Mental Heatlh: Mental Health Act Flashcards
For what ages sectioning apply?
This is used for someone over the age of 16 years who will not be admitted voluntarily.
Can we section a patient who is solely under the use of alcohol/drugs?
Patients who are under the influence of alcohol or drugs are specifically excluded
(intoxication or withdrawal though are not excluded)
Section 2
- how long for
- what for
- who is needed to section
Section 2
- admission for assessment for up to 28 days, not renewable
- an Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors
- one of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
- treatment can be given against a patient’s wishes
Section 3
- how long for
- what for
- who is needed to section
Section 3
- admission for treatment for up to 6 months, can be renewed
- Approved Mental Health Professional along with 2 doctors, both of which must have seen the patient within the past 24 hours
- treatment can be given against a patient’s wishes
Section 4
- how long for
- what for
- who is needed to section
Section 4
- 72-hour assessment order
- used as an emergency, when a section 2 would involve an unacceptable delay
- a GP and an approved mental health worker or nearest relative
- often changed to a section 2 upon arrival at hospital
Section 5(2)
- how long for
- what for
- who is needed to section
Section 5(2)
- a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
Section 5(4)
- how long for
- what for
- who is needed to section
Section 5(4)
- similar to section 5(2)
- allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
Section 17a
- what’s that? what’s used for?
Section 17a
- Supervised Community Treatment (Community Treatment Order)
- can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication
What’s section 135?
Section 135
- a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
What’s section 136?
Section 136
- someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
- can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
Can people with a learning disability be detained under section 3?
For Section 3 people with Learning Disability and no other mental disorder may only be detained ‘if the disability is associated with abnormally aggressive or seriously irresponsible behaviour’
What is Part 2 of the Mental Health Act is about?
Part 2
- deals with detention, guardianship and CTO (community treatment order) for civil (i.e. non-offender) patients
- some aspects also apply to detention or guardianship when patient are detained through courts
What’s Part 3 of the Mental Health Act about?
Part 3: deals with mentally disordered offenders and defendants in criminal proceedings
What’s Part 4 of mental health act about?
Part 4: deals with medical treatment for mental disorder of detained patients (including CTO Recall patients).
What’s section 12 approved doctor?
Section 12 Approved Doctor:
a doctor who has been approved under the Act by the Secretary of State for Health (or certain other specific bodies) as having special experience in the diagnosis or treatment of mental disorder
What’s ‘Approved Clinician’?
Approved Clinician:
- a mental health professional approved by the Secretary of State for Health (or certain other specific bodies)
- acts as an approved clinician for the purpose of the Act
- some decisions can only be taken by an AC
What’s responsible clinician?
Responsible Clinician:
- the Approved Clinician with overall responsibility for a patient’s case
- certain decisions can only be taken by the RC
All RCs MUST be ACs [but not all ACs are RCs]
What’s ‘Approved Mental Health Professional’?
Approved Mental Health Professional (AMHP)
- a social worker or other professional approved by the local authority to carry out a variety of functions under the Act
Who’s ‘Nearest Relative’?
- a family member who has certain responsibilities and powers if a patient is detained under MHA → to ensure that the patient’s rights are protected
- if there is no known NR, the patient (or the AMHP if he/she lacks capacity) can apply to county court to appoint one
- NR can be legally displaced under certain conditions
Is Nearest Relative the same as Next of Kin?
it’s different from ‘Next of Kin’ – Next of Kin does not have any rights under the MHA
What’s Nearest Relative hierarchy order?
NR hierarchy order:
husband/wife/civil partner > son/daughter > father/mother > brother/sister > grandparent > grandchild > uncle/aunt > nephew/ niece
The powers of Nearest Relative
- To be consulted and/or given information
- To apply for detention or Guardianship under the Act
- To object to detention (under Section 3) or Guardianship
- To discharge a detained patient and apply to MHA Tribunal if this is refused
- To ask for Independent Mental Capacity Advocate
- To appoint someone else as NR
What’s section 117?
Section 117
- additional to section 3
- aftercare: patients are entitled to this free of charge until it is decided this is no longer necessary
Requirements for section 135
- AMHP (approved mental health professional) needs to apply for a Section 135 warrant and a Magistrate has be satisfied that it is appropriate
- the person should be told the reason for removal before it is done
- the person can be detained at the place of safety for up to 72 hours
- the police officer must be accompanied by an AMHP and a doctor
- the AMHP, hospital managers or the local authority should ensure that an ambulance or other transport is available to take the person to a place of safety
What’s the key feature for community treatment order?
