Psychiatry and the law Flashcards
Number of professionals required to section under mental health act
1 AMHP
2 registered doctors (i.e. F2 or above), one of which is section 12 approved (i.e. a psychiatrist or similarly trained)
Length of section 2
28 days, non-renewable
Length of section 3
6 months, renewable
Length of section 5(2)
72 hours
Reason to detain under section 5(2)
Detain for mental health reasons only to allow MHA assessment (for section 2/3)
No treatment can be given
What does a section 136 entail
Allows police to detain person from public place for MHA assessment
Length of section 136
36h
Criteria for detention under MHA
- Mental disorder present
- Of nature or degree to require hospital treatment
- Treatment necessary in the interest(s) of patient’s health, safety, or safety of others (any is sufficient, not all) and cannot be provided in the community (refusal w/o trial is allowed)
- Appropriate treatment is available (but not necessarily engaged in)
Which diagnostic code is necessary for MHA detention?
None, no specific diagnosis needs to be made
Can substance misuse be detained under MHA?
Only if causing a mental disorder (e.g.psychosis) but not simply for dependence
What happens if nearest relative requests discharge from section
Threshold is lowered so that only risk to safety of others (not pt’s mental/physical health) is sufficient
What does section 17 grant?
Leave from hospital
What is a community treatment order?
Mandates treatment in the community, if DNA can be recalled under section
How long are you initially allowed to give treatment w/o consent under MHA?
3 months
How can you continue to administer treatment after 3mo of section?
Patient consents (T2 form) or SOAD (T3 form)
What is a T2 form?
Pt consent form for treatment
What is T3 form?
SOAD allows treatment to continue >3mo despite pt refusing consent
What is a section 37?
Person convicted of offence punishable w/ imprisonment + ‘sentenced’ to psychiatric treatment
Minimum age of treatment under MCA
16, with special considerations for 16-17 yo
Minimum age for MHA detention
N/A, there is no defined lower limit
When can MHA be used for treatment of a medical problem?
Only if direct result of psychiatric disorder (e.g. anorexia nervosa refeeding)
Which section for psychiatric admission when no second doctor is available?
Section 4 for 72 hours
Detention for treatment in A&E
MCA/136 only, not 5(2) because requires that they are inpatients
Does section 5(2) apply to outpatients, inpatients, or both?
Inpatients only!
Duration of section 17
Up to 6 months, but must be seen fornightly by clinical team
Scope of section 117
Statutory aftercare that patients on section 3 are entitled to upon discharge
Right of appeal in section 2
Within first 14 days
Right of appeal in section 3
Once per 6 months to MHRT, once per 6 months to hospital managers
Review automatically upon renewal
Duration of CTO
6 months, renewable
Scottish equivalent of section 5(2)
Section 36(1)
Five key principles of the Mental Capacity Act
- Assume capacity until proven otherwise
- Reasonable steps to enable person to make decision with capacity
- Unwise decisions are allowed, it is the prcoess and not the decision that determines capacity
- Decisions in those who lack capacity must be in their best interests
- Least restrictive option must be used
4 abilities defining capacity
- Understand information
- Retain information
- Process/weight up that information
- Communicate decision
2-stage test for determining incapacity
- Person has an impairment/disturbance in the functioning of mind or brain that makes them…
- Lacks one of the 4 abilities for capacity
4-step process of substitute decision making under MCA
- Enable capacity –> time and decision specific
- Identify advance care directives (or refusals)
- Identify if pt has nominated LPA
- Act in patient’s best interests
What are DOLS
Deprivation of liberty safeguards designed to protect human rights of patient’s lacking capacity whose treatment deprives liberty
Which pt groups are most affected by DOLS
Residents of care homes
Dementia
LD/developmental disorders
Following traumatic brain injury
When must DOLS be used?
When care/treatment plan in best interests will deprive pt of liberty, doctors must obtain permission before providing treatment
Legal framework for emergency treatment w/o consent or RC approval
Section 62
RC should add to Section 63 form at earliest opportunity
Psychiatric conditions where DVLA must be informed by patient
Any psychotic disorder (incl psychotic depression)
Bipolar
Alcohol dependence
Psychiatric conditions where the DVLA may need to be informed
If impaired concentration/orientation/judgement:
Agoraphobia
Anxiety
Depression
OCD
Eating disorder
Dementia
PTSD
PD
