Sectioning

Question 1

WHat is a section 2? how long? Where to send patients appeals and before when?
How to make the application?

Answer 1

Admission for assessment. Lasts for 28d. Must be signed by 2 doctors and an AMHP. One of the doctors must be section 12 approved. Cannot be renewed and patients can appeal.

Question 2

What is a section 3? requirements? application?

Answer 2

Admission for treatment for up to 6 months. Exact mental disorder must be stated. Allows treatment to be given for mental illness for the first 3 months. For the following 3 months, the patient must consent to treatment or a third opinion must be obtained. Must be signed by two doctors and an AMHP. One of these doctors must be Section 12 approved. Patients can appeal.

Question 3

What is a section 4? how long does it last? requirements? when to use? What happens when in hospital?

Answer 3

allows a patient’s urgent admission to hospital for assessment of a suspected mental disorder
72hrs
admission to hospital must be an urgent necessity
application of an AMHP or a patient’s Nearest Relative and just one doctor, who must be s12 approved
Once the patient is admitted, a second medical recommendation ‘turns’ a section 4 admission into a section 2.
May be used if admission under section 2 would cause undesirable delay (admission
must follow the recommendation rapidly)

Question 4

what is a section 5(2)? how long does it last? Who to apply to? What department does it not apply to?

Answer 4

Emergency holding power for current inpatients used to prevent patients leaving hospital.

• Can be signed by the patient’s responsible consultant or their nominated deputy.
• Lasts up to 72hrs - Allows for sufficient time for a section 2 or 3 to take place.
• Cannot treat against patients will.
• CAN ONLY APPLY IF YOU HAVE FULL MEDICAL REGISTRATION i.e. FY2 or above.
• Cannot be applied to any outpatients or patients in the emergency department (as they are technically not inpatients).
• To apply a Section 5(2), you must complete Form H1 (after examining the patient yourself).

Question 5

What is a section 5(4)? how long does it last?

Answer 5

Nurses’ holding powers - Emergency holding power for inpatients. Lasts for 72hrs. Can be signed by a registered mental health nurse. Cannot treat against the patients will.

Question 6

What is a section 136? How long does it last? Where should patient be taken?

Answer 6

Used by the police to bring people who are believed to be mentally unwell from a public place to a ‘place of safety’. Duration = up to 24 hours, with an option to extend for a further 12 hours. Does not allow treatment against the patient’s will.

They can’t use this section when you are at home. Or if you are in someone else’s home.

Question 7

What is a section 135? Who must accompany police?

Answer 7

Section 135 is used by police and healthcare professionals to go into your home. Even if you don’t want them to. They will do this if they are worried about your mental health.
The police can keep you or take you to a ‘place of safety’.

It is used when professionals believe that a person has a mental illness and:
you are in a private place such as your home
you are not able to care for yourself
you are being treated badly by someone
you are being neglected by your carer
Or:
you are in a private place
you were detained in hospital or other accommodation under the Mental Health Act but you have left without permission.

Duration = up to 24 hours, with an option to extend for a further 12 hours.

Question 8

What is an informal admission?

Answer 8

someone who has agreed to come into hospital for assessment and treatment of a mental health condition or someone who was detained under the MHA but the section has ended and they have remained on the ward

Question 9

What are the deprivation of liberty safeguards? Aim?

Answer 9

Provides a person with a representative (a person who is given certain rights and who should look out for and monitor the person receiving care)

allow a challenge in the Court of Protection against ‘false imprisonment.’

give a right for deprivation of liberty to be reviewed regularly

The aim of DoLS is to make sure that people who lack capacity are looked after in a way that does not inappropriately restrict their freedom.

Question 10

What is section 117?

Answer 10

Aftercare
requires provision of after-care for patients who have been detained on the
‘long sections’ (3, 37, 47, or 48).

stipulates that
no patient should be discharged without planned aftercare: the systematic assessment
of health and social needs, an agreed care plan, the allocation of a
keyworker, and regular reviews of progress

Question 11

What does the planned aftercare involve in section 117?

Answer 11

the systematic assessment
of health and social needs, an agreed care plan, the allocation of a
keyworker, and regular reviews of progress

Question 12

Which are the long sections?

Answer 12

3, 37, 47, 48

Question 13

Define capacity?

Answer 13

Capacity entails being able to grasp and retain information relevant to a decision,
and to weigh it as part of a process of making that decision

Question 14

Which sections does consent to treatment not apply for?

Answer 14

sections 4, 5, 35, 135 and 136

Question 15

What does Deprivation of liberty involve?

Answer 15

The person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements
Continuous supervision and control: Monitoring and watching patients, decide activities, control things such as meals, leisure times and bedtimes.
Not free to leave: If they attempt to leave they would be stopped
The person lacks capacity to consent:

Question 16

To have capacity to make a decision, what must a person be able to do?

