Mental Health Legislation COPY Flashcards
Involuntary treatment may need to be given for mental illness, why?
- Treatment of a small group of patients
- Severely unwell, lost touch with reality (psychotic)
- Risk to self or others
what is the legal hurdle that is involved in giving involuntary treatment for a mental illness?
Mental health legislation provides a legal mechanism
what are the general criticisms of involuntary treatment?
- Seen as ill-liberal
- May be poorly compatible with international human rights norms
- European Convention on Human Rights / Human Rights Act/ Scotland Act
- Universal Declaration of Human Rights (United Nations)
- Convention on the Rights of Persons with Disabilities (United Nations)
- Unnecessary for most patients
- Counterproductive for some patients
- Practical problems in administering treatments
what are the ethical principles involved in the ethical criticisms of involuntary treatment?
- Non-maleficence
- Autonomy (liberty)
- Paternalism (hard – ignores patient’s views)
- Non-discrimination (physical vs mental illness e.g. diabetes)
what are some ethical justifications for involuntary treatment?
- Beneficence (including reducing risk)
- Autonomy (may promote reasoned autonomy)
- Right-to-treatment (is this a human right?)
- Paternalism (soft – “shaping”)
What is the Mental Health Legislation in the UK?
Scotland:
- Mental Health (Care & Treatment) (Scotland) Act 2003
- “MHA”
England and Wales:
• Mental Health Act 1983 [amended by Mental Health Act 2007]
Northern Ireland:
• Mental Health (Northern Ireland) Order 1986
why the mental health law?
- Power to provide compulsory care and treatment for people with a mental disorder
- Rights and safeguards to make sure those powers are used appropriately
- Duties on NHS Boards and local authorities to provide a wide range of services for people with a mental health disorder
what are the principles that come under the mental health act
Non-discrimination
Equality
Respect for diversity
Reciprocity
Informal care
Participation
Respect for carers
Least restrictive alternative
Benefit
Child welfare
we use the term mental disorder
what is a mental disorder defined as?
- any mental illness,
- personality disorder or
- learning disability
- however caused or manifested
a mental disorder is not a mental disorder if only one of the following are present:
- Sexual orientation
- Sexual deviancy
- Transsexualism
- Transvestism
- Dependence on, or use of, alcohol or drugs
- Behaviour that causes, or is likely to cause, harassment, alarm or distress to any other person
- Acting as no prudent person would
what does the mental health act give powers to?
- Civil compulsory powers
- To detain
- To assess
- To treat
- Determined by:
- an approved medical practitioner, s.22 (AMP)
- Mental Health Officer (MHO)
- The court
who can be detained?
- > 18yrs
- < 18
- Can still be detained
- ‘Need’ child / adolescent specialist (CTO etc)
- Use specialist resources (where ever possible)
what are the different Civil Compulsory Powers?
Emergency detention certificate EDC
Short-term detention certificate STDC
Compulsory Treatment Order CTO
Nurses holding power
How long does Emergency detention certificate EDC allow detention for?
Authorises detention for up to 72 hours
how long does Short-term detention certificate ST allow detention for?
Authorises detention for up to 28 days
how long does Compulsory Treatment Order CTO allow detention for?
Authorises detention for up to six months
how long does Nurses holding power allow detention for?
Authorises detention for up to two hours
an EDC allows for upto 72 hours of detention, how is it authorised?
- Authorises transfer to psychiatric hospital
- Fully registered practitioner
- MHO consent “where practicable”
- No right of appeal
- “likely” has MD & SIDMA (significant impairment of decision making ability) for MD
- Granting of STDC undesirable delay
- Significant risk exists to self or others
- Assessment & ER treatment only
STDC authorises detention for upto 28 days, but what is involved?
- Must be an Approved Medical Practitioner (AMP)
- MHO essential
- Named person consulted
- Assessment & treatment
- Right of appeal
What is the criteria for STDC?
- The patient has a mental disorder
- The patient’s ability to make decisions about the provision of medical treatment is significantly impaired as a result of that mental disorder
- It is necessary to detain the patient in hospital for the purpose of determining what treatment should be given to the patient or giving that treatment
- There would be a significant risk to the health, safety or welfare of the patient or to the safety of any other person if the patient were not detained in hospital
- The granting of a certificate is necessary
a CTO allows detention for upto 6 months, how is it done?
- Application by MHO to the MHTS
- Two medical reports: GP and AMP
- Proposed Care Plan
- Criteria as for STDC
- Community or hospital
what is the criteria for detention?
- Mental disorder
- Significant Impairment of Decision Making Ability for medical treatment about mental disorder
- Significant risk to health, safety or welfare of the person or the safety of any other person
- Treatment available
- Order necessary
‘Significant impairment of decision making ability about medical treatment for mental disorder’ - SIDA, what things are classed as this?
