Therapy and counselling, mood stabilisers, mental health law Flashcards

Question

What are the features of psychodynamic therapy?

Answer 1

Freud’s original model focused on therapy as a process of uncovering past trauma to resolve present day symptoms (originally ‘hysterical’ symptoms, such as dissociative paralysis) Modern day psychoanalytic approaches are still founded on Freud’s theory but the focus is more broadly on making connections between past and present Helping the person to become more aware of the unconscious processes which are giving rise to symptoms or to difficult repeating patterns Helping the person construct a narrative of their life and give meaning to symptoms

Answer 2

The therapeutic relationship with the therapist is seen as part of the focus of the work, with the idea that patterns of relating to others in everyday life will come up in therapy, where they are worked on safely In the NHS psychodynamic therapy typically takes around a year (may be longer) and involves weekly sessions NICE Guidelines – Depression in young people and adults

Answer 3

Dissociative disorders, somatoform disorders, psychosexual disorders, certain personality disorders, chronic dysthymia, recurrent depression

Answer 4

It is based upon the idea that childhood experiences, past unresolved conflicts and previous relationships significantly influence an individual’s current situation. It is based on psychoanalytic principles

Answer 5

The unconscious is explored using free association (the client says whatever comes to their mind) and the therapist then interprets these statements. Conflicts and defence mechanisms 220 (e.g. denial, projection) are explored and the client subsequently develops insight in order to change their maladaptive behaviour. There is much emphasis on the relationship between the therapist and patient. Therapies can be offered on an individual, couples, group or residential community basis. Key therapeutic tools: 1. Transference: The patient re-experiences the strong emotions from early important relationships, in their relationship with the therapist. When the current emotions are positive it is said to be positive transference and vice versa for negative emotions. 2. Counter-transference: The therapist is affected by powerful emotions felt by the patient during therapy and reflects what the patient is feeling.

Answer 6

Psychoanalysis is an intense therapy that usually involves between one and five 50-minute sessions per week, possibly for a number of years. This is a much longer duration than in CBT.

Answer 7

Psychoeducation (PE) is the delivery of information to people in order to help them understand and cope with their mental illness. It is usual to inform the patient of: 1) the name and nature of their illness; 2) likely causes of the illness, in their particular case; 3) what the health services can do to help them; and 4) what they can do to help themselves (self-help). PE may take place individually or in groups, and will usually take the person’s own strengths and coping strategies into account.

Answer 8

Counselling is a form of relieving distress and is undertaken by means of active dialogue between the counsellor and the client. It is less technically complicated than other forms of psychotherapy and can range from sympathetic listening to active advice on problem solving

Answer 9

Adjustment disorder; mild depressive illness; normal and pathological grief; childhood sexual abuse; other forms of trauma (e.g. rape, postnatal depression, pregnancy loss and stillbirth); substance misuse; chronic medical conditions; and prior to decision making, e.g. genetic testing or HIV testing.

Answer 10

Behaviour and emotional life are shaped by previous experience, the current environment, and the relationships that individuals have. People have the tendency towards positive change and fulfilment which can be halted by ‘life problems’. A collaborative relationship with a counsellor is one method of addressing these issues

Answer 11

To help the client or patient find their own solutions to problems, while being supported to do so and being guided by appropriate advice.

Answer 12

Is used to describe the psychological support given by mental health professionals to patients with chronic and disabling mental illnesses. It does not aim to produce change, but rather to help people cope with adversity or unsolved problems over a sustained period. Key elements include active listening, providing reassurance, providing explanation of the patient’s illness, providing guidance and possible solutions to difficulties they are faced with, as well as enabling the patient to express themselves in a safe environment.

Answer 13

Consists of a structured combination of counselling and CBT. It facilitates individuals to learn to deal actively with their life problems by selecting an option for tackling each one, trialling out solutions and reviewing their effect. Indications are mild anxiety and depressive disorders.

Answer 14

IPT is used to treat depression and eating disorders. The focus is on an interpersonal problem such as a complicated bereavement, relationship difficulties or interpersonal deficit, adopting techniques from different psychotherapies. The therapy focuses on the difficulties that arise in relationships and the impact on the individual. It has some overlap with CBT and psychodynamic therapy and deals with four interpersonal problems (grief at the loss of relationships, role disputes within relationships, managing changes in relationships and interpersonal deficits) which may be causing difficulty in initiating or maintaining relationships.

