Psychiatry and the Law Flashcards
What is valid consent?
-Informed
-Freely given
-Given by a person with Capacity for the decision in question
-Maintained during the period of treatment
CURB: communicate, understand, retain, balance
What is capacity to consent?
An individual (≥16 years) is assumed to have capacity unless it is established that they lack capacity.
-Incapacity means to be incapable of:
=acting; or
=making decisions; or
=communicating decisions; or
=understanding decisions; or
=retaining the memory of decisions
What legal frameworks considers treatment without consent?
-Common law
=Allows for treatment in emergency situations of physical or mental disorders in adults unable to consent
=Best interests of individual
=Necessary to sustain life, prevent serious deterioration or alleviate severe pain or suffering
-Incapacity act
=define incapacity, establish processes and safeguards regulating decision-making on behalf of incapable adults
=allow people who lack capacity to be given treatment for physical disorders and to be accommodated against their will
-Mental health act
=assessment and possible interventions in persons with mental disorder, balance of principles and rights and need to manage individual and community risk
=allow people with significantly impaired decision-making ability to be detained in hospital for assessment and given treatment for mental disorder against their will
-Court
=generally non-urgent but controversial or highly unusual cases
Describe the Adults with Incapacity Act 2000 (Scotland)
-Legal framework used for adults (aged ≥ 16 years) with incapacity
-Advance Directive (=‘advance decision’ in England or ‘living will’)
=Sets out person’s wishes about future healthcare should he or she become incapable of taking decisions about treatment
-Power of Attorney
=Legal document that allows someone (‘Granter’) to choose another person(‘Attorney’) to make decisions on their behalf
=Two types: Welfare (includes personal welfare, residence, and medical decisions), and Financial
-Medical treatment
=Certificate of incapacity authorising treatment issued by medical practitioner
=Must state nature and likely duration of incapacity and proposed treatment
What is mental health legislation?
-Assessment, treatment and rights of people with a mental disorder
-Protects patient and the public, e.g. permits treatment against patient’s wishes when significant risk to self or others
What are the different legal systems within the UK?
-Scotland: Mental Health (Care and Treatment) (Scotland) Act 2003
-England and Wales: Mental Health Act 1983 as amended by the Mental Health Act 2007 (MHA)
-Northern Ireland: Mental Health (Northern Ireland) Order 1986
What is mental health disorder according to the mental health act 2003?
-Mental disorder means any mental illness, personality disorder or learning disability however caused or manifested
-A person is not mentally disordered by reason only of the following:
=sexual orientation
=sexual deviancy
=transsexualism
=transvestism
=alcohol or drug dependence or use
=behaviour that causes, or is likely to cause, harassment, alarm or distress to any other person
=acting as no prudent person would act
Describe an emergency detention certificate
-Emergency admission up to 72 hours
-Consent by mental health officer if practicable, signed by one fully registered medical practitioner
-No appeal, treatment not authorised
-Criteria
=Mental disorder
=Significantly impaired ability to make decisions about treatment
=Significant risk to health, safety or welfare; or safety of others
=Urgent
=Undesirable delay to obtain short term detention certificate
Describe a short-term detention certificate
-Short-term admission for 28 days
-Consent by MHO, signed by approved medical practitioner
-Appeal by Mental Health Tribunal, treatment authorised
-Criteria
=Mental disorder
=Significantly impaired ability to make decisions about treatment
=Requires hospital assessment or treatment
=Significant risk to health, safety or welfare; or safety of others
=Necessary
Describe Nurse’s Holding Power
-To detain pending a medical examination 3 hours
-Signed by registered mental nurse/ learning disability nurse
-Nil consent, appeal, treatment
-Criteria
=Mental disorder
=Necessary for the protection of patient’s health, safety or welfare; or safety of others to restrain from leaving hospital
=Not practical to secure immediate medical examination
=Necessary to carry out a medical examination to determine if an emergency or short term detention certificate is required
Describe compulsory treatment order
-Purpose to treat, 6 months- yearly
-Signed by 2 Drs (1AMP)/ MHO, proposed care plan
-Tribunal consent and appeal, Treatmnet as authorised by tribunal
-Criteria
=Mental disorder
=Significantly impaired ability to make decisions about treatment
=Significant risk to health, safety or welfare; or safety of others
=Available treatments likely to prevent mental disorder from worsening or alleviate symptoms or effects
=CTO is necessary
What is an adult at risk according to the adult support and protection act 2007
-An ‘Adult at Risk’ is an individual over 16 years who is:
=Unable to safeguard their own well being, property, rights or other interests
=At risk of harm (physical, psychological, sexual, financial)
=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
Describe how mental health affects fitness to drive
-Patient’s responsibility to inform Driver and Vehicle Licensing Agency (DVLA) of any condition that may interfere with their driving
-Doctor’s responsibility to advise patient of any such condition
-Patient with condition requiring notification should not drive until they hear back from DVLA and must not drive during an acute illness
Common mental health conditions about which DVLA should be notified and likely licensing outcome
-Depression or anxiety, severe – licence revoked until stable
-Acute psychotic episode – licence revoked till stable with good insight for 3/12
-Hypomania or mania – licence revoked till stable with good insight for 3/12
-Schizophrenia – must not drive during acute illness
-Neurodevelopmental disorders (e.g. ADHD) – May be able to drive but notify DVLA
-Dementia – May be able to drive but notify DVLA
-Learning disability – Mild: may be able to drive but notify DVLA, Moderate – severe: should not drive
-Personality disorders with severe behavioural disturbance –may be able to drive but notify DVLA
-Persistent harmful use or dependence on alcohol / substance use –licence revoked ≥ 6/12 or 1 year free of alcohol / substance use, depending on substance and severity. If multiple substance used, unlikely to be licensed
-Any other condition likely to affect safe driving – case specific, likely a period of stability required
Driving criteria
-Schizophrenia: stable for 3 months
-Severe anxiety or depression: particular danger posed by those who may attempt suicide at the wheel, cannot drive if significant memory or concentration problems, agitation behavioural disturbance or suicidal thoughts. Granted after 3 months of well and stable, treatment adherence, no side effects
-Psychotic disorder and mania: subject to a favourable report from a suitable specialist