- lack of insight,
- cognitive impairment,
- presence of psychosis,
- severe depressive symptoms or
- learning disability
what do the Mental Health Tribunal for Scotland
(MHTS) do?
Civil applications and review of civil & criminal orders
CTO applications
Appeals
2 year mandatory reviews
Cross border transfers
Excessive security
what powers do the police have under the mental health act?
- Removal from a public place
- Appears to be in immediate need of care or treatment to a place of safety
- Detain for up to 24 hours
- Purpose to allow assessment and make arrangements for their care and treatment.
- Mental Health Nurses do have holding powers until assessment by A doctor
what is the definition of an adult with incapacity?
what principles must be considered while applying the act?
- The intervention must benefit the adult
- Any intervention shall be the least restrictive in relation to the freedom of the adult, consistent with the purpose of the intervention
- Account must be taken of the past and present wishes of the adult
- Where practicable, account should be taken of the views of relatives and carers, the views of relevant others (guardians, attorneys, etc.)
Capacity is ________ to be present unless ______ otherwise
presumed
proven
depends on the situation:
- May have capacity for some ________ but not others
- Said to be decision _______
decisions
specific
what information may we gather to assess capacity?
- Appropriate information from the history and the evidence before the court
- Consult the notes
- Has the decision about certain capacity things already been made?
- Any carers/family etc
- Any previous assessments
- Any previous power of attorney
- Any previously stated views
in a clinical assessment you should focus on criteria for capacity which is what?
- Communication
- Understanding
- Retention of information
- Decision
in a clinical assessment you should look for if the person can communicate
and then think what ways can this be overcome?
- Sign language
- Written communication
- Makaton (simplified sign language)
- Hearing Aid
- Braille
- Translator
- Simplified language - ?SaLT help needed
in a clinical assessment, what do you need to do in relation to the pateints understanding?
- Do they have adequate information?
- Pros and cons
- Ability to weigh the evidence
- Discussed important risks more than 5% - note the decision in Montgomery v Lanarkshire
- Can any lack of understanding be overcome with more information etc
in a clinical assessment, how do you assess a patients retention?
- What did I want you to do?
- What did I tell you?
- Can you explain it to me?
what areas does the AWI (adults with incapacity) allows us to work in?
- Property
- Welfare (Medical)
- Financial
what powers does the AWI give?
Intervention Order:
- One off power required
- Application to the court
Guardianship Order:
- Two doctors (one approved)
- MHO application
- Needs to specify powers
- Can be financial or welfare or both
- Registered with the office of the public guardian.
The authority conferred by subsection (2) shall not authorise:
- (a) the use of _____ or detention, unless it is immediately necessary and only for so long as is necessary in the circumstances;
- (b) action which would be inconsistent with any decision by a competent _____;
- (c) placing an adult in a hospital for the treatment of mental disorder against his ____.
force
court
will
what come sunder AWIA and MHA?
AWIA:
- Welfare
- Financial and property
- Physical illness
MH(S)A:
- Psychiatric
- Can encompass secondary physical issues eg NG feeding
what is the aetiology of delerium and incapacity?
- Chest infection
- Sepsis
- Alcohol
- BDZ withdrawal
what are the treatment options of delerium and incapacity?
- AB’s
- AB’s
- Hydration, Thiamine, Parvolex, Diazepam
- BDZ
what is the difference between Advance Directive v Advance statement
AD:
- not statute
- treatment you don’t want when incapacitated
- Has to be specific to the situation
- In writing
- Still valid
AS:
- MH(C&T)(S)A
- Treatment for MD that do or do not want when incapacitated
- Dr to “give due regard” to
- If override, write to the MWC with reason
what is adult protection?
- Law, policies & procedures that dictate and influence responses in situations where it is suspected, or known, that certain adults are experiencing harm or abuse.
- Deals with harm inflicted by others, self-harm & neglect
what is the definition of adults at risk?
- unable to safeguard their own well-being, property, rights or other interests;
- at risk of harm; and
- because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected
must meet all of these things to be termed an adult at risk
what are the different types of harm?
conduct which causes physical harm,
conduct which causes psychological harm (for example by causing fear, alarm or distress),
unlawful conduct which appropriates or adversely affects property, rights or interests (for example theft, fraud, embezzlement or extortion),
conduct which causes self-harm
what do you do if you suspect an adult is at risk?
- Discuss with a senior
- Document concerns
- Report to the relevant local authority
what are the duties of the local authorities under the adult support and protection act
make inquiries to establish whether action is required, where it is known or believed that an adult is at risk of harm and that intervention may be necessary to protect the adult
apply to the sheriff for the grant of a protection order. This may be an assessment order, a removal order, a banning order or temporary banning order