Answer 15

EMDR is a psychotherapy treatment that aims to help patients access and process traumatic memories with the goal of emotionally resolving them. It is an effective treatment for PTSD. It involves the client recalling emotionally traumatic material while focusing on an external stimulus. The stimulus usually involves the therapist directing the patient’s lateral eye movements by asking them to look one way and then another or follow their finger.

Answer 16

Adverse life events PE, counselling, relaxation training. Depression PE, counselling, CBT, psychodynamic therapy, IPT, behavioural activation. PTSD PE, CBT (trauma focused), EMDR. Schizophrenia PE, CBT, family therapy. Eating disorders PE, CBT, IPT, family therapy, CAT. Anxiety disorders PE, CBT, behavioural therapies. Substance misuse PE, CBT, motivational interviewing, group therapy. Borderline personality disorder PE, DBT, psychodynamic therapy, CAT.

Answer 17

NICE guidance – Psychosis, Depression, Perinatal difficulties, substance use, eating disorders Family attend together. Interactions are observed by other therapists to help therapists and family reflect. Works with a family’s strengths to help family members think about (and try) different ways of behaving with each other.

Answer 18

DBT is used for individuals with borderline PD. The therapy adopts components of CBT and also provides group skills training to provide the individual with alternative coping strategies (rather than deliberate self-harm) when faced with emotional instability

Answer 19

NICE Guidelines – Borderline Personality disorder, Self-harm & Suicidality Emotion dysregulation, interpersonal difficulties, repeat self-harm / impulsivity Intensive therapy 1-hour individual therapy weekly 2 hours group skills training weekly 12-18 months total Learn and apply skills to understand and regulate emotions, manage interpersonal difficulties and tolerate distress.

Answer 20

‘Dialectics’ means trying to balance seemingly contradictory positions Balancing acceptance (yourself and your experiences as you are) and change (making positive changes in your life)

Answer 21

Combines cognitive theories and psychoanalytic approaches into an integrated therapy. It is based on various areas of analysis including analysing problems and difficulties, how they began and how they affect everyday life as well as analysing the reasons behind symptoms. Can be used for a range of psychiatric problems such as eating and personality disorders.

Answer 22

Mood stabilizers are drugs that are used to prevent depression and mania in bipolar affective disorder and schizoaffective disorder.

Answer 23

Lithium Topiramate Gabapentin

Answer 24

Stop antidepressant > Is patient taking antimanic medication > No: Consider antipsychotic or mood stabiliser - consider short term benzodiazepine for all patients Yes: If taking antipsycho check compliance and dose or add mood stabiliser - if taking mood stabiliser only check levels and consider antipsychotic - consider short term benzo

Answer 25

First-line prophylaxis in bipolar affective disorder. Also effective in an acute manic episode (if an atypical antipsychotic is ineffective) and as an adjunctive treatment for depression (to prevent antidepressant-induced hypomania).

Answer 26

Lithium is an element in the body that is handled in a similar way to sodium. There is some evidence that bipolar patients have an ↑ intracellular concentration of sodium and calcium, and that lithium can ↓ these. With lithium, a decreased activity of sodium-dependent intracellular secondary messenger systems has been shown, as well as modulation of dopamine and serotonin neurotransmitter pathways, ↓ activity of protein kinase C and ↓ turnover of arachidonic acid. Lithium may also have neuroprotective effects mediated through its effects on N-methyl-D-aspartate (NMDA).

Answer 27

GI & LITHIUM Leucocytosis, Impaired renal function, Tremor (fine)/Teratogenic, Thirst (polydipsia), Hypothyroidism/Hair loss, Increased weight and fluid retention, Urine ↑ (polyuria), Metallic taste. In toxicity (‘TOXIC’): Tremor (coarse), Oliguric renal failure, AtaXia, Increased reflexes, Convulsions/Coma/Consciousness

Answer 28

Avoid in renal failure, pregnancy (teratogenic) and breast feeding. Caution with QT prolongation (including concomitant use of drugs that ↑ QT interval), epilepsy (↓ seizure threshold), diuretic therapy. Lithium is contraindicated in untreated hypothyroidism, Addison’s disease and Brugada syndrome (heart disease with ↑ risk of sudden cardiac death).

