Revision - MHA & MCA Flashcards
Which healthcare professionals must be involved in the MHA assessment?
2x doctors (1 must be section 12 approved)
1x AMHP (approved mental health professional)
What is the role of the AMHP in the MHA?
- Makes the application to the receiving hospital
- Independent and make the final decision
What is the 3 criteria for detention under the MHA?
1) Must be suffering from a MENTAL DISORDER of a nature or degree warranting admission
2) Must be a RISK to their own health and/or own safety and/or the safety of others
3) Must be UNWILLING TO BE ADMITTED voluntarily or LACK THE CAPACITY to make this decision
Do ‘nearest relative’ or ‘next of kin’ have legal rights under the MHA?
Nearest relative
Most of these rights can only be used if you are detained in hospital under the Mental Health Act.
What are the legal rights of a nearest relative under the MHA?
Your nearest relative can ask for a Mental Health Act assessment (this will decide if you should be detained in hospital).
Your nearest relative can apply to discharge you from the Mental Health Act.
The nearest relative does NOT have the right to be told everything about you. This could include information about what treatment you are having.
Give the top 4 ‘nearest relatives’
1) Husband, wife or civil partner
2) Son or daughter
3) Mother or father
4) Brother or sister
If there are 2 people who could be the nearest relative, who is it?
The eldest
Under the MHA, what 3 things can you treat?
1) The cause of the mental disorder e.g. treatment treatment of organic disease (n
e.g. hypothyroid causing depression)
2) The mental disorder e.g. psychotropic medication, ECT
3) Direct consequences of the mental disorder e.g. self-neglect, feeding in eating disorder, overdose, self-injury
What section of the MHA covers admission for ASSESSMENT?
Section 2
How long can you be detained under section 2 MHA?
28 days
Can a section 2 be renewed or extended?
No - but you may be assessed before the end of the 28 days to see if sectioning under section 3 is needed.
What section of the MHA covers admission for TREATMENT?
Section 3
How long can you be detained under section 3 MHA?
Up to 6 months
Can a section 3 be renewedor extended?
Yes
Who must be involved in detaining under section 2 MHA?
2x doctors + 1x AMHP
Who must be involved in detaining under section 3 MHA?
2x doctors + 1x AMHP
Is there a right to appeal being detained under section 3 MHA?
Yes
Twice in first 6 months and then annually.
Is there a right to treat under section 2 MHA?
Yes
Is there a right to treat under section 3 MHA?
Yes
How does section 2 MHA end?
Revoked or detained under section 3
How does section 3 MHA end?
Revoked or renewed
What section of the MHA covers holding powers for informal patients?
Section 5
How does Section 5(2) differ from Section 5(4) MHA?
5(2) –> doctor’s holding power
5(4) –> nurse’s holding power
Who does section 5(2) MHA apply to?
Can apply if you are a voluntary patient or inpatient (including inpatients being treated for a physical problem).
Who does section 5(4) MHA apply to?
Section 5(4) applies if you are a voluntary patient receiving treatment for a mental disorder as an inpatient.
What nurses are able to detain a patient under 5(4) of the MHA?
A nurse specially qualified and trained to work with mental health problems or learning disabilities
How long can you be detained under section 5(2) of the MHA?
Up to 72 hours
How long can you be detained under section 5(4) of the MHA?
Up to 6 hours
Is there a right to treat under section 5(2) of the MHA?
No
Is there a right to treat under section 5(4) of the MHA?
No
Is there a right to appeal under section 5(4) of the MHA?
No
Is there a right to appeal under section 5(2) of the MHA?
No
Can section 5(2) of the MHA be renewed?
No
Can section 5(4) of the MHA be renewed?
No
How does section 5(2) of the MHA end?
Triggers MHA assessment.
How does section 5(4) of the MHA end?
Needs 5(2) assessment
What section of the MHA involves police sections?
Section 135/136
How long can you be detained under section 136 MHA?
Up to 24 hours
Who can detain the patient under section 136 MHA?
Police
Is there a right to treat under section 136 MHA?
No
Is there a right to appeal under section 136 MHA?
No
Can section 136 MHA be renewed?
