Psychiatry - Mental Health Act Flashcards
Mental Capacity Act
&
Mental Health Act
England & Wales:
- Mental Health Act Care 1983 – amended in 2007
- Regulates the Tx of patients with mental disorder
- Mental Capacity Act 2005 regulates decision-making on behalf of incapable adults
Mental Capacity Act
&
Mental Health Act
Consent to treatment?
- Pts have the right to decide which Tx to have or not to have
- Right retained even if refusal of Tx could result in death / significant deterioration in health
- With use of appropriate laws, Tx can be given without consent
Mental Capacity Act
&
Mental Health Act
Consent to treatment?
- For pts to make an informed decision doctors have a duty to provide sufficient information about Tx
- Provide a balanced and accurate view of diagnosis and prognosis, nature and purpose of the proposed treatment, any alternative treatment options,
- and the likely risks and side-effects, answering any questions honestly and only withholding information if its disclosure would cause the patient serious harm
Forms of consent:
- Implied
- Express
Mental Capacity Act
&
Mental Health Act
Advance Statements?
- Advance statements / advance directive / living will
- Indicating Tx preferences when greater capacity existed e.g. progressive disease
- These wishes should be given due regard provided:
- The decision in the advance statement is clearly applicable to the present circumstances.
- There is no reason to believe that the patient has changed their mind
- Acting against an advanced statement – need to justify this
- No statement available then take into consideration pt’s known wishes using the common law principle of ‘best interests
Mental Capacity Act
&
Mental Health Act
Treatment without consent?
There are four broad areas where treatment may take place despite lack of consent:
- Tx undertaken under common law
- Tx under the provisions of an incapacity act
- Tx under the provisions of a mental health act
- Tx authorised by a court
Mental Capacity Act
&
Mental Health Act
Common Law?
- If criteria for emergency detention under mental health legislation is not fulfilled then common law can be used for Tx in certain situations e.g. sedation for acute behavioural disturbance
- Acting against pt’s wishes so duty of care can be adequately carried out
Mental Capacity Act (MCA) 2005
Principles:
- A person is assumed to have capacity unless otherwise established as lacking
- A person is not to be treated as unable to make a decision unless all practicable steps to help him/her to do so have been taken without success
- A person is not incapable merely because they make an unwise decision
- An intervention under the Act on behalf of a person who lacks capacity must be in their best interests
- Any intervention under the Act on behalf of a person who lacks capacity should restrict as little as possible their basic rights and freedoms
Mental Capacity Act (MCA) 2005
Assessment of Incapacity?
A person lacks capacity if unable to make a decision in relation to any matter because of a permanent or temporary impairment in the functioning of the mind:
A person is unable to make a decision if unable to:
- Understand the information relevant to the decision
- Retain that information for a sufficient period to make a decision
- Use or weigh up information as part of the process of making the decision
- Communicate decision
Mental Capacity Act (MCA) 2005
- Lasting Powers of Attorney (LPA)
- Court Appointed Deputies
- Advance decisions
Bodies with powers under the Act:
- Court of Protection
- The Public Guardian
Mental Health Act (MHA)
- Decisions under the Act should be taken with a view to minimising the harm done by mental disorder an by maximising the safety and health of patients and protecting the public from harm
- Least restrictive intervention
- Respect pt’s needs, values and circumstances and consider their wishes
- Patients, their carers and family members should be involved, as far as is practicable, in planning and developing care
- Decision-makers must seek to use the resources available to them and to patients in the most effective, efficient, and equitable way
Mental Health Act
Definitions?
Approved Doctor:
- Under section 12(2) the Secretary of State may approve a registered medical practitioner as having special experience in the diagnosis and treatment of mental disorder
Responsible clinician:
- The practitioner in charge of the patient’s treatment, (usually a consultant psychiatrist)
Approved Mental Health Professional (AMHP):
- A professional (usually a social worker) who has undergone specific training and assessment for purposes of the Act
Nearest Relative Mental Health Review Tribunal (MHRT)
Mental Health Act Commission (MHAC)
Second Opinion Appointed Doctor (SOAD)
Mental Health Act
Sections?
Compulsory Detention in Hospital
Section 2 – admission for assessment
Section 3 - admission for treatment
Section 4 - emergency admission
Section 5(2) - emergency detention of informal inpatient (up to 72 hours)
Section 5(4) – emergency detention by trained nurses (6 hours)
Section 20(4) –renewal of compulsory detention in hospital
Mental Health Act
Treatment of patients subject to compulsion
- Detained pt (except under emergency provisions) may be given medication for mental disorder for up to 3 months, whether they consent and/or have capacity or not
- Section 58: Over 3 months medication or ECT requires pt’s consent (RC complete form 38), if refuses/lacks capacity agreement of a SOAD required (issues form 39)
- Section 62: Tx urgently necessary – RC without SOAD e.g. ECT to severely ill / at risk pts awaiting SOAD
Mental Health Act
Other Sections
- Section 17 – leave
- Section 17a – supervised community treatment order
- Section 7 - application for guardianship
- Section 117 – aftercare and care programme approach
- Section 136 – police, place of safety, up to 72 hours
- Section 135 –AMHP, place of safety
Mental Health Act
Forensic Psychiatry Sections
- Section 35
- Section 36
- Section 37 (without restrictions)
- Section 38
- Section 37/41 (with restrictions)
- Section 47
- Section 48
Other?
Somatoform disorders:
- Somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition.
- The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Eating disorders
Old age psychiatry
Safeguarding vulnerable adults and children
Types of abuse