Answer 29

Before lithium treatment is started U&Es and eGFR (lithium has renal excretion and is nephrotoxic), TFTs, pregnancy status and baseline ECG should be checked. Drug levels should be closely monitored and patients should be informed of potential side effects and toxicity. Lithium levels should be monitored 12 hours following the first dose, then weekly until therapeutic level (0.4–1.0 mmol/L) has been stable for 4 weeks. Once stable check every 3 months. U&Es should be checked every 6 months. TFTs should be checked every 12 months.

Answer 30

Usually given as lithium carbonate. Must be given for at least 18 months for clear benefit. Starting dose 400 mg at night. Titrate dose (400–1200 mg/day) to keep plasma levels between 0.5 and 1.0 mmol/L.

Answer 31

Check lithium levels (12 hours post dose), at least every three months and during any intercurrent illness (can ↑ causing toxicity). At each consultation, ask about any signs of toxicity or signs of hypothyroidism. Check thyroid function, U&Es, calcium and creatinine every 6–12 months. Inform patients: of potential toxicity and symptoms of this; the need for contraceptives in women of child bearing age; the need for regular fluid intake; the need for compliance in taking medication; of the dangers of crash diets; to avoid NSAIDs; not to exceed more than 1–2 units of alcohol per day; that it takes 3–6 months to be established on lithium, and that lithium cards are available from pharmacists.

Answer 32

Prescribe if you are not a specialist. Give lithium to women of child bearing age. Lithium is teratogenic and can cause congenital heart defects. Give in severe renal failure. Prescribe NSAIDs, diuretics (particularly thiazides) or ACE inhibitors without careful thought. Prescribe lithium if you feel that adherence to treatment will be a problem. Withdraw lithium abruptly. Abrupt withdrawal (either because of poor compliance or rapid change in dose) can precipitate relapse. Withdraw lithium slowly over several weeks, monitoring for signs of relapse

Answer 33

Lithium toxicity is a medical emergency which can lead to seizures, coma and death. Lithium toxicity is enhanced by the 4 D’s: Dehydration, Drugs (ACE inhibitors, NSAIDs), Diuretics (thiazide), Depletion of sodium. If signs of toxicity are identified, lithium should be stopped immediately. A high intake of fluid should be provided including intravenous sodium chloride therapy, to stimulate osmo tic diuresis. In the most severe cases, renal dialysis may be needed.

Answer 34

Comparable efficacy to lithium as a mood stabilizer. If lithium (and an atypical antipsychotic) is ineffective or unsuitable in acute mania. Used in combination with lithium for rapid cycling bipolar affective disorder

Answer 35

Valproate is a simple branched-chain fatty acid. It is thought to inhibit the catabolism of GABA, ↓ turnover of arachidonic acid and activate extracellular signal-regulated kinase. This alters synaptic plasticity, interferes with intracellular signalling, promotes brain-derived neurotrophic factor (BDNF) expression and ↓ levels of protein kinase C.

Answer 36

GI and VALPROATE GI disturbances, Very fat (↑ weight), Aggression, LFTs ↑, Platelets low (thrombocytopenia), Reversible hair loss (in 10%), Oedema (peripheral), Ataxia, Tremor/Tiredness/Teratogenic, Emesis.

Answer 37

Avoid in pregnancy (can cause neural tube defects in the fetus and result in spina bifida), hepatic dysfunction and porphyria.

Answer 38

FBC (to check platelets) before therapy and before any surgery. Monitor LFTs and prothrombin time (PT) before therapy and during first 6 months. Pregnancy test and weight/BMI before commencing. Check LFTs, FBC and weight again after 6 months then annually.

Answer 39

Dose started at 250–500 mg daily, and subsequently titrated upwards. Oral. IV only used for epilepsy.

Answer 40

Mania (not first-line), prophylaxis of bipolar affective disorder unresponsive to lithium. Alcohol withdrawal.

Answer 41

Carbamazepine blocks voltage-dependent sodium channels, and therefore inhibits repetitive neuronal firing. It ↓ glutamate release and ↓ turnover of dopamine and noradrenaline.

Answer 42

GI disturbances, dermatitis, dizziness, hyponatraemia, blood disorders e.g. leucopenia, thrombocytopenia.

