Psychiatry and the Law

Question 1

Mental Health Act 1973/2007

Answer 1

Ensures essential treatment for patients with mental
disorders who do not recognise they are ill or need treatment
o Safety of patient, safety of others, and preventing deterioration which would lead to
endangerment as condition progresses

Question 2

Mental Disorder

Answer 2

Defined as Disorder or Disability of the Mind; ETOH or substance
abuse is not considered to be a mental disorder under MHA

Question 3

Approved Mental Health Professional

Answer 3

Mental Health Professional who has undergo specific

training; Applications for patients for MHA

Question 4

Section 12 Approved Doctor

Answer 4

Typically Consultant or Senior Registrar; Doctor with

appropriate training and approval to certify under MHA

Question 5

Section 2

2 Drs, ≥S12A

Answer 5

Assessment Order allowing Detention 28 days;

Either converted to Section 3 or discharged after; Non-renewable

Question 6

Section 3

2 Drs, ≥S12A

Answer 6

Treatment Order allowing Detention and Treatment 6 months
Renewable for another 6 months, then yearly
There must be appropriate medical treatment available for this condition;
Definitive Treatment and Management Plan prior to application

Question 7

Section 4

1 Dr

Answer 7

Emergency Admission for patients not already in hospital for 72h
Application for Section 2 will cause dangerous delay
Converted to Section 2 upon admission

Question 8

Section 5(2)
1 Dr

Answer 8

Detention of patients already in hospital, but not in ED, 72h
Allows time to discussion with Psychiatry for Section 2

Question 9

Section 5(4)
AMHP

Answer 9

Detention of patients already in hospital, but not in ED, 6h

Allows time to discussion with Psychiatry for Section 2

Question 10

Section 136

Answer 10

Police Officers to remove person believed to be suffering from mental disorder
from public place, to place of safety (Psychiatric Ward/Hospital, Designated
room in Police Station, or ED);
Assessment by AMHP or Dr; Converted to Sections 2 or 3

Question 11

Safeguarding Patients

Answer 11

• Ensures that patients are not wrongly detained or kept under MHA longer than necessary
• All patents under Section 2 or 3 referred to Mental Health Review Tribunal at least by 6
months from initial Section application, if patient hasn’t already applied themselves
o Patient can ask for a hearing at any time
o Panel Comprises Legal Member (E.g. Experienced Lawyer), Doctor (Independent
Psychiatrist who has examined patient prior) and Lay Member (Majority have
practical experience working in Social or Mental Health)
o Involves Patient, Nearest Relative and members of clinical treatment team

Question 12

Advocacy

Answer 12

Ensures patients do not face discrimination or unfairness
o Advocate – Independent person who expresses patient views and defend rights; Duty
of Local Authorities to provide independent advocate for patients detained
involuntarily; Explanation, Completing Paperwork or Rights Advocacy etc

Question 13

Section 3

Answer 13

Medications given for up to 3 months of detention, after which either patient has
to consent, or independent doctor to confirm treatment is in patient’s best interests

Question 14

ECT

Answer 14

Not given to refusing patient with capacity, and many only given to incapacitated
patient if it does not conflict with ADRT, Nearest Relative, or Court Decision
o Life-threatening – Responsible clinician can authorise up to 2 treatments for patients
detained under Section 3

Question 15

Consent for Treatment under MHA 2007: Physical Disorder

Answer 15

Not permitted to treat without consent, even under Section 3 with few
exceptions; Enforced Refeeding in Severe Anorexia, or Physical Sequelae of Attempted
Suicide which is the direct result of underlying mental disorder
• NB: Patients with Comorbid physical conditions without Capacity treated under MCA 2005

Question 16

MENTAL CAPACITY ACT 2005

Answer 16

Provides means to Assess Capacity, and if lacking, how to care for them and Make Decisions
in their Best Interests; Applies to ≥16yrs; if <16yrs, Consent given by parents

Question 17

Capacity

Answer 17

General Understanding of Decision and why they have to make it, General
Understanding of Consequences of making/not making decision, Able to Understand, Retain,
Use and Weigh Up Information Presented, and able to Communicate Decision to others

