 2003
England and Wales:
- Mental Health Act 1983 [amended by Mental Health Act 2007]
Northern Ireland:
- Mental Health (Northern Ireland) Order 1986
Why is mental health law important?
- Power to provide compulsory treatment to people with mental disorder
- Safeguards to make sure used appropriately
- Duties on NHS board to provide range of services for people with mental health disorder
What are some of the principles of the Mental Health (Care and Treatment)(Scotland) Act 2003?
- Non-discrimination
- Equality
- Respect for diversity
- Reciprocity
- Informal care
- Participation
- Respect for carers
- Least restrictive alternative
- Benefit
- Child welfare
What does the MH(S)A stand for?
Mental Health (Care and Treatment)(Scotland) Act 2003
What does the MH(S)A define mental disorder as?
- Any mental illness or
- Personality disorder or
- Learning disability
- However caused or manifested
The MH(S)A gives powers to what?
- Civil compulsory powers
- To detain
- To assess
- To treat
People who the MH(A)S applies to is determined by?
- An approved medical practitioner
- Mental Health Officer (MHO)
- The court
What ages can be detained by the MH(S)A?
Anyone can be detained, but if under 18:
- Need child/adolescent specialist
- Use specialist resources wherever possible
What are the different civil compulsory powers of the MH(S)A?
- Emergency detention certificate (EDC)
- Short term detention certificate (STDC)
- Compulsory treatment order (CTO)
- Nurses holding power
What does EDC stand for?
Emergency detetion certificate
How long does an emergency detention certificate allow detention for?
Up to 72 hours
What does an emergency detention certificate allow?
Assessment and ER treatment only
Transfer to psychiatric hospital
Do patients have a right to appeal an emergency detention certificate?
No
Who can administer an emergency detention certificate?
Fully registered practitioner
When can an emergency detention certificate be used?
Patient is significant risk to self or others
How long does a short term detention certificate allow detention for?
Up to 28 days
Do patients have a right to appeal a short term detention certificate?
Yes
What does a short term detention certificate allow?
Assessment and treatment
What is the criteria for a short term detention certificate to be used?
- Mental disorder
- Ability to make decisions about medical treatment impaired (known as SIDMA)
- Meaning lack of insight, cognitive impairment, psychosis, severe depressive syndrome or learning disability
- It is necessary for purpose of treatment
- Significant risk to own or others
Who must a short term detention certificate be used by?
Approved medical practitioner (AMP)
What does AMP stand for?
Approved medical practitioner
What does CTO stand for?
Compulsory treatment order
What does STDC stand for?
Short term detention certificate
How long does a compulsory treatment order allow detention for?
Up to 6 months
What is the criteria for a compulsory treatment order to be used?
Same as STDC:
- Mental disorder
- Ability to make decisions about medical treatment impaired (known as SIDMA)
- Meaning lack of insight, cognitive impairment, psychosis, severe depressive syndrome or learning disability
- It is necessary for purpose of treatment
- Significant risk to own or others
Who can use a compulsory treatment order?
- Application by MHO to the MHTS
Nurses holding power allows detention for how long?
Up to 2 hours
What is SIDMA?
“significant impairment of decision making ability about medical treatment for mental disorder”
What does MHTS stand for?
Mental health tribunal for Scotland
Mental Health Tribunal for Scotland considers what?
- Considers
- Civil applications and review of civil and criminal orders
- CTO applications
- Appeals
- 2 year mandatory reviews
- Cross border transfers
- Excessive security
Does the MH(S)A authorise treatment of all a patients problems?
No, does not authorise treatment for an unrealted physical disorder
What are police powers under the MH(S)A?
- Removal from public place
- Appears to be in immediate need of treatment for safety
- Detain up to 24 hours
- Mental health nurses have holding powers until assessment by a doctor
Under the MH(S)A, police can detain for how long?
Up to 24 hours
What does AWIA stand for?