Answer 43

Caution in cardiac disease and blood disorders. Contraindicated in AV conduction abnormalities and acute porphyria. Avoid in pregnancy (can cause neural tube defects in the fetus). NOTE: Is a potent enzyme inducer so drugs such as COCPs will be metabolized faster. If the COCP is being used as a contraceptive, other methods should be considered.

Answer 44

Check WCC after a week. Measure plasma carbamazepine levels if signs of toxicity. LFTs and U&Es (hyponatraemia). Baseline measure of weight is desirable

Answer 45

Start at 400 mg daily in divided doses. Build up (max 1.6 g/day). Oral.

Answer 46

Used to treat bipolar depression. It is less teratogenic than the other mood stabilizers and therefore usually the drug of choice in women of child bearing age. Lamotrigine does not treat or prevent manic episodes.

Answer 47

Lamotrigine is thought to work by inhibition of sodium and calcium channels in presynaptic neurons and subsequent stabilization of the neuronal membrane.

Answer 48

GI disturbances, rash (in around 5% of patients), headache and tremor

Answer 49

A combination of lamotrigine and carbamazepine may cause neurotoxicity

Answer 50

LFTs, FBC and U&Es prior to starting. Do not routinely measure plasma lamotrigine levels unless there is evidence of ineffectiveness, poor adherence or toxicity. NOTE: Inform patients to see doctor if signs of hypersensitivity e.g. severe rash, fever, lymphadenopathy (antiepileptic hypersensitivity syndrome)

Answer 51

Must be initiated very gradually beginning at 25 mg daily. NOTE: Avoid abrupt withdrawal (unless serious Stevens–Johnson rash). Oral.

Answer 52

for treatment to be given to the patient, consent should be gained, i.e. the patient has a right to decide for themselves which treatment to undergo and which treatments to refuse.

Answer 53

one’s ability to make decisions. Capacity can involve consent about personal welfare, healthcare and financial decisions.

Answer 54

Person may lack capacity at one point in time but may have capacity at another point in time. If the lack of capacity is likely to be temporary, e.g. delirium, it may be possible to delay the decision until the person has recovered.

Answer 55

May have capacity to consent for one decision but not for another (e.g. may have capacity to consent for a simple endoscopy but not for a more complex surgical procedure which poses greater risks, such as a hemicolectomy).

Answer 56

1. Treatment under the Mental Capacity Act. 2. Treatment under the Mental Health Act. 3. Treatment authorized by a court.

Answer 57

Common law is the law based on previous court rulings, which differ from laws that are created by acts of parliament such as the Mental Health Act and the Mental Capacity Act.

Answer 58

A person may lack capacity to make a decision for a variety of reasons, e.g. dementia, delirium, intellectual disability, neurological disorder. The Mental Capacity Act (MCA) aims to identify those people who may lack capacity to consent to or refuse treatment (see OSCE tips 1 and Fig. 12.7.1) and to protect them. The MCA applies to England and Wales only and failures to comply with the Act are potentially criminal offences.

Answer 59

Look at page 252 of susmit das book

Answer 60

CARD Cognitive impairment, e.g. dementia. Abnormal behaviour. Refusing treatment. Delirium.

Answer 61

1. Best Interests: Decisions made on behalf of the patient must be in their best interests. 2. Help to make decisions: People must be given all appropriate help before anyone concludes that they cannot make their own decisions, e.g. use of interpreters and multiple times (as capacity may fluctuate). 3. Eccentric or unwise decisions are allowed: Capacity is determined by the way in which a decision is made and not the decision itself. Therefore, it does not matter how unwise the decision is. 4. Least restrictive intervention: Decisions made on the patient’s behalf should be the least restrictive option. 5. Presumption of capacity: Capacity is assumed to be present until proven otherwise

Answer 62

This allows a person with capacity to appoint an attorney (usually a relative or close friend) to make future decisions on their behalf if they lose capacity. There are two types of lasting power of attorney: 1. Property and affairs deals with property and financial affairs. 2. Personal welfare deals with decisions about healthcare, living conditions and location.

Answer 63

process that allows patients to make decisions about their future care. It takes the form of making an advance statement or an advance decision to refuse treatment, or appointing a lasting power of attorney.