Answer 16

understand the information about the decision
retain that information long enough to be able to make a decision
weigh up the information available and understand the consequences of the decision
communicate the decision (by any means possible eg. blinking)

Question 17

What does the MCA 2005 aim to do? What terms are under the Mental Capacity Act (2005)?

Answer 17

Empowers people to make decisions for themselves where possible and protect people who lack capacity by providing a flexible framework that puts the individual at the heart of decision making process

Lasting Power of Attorney (LPA)
Deputies appointed by the Court of Protection
Public Guardian
Advance Decisions to refuse treatment
Independent Mental Capacity Advocate (IMCA
Independent Mental Health Advocate (IMHA)
Deprivation of Liberty Safeguard (DOLS)

Question 18

Principles of MCA 2005?

Answer 18

1. Presumption of capacity
2. Individuals being supported to make their own decisions
3. Unwise decisions - People have the right to make decisions that others might regard as unwise or eccentric.
4. . Best interests - Anything done for or on behalf of a person who lacks mental capacity must be done in their best interests.
5. Less restrictive option

Question 19

MCA 2005 two stage capacity test?

Answer 19

o Stage 1 – There is an impairment or disturbed functioning of the mind
o Stage 2 – the patient is unable to make a decision. Decision-making is impaired if the patient is unable to:
 understand the relevant information
 retain it for long enough to make a decision
 weigh up the information
 communicate their decision.

Question 20

Define Lasting power of attorney?

Answer 20

A legal document that lets you (the ‘donor’) appoint one or more people (known as ‘attorneys’) to help you make decisions or to make decisions on your behalf. This gives you more control over what happens to you if you have an accident or an illness and cannot make your own decisions (you ‘lack mental capacity’).

Question 21

Define Deputies appointed by the Court of Protection?

Answer 21

A person appointed by the court of protection who is authorised to make decisions on on the behalf of a person who lacks mental capacity

Question 22

Define public guardian

Answer 22

The role of the Public Guardian is to protect people who lack capacity from abuse.

Question 23

How does a public guardian help protect people who lack capacity?

Answer 23

• Setting up and managing a register of Lasting Powers of Attorney (LPA);
• Setting up and managing a register of Enduring Powers of Attorney (EPA);
• Setting up and managing a register of court orders that appoint Deputies
• Instructing Court of Protection Visitors to visit people who may lack mental capacity to make particular decisions and those who have formal powers to act on their behalf such as Deputies;
• Receiving reports from Attorneys acting under LPAs and from Deputies; and
• Providing reports to the COP, as requested, and dealing with cases where there are concerns raised about the way in which Attorneys or Deputies are carrying out their duties.

Question 24

Define Advance Decisions to refuse treatment

Answer 24

Advance Decisions to refuse treatment
- enables someone aged 18 and over, while still capable, to refuse specified medical treatment for a time in the future when they may lack the capacity to consent to or refuse that treatment

Question 25

Define Independent Mental Capacity Advocate (IMCA) ?

Answer 25

an advocate appointed to act on the behalf people who lack the capacity to make certain decisions. It is for people who do not have a close family member or a person who cares for you to support you.

Question 26

Define Independent Mental Health Advocate (IMHA)

Answer 26

An advocate whose role is to help service users to obtain and understand their rights under the Mental Health Act, the parts of the Mental Health Act which apply directly to them, the medical treatment they are receiving or might receive in future - and the reasons for that treatment and the rights that other people have in relation to them under the Mental Health Act.

Question 27

Service users under the IMHA?

Answer 27

Patients detained under the Mental Health Act (except for individuals under sections 4, 5(2), 5(4), 135 and 136), Conditionally discharged restricted patients, Patients subject to guardianship, Patients subject to supervised community treatment orders

Question 28

Define sectional? Define Mental disorder?

Answer 28

Sectioned = admitted to hospital, detained and treated without their consent either for their own health and safety or for the protection of other people.
Mental disorder = Any disorder or disability of the mind – except for people with learning disabilities (unless the disability is associated with abnormally aggressive or seriously irresponsible conduct)

Question 29

Purpose of DNACPR?

Answer 29

to provide immediate guidance to those who are looking after an individual (in healthcare/social care settings) on the best action to take or not to take should a patient suffer a cardiac arrest or die suddenly.

Question 30

Describe ageism in healthcare

Answer 30

• Failure to afford older people sufficient respect, choice and control
• The attitudes towards, language about and labelling of older people (eg. Written off as ‘acopic’ or ‘bed blocking’)
• Some services and system rules are skewed in favour of the young, with far worse access and quality for older people in services like mental health and psychological therapies
• The receiving of less attention and treatment for conditions that largely affect older people eg. dementia, osteoarthritis, osteoporosis or incontinence; compared to those equally common in mid-life.