- it’s suitable only where there is no reason to think that the patient will need further treatment as a detained in-patient for the time being
- but where the responsible clinician needs to be able to recall the patient to hospital if necessary
Requirements of CTO (Community Treatment Order)
- they make themselves available for examination by the RC or SOAD (Second Opinion Approved Doctor, appointed by the Care Quality Commission) if they are required to take medication
- they make themselves available for examination by RC for renewal of the CTO
- other conditions may be added e.g. where they live , supervision , medication etc. as long as they do not constitute a Deprivation Of Liberty
What’s section 35?
section 35
- applies when a criminal court sends the patient to hospital for a medical report
What’s section 36?
Section 36
applies when Crown court sends patient to hospital for treatment
What’s section 37?
Section 37
Hospital Order: applies when court decides to send the patient to hospital instead of prison (after assessment and agreement by two doctors).
What’s section 37/41?
Section 37/41
- Section 37 with specific restrictions imposed by Ministry of Justice
What’s section 38?
Section 38
applies when criminal court gives an interim hospital order while it decides the sentence
What’s section 47/49?
Section 47/49
applies when a sentenced prisoner needs hospital treatment (for mental disorder)
What’s:
- Independent Mental Health Advocate
- Independent Mental Capacity Advocate
- independent Mental Health Advocate (IMHA)- an advocate able to offer help to patients under arrangements which are specifically required to be made under the Act
- Independent Mental Capacity Advocate (IMCA)- an advocate able to offer help to patients who lack capacity under arrangements which are specifically required to be made under the Mental Capacity Act
*IMHA/IMCA should be independent of any professionals involved in patient’s medical treatment
*They are an additional safeguard for patients as their main role is to help patients get information and have an understanding of their rights, care and treatment.
What are the Tribunals?
- Tribunal (or ‘First-tier tribunal’) is a judicial body which has the power to discharge patients from detention, CTO, Guardianship and conditional discharge
- Every detained patient has the right to a Tribunal as it is a significant safeguard for patients who have had their liberty curtailed under the Act
- Patients have a right to have a solicitor of their own or one appointed through the Tribunal process
- It comprises of a panel (usually three professionals) which is not affiliated with the treating team/hospital
- The RC and the care co-ordinator are asked to provide reports and give evidence explaining the rationale for detention
Definition of Lack of Capacity (for the purpose of the Act)
For the purposes of this Act:
- a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain
According to the act, in what instances, a person lacks capacity?
- they have an impairment or disturbance (for example, a disability condition or trauma) that affects the way their mind or brain works
and
- the impairment or disturbance means that they are unable to make a specific decision at the time it needs to be made
*the impairment or disturbance does not have to be permanent. A person can lack capacity to make a decision at the time it needs to be made even if:
- the loss of capacity is partial, temporary or changes over time
- a person may also lack capacity to make a decision about one issue but not about others
What constitutes Depraviaiton of Liberty?
Revised test for deprivation of liberty
The Supreme Court has clarified that there is a deprivation of liberty for the purposes of Article 5 of the European Convention on Human Rights in the following circumstances:
- The person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements
- The person’s compliance or lack of objection, the relative normality of the placement and the purpose behind it are all irrelevant to this objective question
Criteria for assessment of capacity
- Does the person have a general understanding of what decision they need to make and why they need to make it?
- Does the person have a general understanding of the likely consequences of making, or not making, this decision?
- Is the person able to understand, retain, use and weigh up the information relevant to this decision?
- Can the person communicate their decision (by talking, using sign language or any other means)? Would the services of a professional (such as a speech and language therapist) be helpful?
Criteria for detention under the Mental Health Act?
- a mental disorder
- it is of both a nature and of a degree to warrant detention
- poses a risk to self and a risk to others
The rights of a patient detained under section 3
- the right to appeal his Section 3 detention → it’s possible at any stage during his Section 3 detention
- right to select his own mental health law solicitor, or to request that the detaining hospital choose a solicitor for him. If he lacks capacity to select a mental health law solicitor, the detaining hospital has to select a solicitor for him.
- nearest relative has the right to formally request that a person be discharged from his Section 3 → request has to be made to the man’s inpatient Responsible Clinician (RC) in writing and the RC will then have 72 hours in which to decide whether to grant discharge from the Section or whether to bar the nearest relative discharge due to concerns a person poses an immediate and grave risk to self and / or to others
- The nearest relative discharge request can be made at any stage during the Section 3 detention