Answer 64

legal document with a specific refusal of treatment in a predefined future situation (where the person would have lost capacity) that is signed by the patient and witnessed. Advance decisions permit a person to refuse treatment but not demand it. They do not allow patients to refuse basic care needs such as food and drink by mouth or basic hygiene. Persons writing an advance decision should have capacity at the point of writing it advance decision only concerns refusing certain treatments. An advance statement can also be used to express other wishes and preferences not directly related to care, e.g. stating food preferences. Advance statements are not legally binding like advance decisions

Answer 65

(made verbally or written) allows the patients to make general statements about their wishes and preferences for the future, if they were to lose capacity.

Answer 66

The aim of DoLS is to make sure that people in care homes, hospitals and supported living, who lack capacity, are looked after in a way that does not inappropriately restrict their freedom. When a hospital or care home identifies that a person who lacks capacity is being, or risks being deprived of their liberty, they must apply for an authorization of deprivation of liberty

Answer 67

An IMCA is someone appointed to support a person who lacks capacity but has no one to speak on their behalf (i.e. no next of kin or lasting power of attorney). The IMCA makes representations about the person’s wishes, feelings, beliefs and values, while bringing to the attention of the decision maker all factors that are relevant to the decision.

Answer 68

The Mental Health Act (MHA) (1983, amended in 2007) is the law in England and Wales that allows people with a ‘mental disorder’ (see Key facts 2 for definition) to be sectioned, i.e. admitted to hospital, detained and treated without their consent – either for their own health and safety, or for the protection of other people. This is used for individuals who will not consent to be admitted voluntarily, or who lack capacity to consent to admission and treatment. Patients who are only under the influence of alcohol or drugs are specifically excluded.

Answer 69

Page 255 Susmit Das book

Answer 70

MHAC: Mental Health Act Commission (MHA is supervised by this commission). AMHP: Approved mental health professional (they make an application for the patient to be sectioned. They may be social workers, nurses, psychologists or OTs, but not doctors). AC: Approved clinician (almost always doctors but can be other professionals. If they are section 12, it means they are approved by the Secretary of State as having expertise in the assessment and treatment of mental disorders as described in Section 12 of the MHA). NR: Nearest relative. CTO: Community treatment order

Answer 71

A mental disorder is defined as any disorder or disability of the mind. It includes mental illness, personality disorder, learning disability and disorders of sexual preference (e.g. paedophilia), but NOT dependence on alcohol or drugs.

Answer 72

Revise Our Mental Health Act Refusal of voluntary treatment. Other options have been considered but are not appropriate. Mental disorder: The behaviour must be the result of a known or suspected mental disorder. Harm (risk of): The person must be at significant risk of self-harm, self-neglect or harm to others. Appropriate treatment: There must be an appropriate treatment option available to the patient.

Answer 73

Purpose: Section 2 (s2) allows for an admission, for assessment and response to treatment. It lasts up to 28 days. The purpose of section 3 (s3) is for the treatment of a mental disorder. Patients can be detained under s3 if they are well known to mental health services or following an admission under s2. For s3, patients can be detained for up to 6 months, but may be discharged before this. Detention under s3 can be renewed for a further 6 months. After that, detention can be renewed for further periods of one year at a time. Recommendations: For s2 and 3, an AMHP or rarely the NR makes the application on the

Answer 74

A patient under s2 can appeal against the section to a tribunal during the first 14 days and to hospital managers at any time. For s3, patients have the right to appeal against detention to a tribunal (only one time) during the first 6 months of detention. If the s3 is renewed, an appeal can be made once during the second 6 months. Then an appeal can be made once during each one-year period. Patients have the right to apply for discharge to the Mental Health Act managers at any time whilst they are detained and an Independent Mental Health Advocate can be sought to raise any issues patients have with their care and treatment. Under s2 and s3, patients can’t refuse treatment. Under s3, patients can be treated against their will for 3 months, but after this time they are seen by a second opinion appointed doctor (SOAD) if they lack capacity to consent or are refusing treatment. A SOAD carries out an assessment to see if they think that the treatment is needed. Some treatments can’t be given without consent unless certain criteria are met. These treatments include ECT.

Answer 75

Free aftercare is provided for patients when discharged from s3. This is known as section 117 aftercare.

