MHA & MCA Flashcards
Which HCPs must be involved in the MHA assessment?
Two doctors and one AMHP (approved mental health professional)
What is the Mental Health Act?
The Mental Health Act 1983 applies if you have a mental health problem (e.g. depression, bipolar). It sets out your rights if you’re sectioned under this Act.
What is the role of the two doctors in the MHA? What must/should they be?
- Make recommendations that the person be detained
- Each must determine if the person meets the criteria in their OWN opinion
One MUST be Section 12 approved
One SHOULD have prior knowledge of the patient
What is ‘Section 12 approved’?
Section 12 approved doctors are those approved by the Secretary of State under section 12(2) Mental Health Act 1983 (MHA), where they are described ‘as having special experience in the diagnosis or treatment of mental disorder’.
What is the role of the AMHP in the MHA?
- Makes the application to the receiving hospital
- Independent and make the final decision
What is the 3 criteria for detention under the MHA?
- Must be suffering from a MENTAL DISORDER of a nature or degree warranting admission
- Must be a RISK to their own health and/or own safety and/or the safety of others
- Must be UNWILLING TO BE ADMITTED voluntarily or LACK THE CAPACITY to make this decision
Is a diagnosis of a learning disability sufficient for detention under the MHA in its own right?
NO
Their presentation must be associated with abnormally aggressive or seriously irresponsible conduct
Nearest relative vs next of kin?
Your next of kin can be anyone you want. This would usually be a relative or close friend. You can’t choose your nearest relative.
Do ‘nearest relative’ or ‘next of kin’ have legal rights under the MHA?
Nearest relative
Most of these rights can only be used if you are detained in hospital under the Mental Health Act.
What are the legal rights of a nearest relative under the MHA?
Your nearest relative can ask for a Mental Health Act assessment (this will decide if you should be detained in hospital).
Your nearest relative can apply to discharge you from the Mental Health Act.
The nearest relative does NOT have the right to be told everything about you. This could include information about what treatment you are having.
What is an AMHP?
An AMHP is a mental health professional who is trained to use the Mental Health Act.
Give the top 8 ‘nearest relatives’
- Husband, wife or civil partner
- Son or daughter
- Father or mother
- Brother or sister
- Grandparent
- Grandchild
- Uncle or aunt
- Niece or nephew
If there are 2 people who could be the nearest relative, who is it?
The eldest
Under the MHA, what 3 things can you treat?
- The cause of the mental disorder e.g. treatment treatment of organic disease (n
e.g. hypothyroid causing depression) - The mental disorder e.g. psychotropic medication, ECT
- Direct consequences of the mental disorder e.g. self-neglect, feeding in eating disorder, overdose, self-injury
What section of the MHA covers admission for ASSESSMENT?
Section 2
A brief overview of section 2 of the MHA:
You can be detained under section 2 if:
- you have a mental disorder
- you need to be detained for a short time for assessment and possibly medical treatment, AND
- it is necessary for your own health or safety or for the protection of other people.
How long can you be detained under section 2 MHA?
Up to 28 days.
The section can’t normally be extended or renewed. But you may be assessed before the end of the 28 days to see if sectioning under section 3 is needed.
What section of the MHA covers admission for TREATMENT?
Section 3
Brief overview of section 3 MHA:
- you have a mental disorder
- you need to be detained for your own health or safety or for the protection of other people, AND
- treatment can’t be given unless you are detained in hospital.
You cannot be sectioned under this section unless the doctors also agree that appropriate treatment is available for you
How long can you be detained under section 3 MHA?
Up to 6 months.
The section can be renewed or extended by your responsible clinician.
Who must be involved in detaining under section 2 MHA?
2 doctors + 1 AMHP
Who must be involved in detaining under section 3 MHA?
2 doctors + 1 AMHP
Is there a right to appeal being detained under section 2 MHA?
Yes - within first 14 days
Is there a right to appeal being detained under section 3 MHA?