Adults with Incapacity (Scotland) Act 2000
AWIA describes “adult” and “incapable” as what?
- Adult
- Person 16 or over
- Incapable
- Incapable of acting or making decisions or communicating decisions or understanding decisions or retaining the memory of decisions
What are some principles that must be considered when applying the AWIA?
- Intervention benefit the adult
- Intervention least restrictive as possible
- Account of past and present wishes of adult
- Where practical, account taken of relatives and carers
Under the AWIA, is capacity presumed to be present or not present?
Capacity is presumed to be present unless proven otherwise:
- Is decision specific, may have capacity for some decisions but not others
What can be done to assess a patients capacity?
- Gather information
- History
- Notes
- Previous assessments
- Carers/family
- Clinical assessment
- Focus on criterial for capacity (communication, understanding, retention of information, decision)
- Can barriers be overcome
- Communication with aids
- Understanding with more information
- Retention ask questions like “what did I tell you” and “ can you explain it to me”
- Decision, is it clear what the decision is and is it consistent
What is the criteria for capacity?
- Communication
- Understanding
- Retention of information
- Decision
What are some different areas that the AWIA addresses?
Areas of things the act allows us to do:
- Property
- Welfare (medical)
- Financial
What are some powers of the AWIA?
- Intervention order
- Application to court
- Guardianship order
- Two doctors (one approved)
- MHS application
- Can be financial or welfare or both
- Registered with the office of the public guardian
What medical treatment is allowed under the AWIA?
- Always treat emergencies
- Cannot treat anything else unless person has capacity, or welfare guardian authorises or go through courts with a certificate of incapacity
- If people disagree, will end up at Court of Session where must implement the judge’s decision
When using a AWIA, if people disagree about treatment what must happen?
- If people disagree, will end up at Court of Session where must implement the judge’s decision
Under the AWIA, a certificate of incapacity does not authorise what?
- Use of force or detention unless immediately necessary and only for as long as required in circumstances
- Action which would be inconsistent with any decision by a competent court
- Placing an adult in a hospital for treatment of mental disorder against their will
What is the choice of which legislation to use determined by?
Is determined by aetiology:
- Mental disorder
- Physical disorder
- Both
Or by treatment needs:
- AWIA
- Welfare
- Financial and property
- Physical illness
- MH(S)A
- Psychiatric
- Can encompass secondary physical issues such as NG feeding
- Psychiatric
What is the aetiology of delirium and incapacity?
- Chest infection
- Sepsis
- Alcohol
- BDZ withdrawal
What are some treatment options for delirium and incapacity?
- Abs
- Hydration, thiamine, parvolex, diazepam
- BDZ
Summarise an advanced directive and an advanced statement?
Advanced directive:
- Not statue
- Treatment you don’t want when incapacitated
- Has to be specific to the situation
- In writing
- Still valid
Advanced statement:
- Treatment for medical disease that do or do not want when incapacitated
- If override, write to the MWC with reason
What legislation guides adult protection?
Adult Support and Protection (Scotland) Act 2007
The Adult Support and Protection (Scotland) Act 2007 definds “adults at risk” as?
- Unable to safeguard own well-being, property, rights or other interests
- At risk of harm and
- Because they have disability, mental disorder, illness or physical or mental infirmity are more vulnerable to being harmed than unaffected adults
Under the Adult Support and Protection (Scotland) Act 2007, harm could be?
- Conduct that causes physical or psychological harm (such as fear, alarm or distress)
- Unlawful conduct
- Conduct which causes self-harm
What do you do if you suspect an adult at risk?
- Discuss with senior
- Document concerns
- Report to relevant local authority
What are local authorities duties after you report a suspected adult at risk, under the Adult Support and Protection (Scotland) Act 2007?
- Make inquires to decide if action required
- Apply to sheriff for grant of protection order, could be
- Assessment order
- Removal order
- Banning order
- Temporary banning order
- Requires consent of vulnerable adult (and therefore capacity)
