Psychiatry and the law

Question 1

Number of professionals required to section under mental health act

Answer 1

1 AMHP

2 registered doctors (i.e. F2 or above), one of which is section 12 approved (i.e. a psychiatrist or similarly trained)

Question 2

Length of section 2

Answer 2

28 days, non-renewable

Question 3

Length of section 3

Answer 3

6 months, renewable

Question 4

Length of section 5(2)

Answer 4

72 hours

Question 5

Reason to detain under section 5(2)

Answer 5

Detain for mental health reasons only to allow MHA assessment (for section 2/3)

No treatment can be given

Question 6

What does a section 136 entail

Answer 6

Allows police to detain person from public place for MHA assessment

Question 7

Length of section 136

Answer 7

36h

Question 8

Criteria for detention under MHA

Answer 8

1. Mental disorder present
2. Of nature or degree to require hospital treatment
3. 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)
4. Appropriate treatment is available (but not necessarily engaged in)

Question 9

Which diagnostic code is necessary for MHA detention?

Answer 9

None, no specific diagnosis needs to be made

Question 10

Can substance misuse be detained under MHA?

Answer 10

Only if causing a mental disorder (e.g.psychosis) but not simply for dependence

Question 11

What happens if nearest relative requests discharge from section

Answer 11

Threshold is lowered so that only risk to safety of others (not pt’s mental/physical health) is sufficient

Question 12

What does section 17 grant?

Answer 12

Leave from hospital

Question 13

What is a community treatment order?

Answer 13

Mandates treatment in the community, if DNA can be recalled under section

Question 14

How long are you initially allowed to give treatment w/o consent under MHA?

Answer 14

3 months

Question 15

How can you continue to administer treatment after 3mo of section?

Answer 15

Patient consents (T2 form) or SOAD (T3 form)

Question 16

What is a T2 form?

Answer 16

Pt consent form for treatment

Question 17

What is T3 form?

Answer 17

SOAD allows treatment to continue >3mo despite pt refusing consent

Question 18

What is a section 37?

Answer 18

Person convicted of offence punishable w/ imprisonment + ‘sentenced’ to psychiatric treatment

Question 19

Minimum age of treatment under MCA

Answer 19

16, with special considerations for 16-17 yo

Question 20

Minimum age for MHA detention

Answer 20

N/A, there is no defined lower limit

Question 21

When can MHA be used for treatment of a medical problem?

Answer 21

Only if direct result of psychiatric disorder (e.g. anorexia nervosa refeeding)

Question 22

Which section for psychiatric admission when no second doctor is available?

Answer 22

Section 4 for 72 hours

Question 23

Detention for treatment in A&E

Answer 23

MCA/136 only, not 5(2) because requires that they are inpatients

Question 24

Does section 5(2) apply to outpatients, inpatients, or both?

Answer 24

Inpatients only!

Question 25

Duration of section 17

Answer 25

Up to 6 months, but must be seen fornightly by clinical team

Question 26

Scope of section 117

Answer 26

Statutory aftercare that patients on section 3 are entitled to upon discharge

Question 27

Right of appeal in section 2

Answer 27

Within first 14 days

Question 28

Right of appeal in section 3

Answer 28

Once per 6 months to MHRT, once per 6 months to hospital managers

Review automatically upon renewal

Question 29

Duration of CTO

Answer 29

6 months, renewable

Question 30

Scottish equivalent of section 5(2)

Answer 30

Section 36(1)

Question 31

Five key principles of the Mental Capacity Act

Answer 31

1. Assume capacity until proven otherwise
2. Reasonable steps to enable person to make decision with capacity
3. Unwise decisions are allowed, it is the prcoess and not the decision that determines capacity
4. Decisions in those who lack capacity must be in their best interests
5. Least restrictive option must be used

Question 32

4 abilities defining capacity

Answer 32

1. Understand information
2. Retain information
3. Process/weight up that information
4. Communicate decision

Question 33

2-stage test for determining incapacity

Answer 33

1. Person has an impairment/disturbance in the functioning of mind or brain that makes them…
2. Lacks one of the 4 abilities for capacity

Question 34

4-step process of substitute decision making under MCA

Answer 34

1. Enable capacity –> time and decision specific
2. Identify advance care directives (or refusals)
3. Identify if pt has nominated LPA
4. Act in patient’s best interests

Question 35

What are DOLS

Answer 35

Deprivation of liberty safeguards designed to protect human rights of patient’s lacking capacity whose treatment deprives liberty

Question 36

Which pt groups are most affected by DOLS

Answer 36

Residents of care homes

Dementia

LD/developmental disorders

Following traumatic brain injury

Question 37

When must DOLS be used?

Answer 37

When care/treatment plan in best interests will deprive pt of liberty, doctors must obtain permission before providing treatment

Question 38

Legal framework for emergency treatment w/o consent or RC approval

Answer 38

Section 62

RC should add to Section 63 form at earliest opportunity

Question 39

Psychiatric conditions where DVLA must be informed by patient

Answer 39

Any psychotic disorder (incl psychotic depression)

Bipolar

Alcohol dependence

Question 40

Psychiatric conditions where the DVLA may need to be informed

Answer 40

If impaired concentration/orientation/judgement:

Agoraphobia

Anxiety

Depression

OCD

Eating disorder

Dementia

PTSD

PD