Question 18

Approaching Capacity

Answer 18

Adults are assumed to have capacity unless established that they have capacity; Not treated
as lacking capacity until all practicable steps taken to help establish capacity; Unwise
decisions can be made with capacity; Treatment without capacity must be in patient’s Best
Interests, and least restrictive to Basic Rights and Freedoms

Question 19

Lacking Capacity

Answer 19

Impairment of Mind or Brain, or Disturbance of Mental Function

Question 20

FORENSIC PSYCHIATRY

Answer 20

Management of Individuals who have broken the law (Mentally Disordered Offenders) and
Individuals with Mental Disorders who are or may be violent

Question 21

Risk Factors for Crime (In General)

Answer 21

Male, Low IQ, Younger Age, Genetics, Ethnicity,
Hyperactivity/Impulsivity, Teenage Parentage and other Upbringing Issues, Low SES, Peer
Influences, Urban Environment, Unemployment, Substance Abuse

Question 22

Actus Rea (Guilty Act)

Answer 22

External/Objective Element of the crime; Action (or lack of)

Question 23

Meas Rea (Guilty Mind)

Answer 23

Mental Element of Person’s Intention to commit crime, or

knowledge that Action (or lack of) will cause crime to be committed

Question 24

Defence of Insanity

Answer 24

Defence must prove Defendant had disease of the mind at the time of
offense, that led to defect of Reason; Supposition that Defendant did not know what he was
doing was wrong at the time

Question 25

Diminished Responsibility –

Answer 25

Only for charge of Homicide; Convince Jury that Due to

Underlying Mental Illness, not fully to blame for crime; Reduction of Charge of Murder to Manslaughter Conviction

Question 26

Mental Disorders and Crime

Answer 26

• Few Psychiatric Patients break the law; Typically, minor offences
• Violent behaviour – 2% prevalence in general population; 7% in Major Mental Illness; 20% if
Substance Abuse Disorder; History of Violent Behaviour is greatest predictor

Question 27

Mental Disorders and Crime: Risk Factors

Answer 27

Psychotic Disorders (Esp if Paranoia, Command Hallucinations, Passivity
Phenomena), Puerperal Psychosis, Delusional Disorders (Esp Jealousy), Severe Depression
(Arson and Infanticide), DS/P/EUPD (16×), Poor insight and Impulse control

Question 28

TREATMENT OF MENTALLY DISORDERED OFFENDERS

Answer 28

Assessment of Offenders with Mental Disorders, and Advisement to the Police regarding
whether to proceed with charges against Mentally Disordered Offenders, Assessment of
Responsibility (E.g. Defence of Insanity, Diminished Responsibility)
Treatment tends to occur in Prison, Secure Psychiatric Hospital, or Community
o Assessment and Treatment of Patients in Prisons, Reports for Parole Boards

Question 29

Fitness to Plead

Answer 29

Able to Understand Nature of Charge, Able to Understand Plea, Instruct
Lawyers and Challenge Jurors, and Follow Evidence in Court
o If Unfit to Plead – Not tried, Detained in Hospital until fit to plead
• Same principles of treatment as any other patient; May require more secure environment;

Question 30

Secure Psychiatric Hospitals

Answer 30

– Where there is continuing risk to other people (Aggression,
Arson, Sexual Offences etc); Specific parts of MHA 2007 regulations
o Patients who pose Grave Imminent Danger to the Public; Most patients are
rehabilitated sufficiently to return back to the community

Question 31

Section 37

Answer 31

Treatment Order similar to Section 3, Mentally Disordered Offenders
convicted of Serious Crime, sentenced to Imprisonment; If discharged from Section
37, transferred to Conventional Prison rather than Home

Question 32

Section 41

Answer 32

Extremely High Risk to others; Further restrictions on top of Section 37;
Only Home Secretary

Question 33

Section 47

Answer 33

– Transfer from Prison to Psychiatric Hospital for Treatment

Question 34

Community Treatment

Answer 34

– Aims to Manage Acute Psychiatric Disturbance, and Rehabilitate
back to Community; Typically follows completion of any mandatory sentence
o Living Situation, Employment, Hobbies, Financial Assistance, Reintegration with
Family (Which plays vital role)
o Crucial to reduce the risk of re-offending