The Law

Question 1

Define Consent

Answer 1

Ones ability to make decisions

Question 2

Name two ways to gather consent

Answer 2

Implied (does not object to and cooperates with procedure)

Expressed (Explicitly asked for and recorded)

Question 3

Consent is time specific, what does this mean?

Answer 3

Someone may lack capacity at one point in time, but have it at another (eg delirium)

Question 4

Consent is decision specific, what does this mean?

Answer 4

The patient may have the ability to consent for one decision but not another (eg a more complex one)

Question 5

What are the three ways in which treatment could take place without consent?

Answer 5

Mental Capacity Act
Mental Health Act
Authorised by Court

Question 6

What is the Mental Capacity Act of 2005?

Answer 6

Aims to identify people who lack capacity and protect them

Can they understand, retain, weigh up the pros and cons and come to a decision (and communicate it)

Eccentric and Unwise decisions ARE allowed

Question 7

What are the four typical features of those lacking capacity (ie CARD)?

Answer 7

Cognitive Impairment
Abnormal Behaviour
Refusing Treatment
Delirium

Question 8

What is Lasting Power of Attorney?

Answer 8

A person with capacity appoints relative/close friend etc to make future decisions if they lose capacity

Can have one for Property and Affairs, and one for Personal Welfare

Question 9

What is an Advanced Care Plan?

Answer 9

Allows patients to make decisions about their future care

Question 10

What is an Advanced Decision/Directive?

Answer 10

Legal Document

Allows person to refuse treatment but not demand it

Question 11

What is an Advanced Statement?

Answer 11

More general wishes for future care

Not legally binding (unlike Advanced Decisions)

Question 12

What is DoLS?

Answer 12

Deprivation of Liberty Safeguard
Makes sure people living in care homes/hospitals/supported living are looked after in a way that doesn’t inappropriately restrict freedom

Question 13

What is an IMCA?

Answer 13

Appointed to someone who lacks capacity but has no one to speak on their behalf

Question 14

What is the Mental Health Act 2007?

Answer 14

Allows people with mental disorders to be sectioned (detained/treated/admitted) either for their own health and safety or for protection of others

Does not include those under influence of drugs and alcohol

Question 15

What is Section 2?

Answer 15

Admission for assessment and response to treatment

Lasts up to 28d

Question 16

What is Section 3?

Answer 16

Allows prolonged treatment of disorder
Detained for up to 6m
Can be renewed for another 6 months and then is renewed yearly

Question 17

What is required for Section 2 and 3?

Answer 17

The recommendations of two approved clinicians

Question 18

In terms of Section 2 and 3, what are the patient’s rights?

Answer 18

• Can appeal to a tribunal within the first 14 days
• In Section 3 they can appeal every 6 months
• They can apply for discharge at any point
• They’re treated against will for 3 months, then they can be seen by Second Opinion Doctor

Question 19

Section 4 is an example of an emergency section. What is it?

Answer 19

• Used when Section 2 would cause a delay (normally switched to Section 2 on admission)
• No right to appeal
• Lasts 72hrs
• Required one doctor and one AMHP

Question 20

Section 5(2) is an example of an emergency section. What is it?

Answer 20

Urgent detention of inpatients (excluding A and E)

No right to appeal

Question 21

Section 5(4) is an example of an emergency section. What is it?

Answer 21

Urgent detention of a patient already receiving mental health care for up to 6 hours (via registered mental health nurses when doctor cannot attend)

Question 22

Section 135 is an example of an emergency section. What is it?

Answer 22

Allows authorised person/police with magistrates warrant to enter premises and remove person to place of safety

Question 23

Section 136 is an example of an emergency section. What is it?

Answer 23

Allows police officers to remove an individual from a public place

Question 24

What is a Community Treatment Order?

Answer 24

Allows patients on Section 3 who are well enough to leave for treatment in community
Patient can be recalled to hospital if they do not comply

Question 25

What is Section 117?

Answer 25

Details the aftercare of Section 3

Question 26

What are Sections 35-38?

Answer 26

Court sends offenders to Hospital for Psychiatric Assessment

Question 27

What is Section 7?

Answer 27

Power to specify where a person lives, requiring them to have professionals involved

Question 28

What is Section 62?

Answer 28

Urgent treatments such as ECT for life threatening depression

Question 29

What is Forensic Psychiatry?

Answer 29

Deals with the assessment and treatment of mentally disordered offenders

Question 30

What is an Open Ward?

Answer 30

Admission wards in Psychiatric Hospitals

Question 31

What is a Low Secure Ward?

Answer 31

Less physical security than medium, but more than standard open
Transferred here if challenging behaviour

Question 32

What is a Medium Secure Ward?

Answer 32

Locked entrances, unbreakable windows, high nurse to patient ratios, restraint training for staff

Question 33

What is a High Secure Ward?

Answer 33

Those who present immediate and grave danger to general public (due to instability or violence)

Ashworth, Broadmoor, Rampton

Question 34

How could a forensic charge be changed based on Mental State?

Answer 34

Age (less than 10 is in able, between 10 and 14 is incapable unless proven otherwise)
Diminished responsibility if abnormality of mind (Murder converted to Manslaughter)
Automatism (eg during sleep walking)

Question 35

Name four predictors of Violent Behaviour

Answer 35

Male
Young Age
Low Socioeconomic Status
Substance/Alcohol Misuse