Risk and legal frameworks Flashcards
What is the mental health act? (created 1983- amended 2007)
when might you use it?
legal frameworks for detaining and treating patients w psychiatric illness
used when patients are unwilling or lack capacity to consent
3 Criteria for you to implement the MHA
what are 2 notable exclusions
- mental ldisorder of a nature or degree which makes it appropriate for them to receive treatment in hopsital
- risk to others or self
- appropriate treatment msut be available
All three must be applicable at the same time
- dependance on drug or alcohol
- learning disabilities
SECTION 136
- what is section 136 of the MHA?
- what are the 3 requirements for it?
- what are they supposed to do once they’ve enacted it?
- How long can you be detained under this section for?
- Is a warrant required?
- Gives police emergency powers
- if they think you have a mental disorder
- you’re in a public space (e.g. A and E)
- You need immediate help
- Take u to a safe space (e.g., hospital, police station, relative’s home) where your mental health will be assessed by a psychiatrist or an AMHP (approved mental health professional)
- Should only last 24 hours but can be extended by 12 hours
- Warrent not required
How does section 135 differ from 136?
- section 135 means that police can enact this if you’re in a private space (therefore allows them to access private address without permission including necessary property damage)
- requires a warrant
What is a Community Section 4 Emergency Detention?
What are the requirements for this?
Who can make the application for this?
How long does detention last for?
Is it renewable?
- Emergency application for admission when only one doctor is available at short notice(they should know the patient/ have seen them within the previous 24 hrs).
- This should be rarely used if possible
Must meet the conditions of other sections in addition to:
- Greater level of urgency needed to admit to hospital
- Finding another doctor would cause an ‘undesirable delay’
Application can be made by an AMHP or nearest relative
Detention lasts for up to 72 hours
Not renewable but can be converted to section 2
Section 5
What scenario would you use this?
What is section 5(4)? How long can you hold someone?
What is section 5(2)? How long can you hold someone? What must be produced afterwards?
Used to detain a patient whgo is already in hospital
Section 5(4)- nurses’ holding power. Must be trained MH or LD nurse. If no doctor is available and can only be done in a psychiatric hospital. You can hold someone for up to 6 hours and this cannot be extended.
Section 5(2)- doctor’s holding power. Only usable by a fully registered doctor (FY2 and above). Can hold a patient for up to 72 hours this cannot be renewed or extended. If previously on a 5(4) then the 72 hours starts from when the 5(4) started. Written report must be sent to manager
Section 2
What is it for?
What does it allow doctors to determine?
How long can this last? Can it be renewed?
Who must recommend it?
Can u give treatment against their will?
Admission for assessment (=/- treatment)
Provides the time for doctors to determine:
- Type of mental disorder
- Whether treatment is required
- What treatment this will be and the likely impact on overall health
Patient kept for up to 28 days- cannot be renewed
Requires recommendation from 2 Dr.s and 1 AMHP
- 1 doctor must have seen the patient within 14 days
- 1 doctor must be section 12 approved
- AMHP is usually a social worker
Treatment can be given against a patient’s will on this section- assuming the criteria for the treatment is met
Section 3
- What is it for
- who carries it out
- how long can it last
- how long can they be treated without consent
- Admission for treatment
- carried out by 2 doctors and 1 AMHP (like section 2)
- lasts for 6 months/// renewd for another 6 and then up to a year at a time
- can be treated without consent for 3 months- after this requires a ‘2nd opinion appointed Dr. (SOAD)’
Which 2 sections are involved in a patient leaving hospital following detention?
Sections 17 and 117
Section 17
Allows patient detained under the MHA to leave the hospital temporarily
used as a stepping stone between recovery and discharge
Section 117
Aftercare
patients detained in hospitals under certain sections are entitled to help in the community following discharge
may include healthcare, social care abd supported accomodation
Community treatment order
What is it?
What conditions must be met to ensure the patients continued wellbeing?
Supervised treatment in the community (often used after someone has been discharged following MHA detainment)\
Conditions:
- failure to meet these conditions may result in readmission to hospital
- patient’s clinician must keep the patient in hospital for up to 72 hours before deciding what to do next
- full mHA assessment is not required if the patient is put back on section 3 (i.e. CTO is converted to 53)
CTOs may be challenged by patients/ NRs if believed to be inappropriate
What are the 5 principles of the mental capacity act?
- Every patient has the right to make his or her decisions and must be assumed to have capacity to so unless proven otherwise
- People must be supported as much as possible to make their own decisions before anyone concludes that they cannot do so
- People have the right to make what others might regard as unwise or eccentric decisions
- Anything done for on behalf of a person who lacks mental capacity must be done in their best interests
- Anything done for, or on behalf of people without capacity should be the least restrictive of their basic human rights and freedoms
How do you assess capacity?
The functional test of capacity (Step 1)
Determine if they have an impairment or distrubance in the functioning of the person’s mind or brain (doesn’t matter if this is permanent or temporary)
Are they able to make a decision? (Step 2)
Does the impariment/ disturbance make them unable to make the particular decisions? This can be proven if they can’t:
Understand the information relevant for making the decision
Retain that info long enough to make the decision
Use or weigh that info as part of the process for making the decision (contentious)
Communicate their decision (whether by using sign language, pictures, symbols, makaton or any other means)
When should capacity be assessed?
Must be done decision specific:
- the assessment of capacity must be done about a particular decision that has to be done at a particular time
- if someone cannot make complex decisions that does not mean that they cannot make simple ones
- decisions about capacity must not be based on a person’s age, appearance, condition or behaviour alone