No but can be extended for up to 12 hours
How does section 136 MHA end?
Triggers MHA assessment
How does section 135 differ from 136 MHA?
135 –> Magistrate warrant to move a person from a private dwelling to a place of safety
136:
- Allow police to detain those who appear to be suffering from a mental disorder
- Only applies in public places
What are the 5 principals of the MCA?
1) A person is ASSUMED to have capacity
2) All practicable steps must be taken to enable decision making
3) People are able to make UNWISE decisions
4) Decisions made on behalf of someone lacking capacity must be in their BEST INTEREST
5) Decisions made on behalf of someone lacking capacity must be LEAST restrictive
What does an advance decision/directive involve?
This is a document that states which TREATMENTS you want to REFUSE in the future.
This is legally binding and must be witnessed.
How are advance decisions and the MHA interlinked?
If you’re detained under the Mental Health Act and receiving treatment for your mental health problem, then advance decisions are NOT followed.
BUT this doesn’t include electroconvulsive therapy (ECT) i.e. you can make an advance decision to refuse ECT.
What does an advance statement involve?
An advance statement is a general preference about your treatment and care.
Takes into account:
- Wishes
- Values
- Beliefs
- Feelings
It is NOT legally binding but HCPs should make a practical effort to follow your wishes.
What is the Deprivation of Liberty Safeguards (DoLS)?
This procedure is designed to protect your rights if the care or treatment you receive in a hospital or care home means you are, or may become, deprived of your liberty, and you lack mental capacity to consent to those arrangements.
How long does an emergency DoLS last?
7 days
How long does a standard DoLS last?
1 year
What 2 people must be involved in a DoLS assessment?
1) Best interests assessor
2) Mental health assessor
Does a DoLS give a right to treatment?
NO –> If treatment’s required then we must assess capacity and, if they lack capacity, provide treatment in their best interests
Can a DoLS be renewed?
No - must reapply
Where does a DoLS apply?
Only applies in care settings
Valid in one setting
Who is specifically EXCLUDED from detainment under the Mental Health Act?
Anyone under the influence of drugs and/or alcohol
Which section of the MHA covers the INFORMAL admission of patients?
I.e. Patients can be admitted for care and treatment without formal restrictions, and they are free to leave at any time?
Section 131
To be admitted under section 131, patients must meet which 3 criteria?
1) Patient must have CAPACITY
2) Patient must CONSENT to the admission
3) Patient must NOT RESIST the admission
What 2 sections of the MHA cover INVOLUNTARY admission?
Section 2 & 3
Section 2 vs section 3 of the MHA?
Section 2 –> used for compulsory detention for ASSESSMENT
Section 3 –> used for compulsory detention for TREATMENT
Who can the application for admission under a section 2 be MADE by?
Who must it be SUPPORTED by?
Can be made by AMHP or the nearest relative.
Must be supported by 2 doctors (one must be approved section 12).
What 3 sections of the MHA cover EMERGENCY situations?
Section 4
Section 5(2)
Section 5(4)
What is a key difference between section 2 and section 3 regarding nearest relatives?
In section 3, the nearest relative can oppose the application for admittance and/or request it is rescinded (unlike section 2).
What is section 4 of the MHA used for?
Where is it primarily used?
Admission for ASSESSMENT in cases of emergency.
Primarily used in OUTPATIENT services where it is not possible to wait for a section 2 to be arranged e.g. GP.
How long does a section 4 allow a patient to be detained for?
Max 72h
after which it is often changed to a section 2
What is a section 135?
A court order that allows police officers to enter PRIVATE property, by force, to remove a person suffering from a mental health disorder and place them in a place of safety.
How long does a section 135 last?
The patient can be detained under this court order for up to 24 hours (although this can be extended by 12 hours).
What is a section 136?
Allows police officers to detain someone suspected of suffering from a mental health disorder, from a PUBLIC PLACE to a place of safety without a warrant.
Describe section 17a
Under section 17a, patients who are on a section 3 can leave hospital for treatment in the community if they are well enough.
The patient can be recalled to hospital if there is non-compliance with treatment or they do not attend appointments.
What section of the MHA covers community treatment orders?
Section 17a