Yes - twice in first 6 months then annually
Is there a right to treat under section 2 MHA?
Yes
Is there a right to treat under section 3 MHA?
Yes
How does section 2 MHA end?
Revoked or detained under S3
How does section 3 MHA end?
Revoked or renewed
What section of the MHA covers holding powers for informal patients?
5
How does Section 5(2) differ from Section 5(4) MHA?
Section 5(2) –> Doctor’s holding power
Section 5(4) –> Nurse’s holding power
Who does section 5(2) MHA apply to?
Can apply if you are a voluntary patient or inpatient (including inpatients being treated for a physical problem).
Who does section 5(4) MHA apply to?
Section 5(4) applies if you are a voluntary patient receiving treatment for a mental disorder as an inpatient.
What nurses are able to detain a patient under 5(4) of the MHA?
A nurse specially qualified and trained to work with mental health problems or learning disabilities
How long can you be detained under section 5(2) of the MHA?
Up to 72 hours
How long can you be detained under section 5(4) of the MHA?
Up to 6 hours
Is there a right to treat under section 5(2) of the MHA?
No
Is there a right to treat under section 5(4) of the MHA?
No
Is there a right to appeal under section 5(4) of the MHA?
No
Is there a right to appeal under section 5(2) of the MHA?
No
Can section 5(2) of the MHA be renewed?
No
Can section 5(4) of the MHA be renewed?
No
How does section 5(2) of the MHA end?
Trriggers MHA assessmen
How does section 5(4) of the MHA end?
Need 5(2) assessment
What section of the MHA involves police sections?
Section 135/136
How long can you be detained under section 136 MHA?
Up to 24 hours
Who can detain the patient under section 136 MHA?
Police
Is there a right to treat under section 136 MHA?
No
Is there a right to appeal under section 136 MHA?
No
Can section 136 MHA be renewed?
No BUT can be extended by 12 hours
How does section 136 MHA end?
Triggers MHA assessment
How does section 135 differ from 136 MHA?
135 –> Magistrate warrant to move a person from a private dwelling to a place of safety
136:
- Allow police to detain those who appear to be suffering from a mental disorder
- Only applies in public places
Note that the MCA is:
Time specific AND decision specific
What are the 5 principals of the MCA?
- A person is ASSUMED to have capacity
- All practicable steps must be taken to enable decision making
- People are able to make UNWISE decisions
- Decisions made on behalf of someone lacking capacity must be in their BEST INTEREST
- Decisions made on behalf of someone lacking capacity must be LEAST restrictive
Describe the 2 stages of the capacity assessment of the MCA
- Diagnostic test –> Does the person have an impairment or disturbance in the functioning of the mind or brain?
- Functional test:
- Understand information relevant to the decision
- Retain that information
- Weigh up that information to make a decision
- Communicate their decision
What is a lasting power of attorney (LPA)?
A power of attorney is a legal document that allows someone to make decisions for you, or act on your behalf, if you’re no longer able to or if you no longer want to make your own decisions.
There are 2 types of LPA:
1) health and welfare
2) property and financial affairs
What are advance statements and advance decisions/directives?
An advance statement and advance decision are documents to say how you would like to be treated in the future if you can’t decide for yourself.
Advance statements and advance decisions are similar but there are differences.
You can only make an advanced statement or advance decision if you HAVE MENTAL CAPACITY.
What does an advance decision/directive involve?
An advanced decision is a document to state which TREATMENTS you want to REFUSE in the future.
This is legally binding and must be witnessed.
How are advance decisions and the MHA interlinked?
If you’re detained under the Mental Health Act and receiving treatment for your mental health problem, then advance decisions are NOT followed.
BUT this doesn’t include electroconvulsive therapy (ECT) i.e. you can make an advance decision to refuse ECT.
What does an advance statement involve?
An advance statement is a general preference about your treatment and care.
