MHA and MCA

Question 1

how does the MHA define a mental disorder?

Answer 1

any disorder or disability of the mind

dependence in drugs and alcohol alone is NOT considered to be a mental disorder.
also, someone with a learning disability would only be considered as suffering from a mental disorder if it is associated with abnormally aggressive or seriously irresponsible conduct.

Question 2

4 stages to consider in making a capacity assessment?

Answer 2

Pt should:
understand the information and why they need to make a decision
be able to use the information or weigh up the information
retain the information for long enough to make a decision
communicate their decision

Question 3

what criteria must a pt fulfil to be held under a section 2 of the MHA?

Answer 3

person must be suffering from a mental disorder of a nature or degree that warrants their detention in hospital for assessment
and
person ought to be detained in the interests of their own health or safety or with a view to the protection of others

Question 4

who must be available for a person to be held under a section 2 of the MHA?

Answer 4

require an AMHP, and 2 doctors- 1 of whom must be section 12 (2) approved

AMHP= approved mental health professional- any mental health professional e.g. social worker, nurse, psychologist, who has undergone specific training in assessing and dealing with patients mental disorder.

Question 5

what are advance decisions?

Answer 5

the MCA allows an advance decision to refuse treatment should a person lack capacity in the future
can only be made if 18 or older, and when person has capacity to make the decision
any tment can be refused except that needed to keep them comfortable e.g. warmth, food and water by mouth

Question 6

what is a lasting power of attorney (LPA)?

Answer 6

allows a person to appoint an attorney to act on their behalf should they lose capacity in the future
LPA can make financial, property, health and welfare decisions for them
formal legal protocol in order to register an attorney
decisions by LPA still required to be made in patient’s best interest.

Question 7

in terms of safeguarding patients who lack capacity, if those who care for them are refusing to treat them as necessary as recommended by the health and social care team, where might the case then be referred to?

Answer 7

a court of protection

Question 8

who can be appointed as a means of safeguarding to speak for a person who lacks capacity when no one is there to speak for them?

Answer 8

an independent mental capacity advocate (IMCA)

Question 9

what are the DOLS?

Answer 9

deprivation of liberty safeguards
part of the MCA which means that it is legal for a hospital or care home to stop a pt from leaving if the pt lacks capacity.
key aspects of the DOLS include that taking away someone’s liberty is in their best interests, this means it is necessary to prevent harm to them, and the detention is proportionate, looking at how likely they are to suffer harm, and how serious the harm might be, and that it has has become an unavoidable necessity. Every effort should be made to prevent it from becoming a necessity.
it should only be used if it is the least restrictive way of keeping someone without capacity safe or making sure they have the right medical treatment.

Question 10

principles of the MCA?

Answer 10

all patients are presumed to have capacity unless established that they don’t have capacity
a new legal right to support individuals in making their own decisions
a right to make unwise decisions
must be done in their best interests
assessment should be time and decision specific
anything done for or on behalf of the person should be the least restrictive option with respect to their basic rights and freedoms.

Question 11

3 purposes of the MHA laws?

Answer 11

ensure essential tment provided for pts with mental disorders who do not recognise themselves to be ill,and refuse tment. 3 criteria used to decide if tment essential: safety of pt, safety of others, and need to prevent deterioration of health that would lead to problem with safety of pt or others.
protect other people
protect individuals from wrongful detention

Question 12

criteria for implementing the MHA?

Answer 12

presence of a mental health disorder as defined by law
disorder is of a certain nature or degree
significant risk to the person’s health, safety, or safety of others
no alternative to hospital admission as a means of safeguarding that risk

Question 13

who must be present for a pt to be sectioned under section 3 of the MHA?

Answer 13

2 doctors to authorise, at least 1 section 12 (2) approved
and an AMHP-not just a SW now
this is a section for a maximum of 6 mnths for tment of a mental disorder ( can be for physical conditions if direct result of mental health problem*)
1 appeal to both hospital managers panel and tribunal

Question 14

what is a section 5 (2) of the MHA?

Answer 14

a holding order for a pt already in hospital
max duration of 72hrs
require 1 doctor to authorise, or responsible clinician (RC)*

Question 15

what is a section 5 (4) of the MHA?

Answer 15

holding order for an informal psychiatric inpatient for up to 6hrs by an AMHP for mental assessment

Question 16

what is a section 136?

Answer 16

police order to remove a person to a place of safety for a max of 72hrs to then be assessed by an AMHP and 1 doctor.

Question 17

who does the MCA apply to?

Answer 17

those aged 16 or over

those under 16 can have consent given by their parents

Question 18

when might people under the age of 16 be given the right to consent to or refuse tment (not life saving)?

Answer 18

if deemed to have capacity-Gillick competence

Question 19

what age do people have to be for the MHA to be applied?

Answer 19

can be any age

Question 20

what is section 17 of the MHA?

Answer 20

whilst detained under S2 or 3 of the MHA, a pt may be granted leave under section 17
the responsible clinician and a dr must agree and sign the section.

Question 21

what is section 117 of the MHA?

Answer 21

anyone who has been detained under section 3 is entitled under section 117 to formal aftercare
must have regular health and social needs reviews, an agreed care plan, an allocated health worker and regular progress reviews.
section 117 also applies to those under a hospital order pursuant to Section 37 (with or without a restriction order) or
following transfer from prison under Section 47 or 48.
pts detained under section 2 NOT entitled to 117 aftercare

Question 22

what is a community treatment order (CTO) or section 17A-G?

Answer 22

a pt discharged from inpatient care is required to attend for/comply with tment in the community, and there is a power to recall the pt to hospital if they do not comply with restrictions-can be brought in my ambulance.
pt on s3 may be considered for this
pt well enough to leave hosp but may not comply with tment outside of hosp and this is necessary for the pt’s health, safety or protection of others.
can still appeal to the tribunal

Question 23

if a pt is incapacitated, what is the influence of the pt’s next of kin on decision making?

Answer 23

if the next of kin is a lasting power of attorney for the patient’s health and welfare, they can make a decision?
next of kin must be consulted, but unless LPA, cannot make a decision for the pt, decision must be made by the professional that understands the treatment, and made in the best interest of the pt.

Question 24

what is section 135 of the MHA?

Answer 24

Mental health professionals can ask for a judge to let them come in your home. Once in they can bring you to a place of safety. They can only do this if they think you have a mental illness and need care.
doctors can keep you on this section for up to 72hrs.

Question 25

when is deprivation of liberty allowed under the MCA?

Answer 25

Your liberty can only be taken away under the Mental Capacity Act if:
you are 16 or over
you lack capacity to make personal care or healthcare decisions
the care home or hospital where you are staying has successfully applied for an authorisation from the local authority
the deprivation of liberty safeguards have been followed
or where the Court of Protection grants permission (the latter required if you are living at home and capacity to be taken away.)

monitored by CQC in England
not able to be applied if pt already detained under the MHA
you do not need to have tment for a mental health problem to be deprived of your liberty

Question 26

what must happen before deprivation of liberty is authorised?

Answer 26

must be 6 assessments:
age
mental health
mental capacity
best interests
eligibility-confirm not detained under MHA
‘no refusals’-ensure doesn’t conflict with any advance decisions or decisions made by a LPA

Question 27

how can a section 3 of the MHA go ahead if a family member refuses?

Answer 27

only if the AMHP applies to the County Court for an
order “displacing” your nearest relative or taking their powers away from them. If the judge agrees to “displace” your nearest relative, the section 3 application can then go ahead.