Takes into account:
- Wishes
- Values
- Beliefs
- Feelings
It is NOT legally binding but HCPs should make a practical effort to follow your wishes.
E.g. You can use an advance statement to say who you would like to manage your affairs, such as paying bills or looking after children.
What is an Independent Mental Capacity Advocate (IMCA)? When would it be used?
An Independent Mental Capacity Advocate (IMCA) is an advocate appointed to act on your behalf if you lack capacity to make certain decisions.
These are people who have been specially trained to support people who are not able to make certain decisions for themselves and do not have family or friends who are able to speak for them.
Will you be given an IMCA if you have a LPA?
No
What is the Deprivation of Liberty Safeguards (DoLS)?
This procedure is designed to protect your rights if the care or treatment you receive in a hospital or care home means you are, or may become, deprived of your liberty, and you lack mental capacity to consent to those arrangements.
What conditions must be met to allow the person to be deprived of their liberty under the safeguards (DoLS)?
- Person aged 18 or over
- Suffering from mental disorder (recognised by MHA)
- Lacks capacity
- MHA wouldn’t be more appropriate
- Restrictions are in their best interest
- Is in a care home or hospital (i.e. only in care settings)
- The restrictions would deprive the person of their liberty
- Best interests
How long does an emergency DoLS last?
7 days
How long does a standard DoLS last?
1 year
What 2 people must be involved in a DoLS assessment?
- Best interests assessor
- Mental health assessor
How can a DoLS be challenged?
- Request a review
- Appeal to the Court of Protection
Does a DoLS give a right to treatment?
NO –> If treatment’s required then we must assess capacity and, if they lack capacity, provide treatment in their best interests
Can a DoLS be renewed?
No - must reapply
Where does a DoLS apply?
- Only applies in care settings
- Valid in one setting
MHA vs MCA?
MHA –> Mental disorder or disability of the mind
MCA –> Impairment or disturbance in the functioning of the mind or brain
Common law, MCA, or MHA:
Unconscious twenty year old brought to ED after a car crash, requiring life saving treatment
Common law
Common law, MCA, or MHA:
Lady with schizoaffective refusing treatment and suffering with hallucinations and suicidal ideation
- Assessment
- Is there a physical cause?
MHA
Common law, MCA, or MHA:
21 year old man with 1st episode psychosis, severe neglect and refusing support
MHA
(can then treat direct cosequences i.e. neglect of mental disorder i.e. psychosis)
Common law, MCA, or MHA:
25 year old lady with abdo pain, alcohol XS, no MH history, new onset hallucinations, wants to leave the ward as feels unsafe
MCA
Common law, MCA, or MHA:
80 year old lady with PR bleeding (possible cancer) needing a scope but refuses as she believes she is already dead inside
MCA
As PR bleeding is a physical problem that needs assessment/treatment
Common law, MCA, or MHA:
Mute patient is post-op minor-surgery and refuses to stay onward for monitoring as says risks are only minor
Do a capacity assessment but if she has capacity then she can go
Who is specifically EXCLUDED from detainment under the Mental Health Act?
Anyone under the influence of drugs and/or alcohol
What are some examples of individuals involved in the application of the MHA? (4)
1) Section 12 doctor
2) Approved mental health professional (AMHP)
3) Responsible clinician
4) Nearest relative (i.e. first relative in the MHA list)
What is a section 12 doctor?
A registered medical practitioner who is approved to give one of the medical recommendations required for the compulsory admission of a patient to hospital under the MHA.
Which section of the MHA covers the INFORMAL admission of patients?
I.e. Patients can be admitted for care and treatment without formal restrictions, and they are free to leave at any time?
Section 131
To be admitted under section 131, patients must meet which 3 criteria?
1) Patient must have CAPACITY
2) Patient must CONSENT to the admission
3) Patient must NOT RESIST the admission
What 2 sections of the MHA cover INVOLUNTARY admission?
Section 2 & Section 3
Section 2 vs section 3 of the MHA?
Section 2 –> used for compulsory detention for ASSESSMENT
Section 3 –> used for compulsory detention for TREATMENT
A person can be detained under section 2 only if both of which 2 criteria apply?
1) The person suffers from a mental disorder that warrants detention in hospital for assessment for at least a limited period.
2) The person ought to be detained in the interests of their own health or safety or the protection of others.
What is the maximum period of time that a person can be detained for assessment under section 2 of the MHA?
28 days
Can section 2 of the MHA be renewed?
No
Who can the application for admission under a section 2 be MADE by?
Who must it be SUPPORTED by?
Can be made by AMHP or the nearest relative.
Must be supported by 2 doctors (one must be approved section 12).
A person can be detained under section 3 only if all of which 3 criteria apply?
1) The person suffers from a mental disorder of a nature or degree that makes it appropriate for them to receive treatment in hospital.
2) It is necessary for the health or safety of the person or the protection of others, that the person should receive treatment which cannot otherwise be provided unless the patient is detained.
3) Appropriate medical treatment is available for them.
What is the max period a person can be detained under section 3?
6 months
Can a section 3 be renewed?
Yes
Who can the application for admission under a section 3 be MADE by?
Who must it be SUPPORTED by?
Can be made by an AMHP or the nearest relative.
Must be supported by 2 doctors (one must be section 12 approved). BOTH doctors must have seen pt in last 24h.
What 3 sections of the MHA cover EMERGENCY situations?
Section 4
Section 5(2)
Section 5(4)
What is a key difference between section 2 and section 3 regarding nearest relatives?
In section 3, the nearest relative can oppose the application for admittance and/or request it is rescinded (unlike section 2).
What is section 4 of the MHA used for?
Where is it primarily used?
Admission for ASSESSMENT in cases of emergency.
Primarily used in OUTPATIENT services where it is not possible to wait for a section 2 to be arranged.
Who can the application for admission under a section 4 be MADE by?
Who must it be SUPPORTED by?
Can be made by an AMHP or nearest relative.
Only requires the support of ONE doctor.
How long does a section 4 allow a patient to be detained for?
Max 72h
after which it is often changed to a section 2
What is a section 5(2)?
An emergency order where an INPATIENT who is a voluntary patient in hospital can be detained for up to 72h for MHA assessment.
Who can apply for a section 5(2)?
Only ONE doctor (usually the one in charge of the patient’s care) is required
how long does a section 5(2) last?
72h
What is a section 5(4)?
Similar to a section 5(2), but a patient can be detained by a NURSE for up to 6 hours to allow FURTHER ASSESSMENT by medical staff.
How long does a section 5(4) last?
Up to 6 hours
When can a section 5(4) application be made by a nurse? (2)
1) The patient is suffering from a mental disorder to such a degree that it is necessary for their health or safety or the protection of others, that they are immediately restrained from leaving hospital.
2) It is not feasible or practical for a clinician to be immediately available to detain the patient under Section 5(2).
What 2 sections of the MHA cover POLICE powers?
Section 135
Section 136
What is a section 135?
A court order that allows police officers to enter PRIVATE property, by force, to remove a person suffering from a mental health disorder and place them in a place of safety.
How long does a section 135 last?
The patient can be detained under this court order for up to 24 hours (although this can be extended by 12 hours).
What is a section 136?
Allows police officers to detain someone suspected of suffering from a mental health disorder, from a PUBLIC PLACE to a place of safety without a warrant.
How long does a section 136 last?
Up to 24h, to allow them to be assessed by a medical practitioner.
What section of the MHA covers community treatment orders?
Section 17a
Describe section 17a
Under section 17a, patients who are on a section 3 can leave hospital for treatment in the community if they are well enough.
The patient can be recalled to hospital if there is non-compliance with treatment or they do not attend appointments.