Answer 76

Section 4 Section 5(2) Section 5(4) Section 135 Section 136 All last up to 72 hours apart from section 5(4) which is up to 6 hours

Answer 77

Used as an emergency, when s2 would involve an unacceptable delay. Often changed to a section 2 upon arrival at hospital. It can be done by one doctor with an AMHP or nearest relative (NR). There is no right to appeal.

Answer 78

Is the urgent detention of inpatients on any ward excluding A&E, by an AC. Patients on s5(2) must then be assessed for s2 or s3 or discharge from s5(2) to become an informal patient. There is no right to appeal.

Answer 79

Allows urgent detention for up to 6 hours of an inpatient already receiving treatment for a mental disorder in hospital. It is carried out by a registered mental health nurse when a doctor is unable to attend immediately. There is no right to appeal.

Answer 80

Allows a police officer or authorized person with a magistrate’s warrant to enter a person’s premises, who is suspected of suffering from a mental disorder, and remove them to a place of safety.

Answer 81

Allows a police officer to remove an individual, who appears to suffer from a mental disorder, from a public place to a place of safety for assessment.

Answer 82

A community treatment order (CTO) allows patients on s3 who are well enough, to leave the hospital for treatment in the community. The decision is made by the responsible clinician (RC) with the agreement of the AMHP. The patient can be recalled to hospital if they do not comply with treatment or attend appointments. Once recalled they may be detained for up to 72 hours for assessment.

Answer 83

Section 117: Deals with aftercare responsibilities after a patient has been detained under s3. Sections 35–38: Used by a court to send offenders to hospital for psychiatric assessment. Section 7 (guardianship): Gives power to specify where the patient lives and requires them to give professionals involved in their care, access to their home. Sections 58 and 59: Deal with treatments requiring consent or second opinion and consent and second opinion, respectively. Section 62: Concerns urgent treatments such as ECT for life-threatening depression.

Answer 84

Admission for assessment – not renewable. Assessment An AMHP or rarely the NR makes the application on the recommendation of two doctors. One of the doctors should be ‘approved’ under Section 12 of the MHA (usually a consultant psychiatrist). 28 days Duration: 28 days Renewal: No Purpose: Assessment +/- treatment (with or without consent) Professionals involved: 2 doctors (one S12 approved), 1 AMHP Evidence required: The patient is suffering from a mental disorder that is… Of a nature or degree that warrants detention in hospital for assessment; and The patient ought to be detained for his or her own health or safety, or the protection of others Tribunal: Yes

Answer 85

Admission for treatment – renewable. Treatment Same as section 2. 6 month Duration: 6 months Renewal: Yes, each renewal then lasts 12 months Purpose: Treatment Professionals involved: 2 doctors (one S12 approved); 1 AMHP; Nearest Relative Evidence required: The patient is suffering from mental disorder that is… of a nature or degree which makes it appropriate for the patient to receive medical treatment in a hospital; and The treatment is in the interests of his or her health and safety and the protection of others; and Appropriate treatment must be available for the patient Tribunal: Yes; also, more significant role of Nearest Relative

Answer 86

Used as an emergency, when a section 2 would involve an unacceptable delay. Often changed to a section 2 upon arrival at hospital. Emergency GP and AMHP or NR. 72 hours Duration: 72 hrs Purposes: Admission for assessment when there is an “urgent necessity” in which waiting for a second doctor would lead to “undesirable delay” Professionals required: 1 doctor; 1 AMHP or Nearest Relative Evidence required: The patient is suffering from a mental disorder that is… of a nature or degree that warrants detention in hospital for assessment; and The patient ought to be detained for his or her own health or safety, or the protection of others; and There is not enough time for 2nd doctor to attend (risk)

Answer 87

A patient who is a voluntary patient in hospital can be legally detained by a doctor. Holding Doctor. 72 hours For a patient already admitted (can be psychiatric or general hospital) but wanting to leave Duration: 72 hours Renewal: No Purpose: Allows time to convene MHA assessment Treatment: Cannot be coercively treated Evidence required: It appears to the registered medical practitioner that an application ought to be made [under the Act] for the admission of the patient to hospital Tribunal: No

Answer 88

Similar to section 5(2) but completed by nursing staff. Holding Nurse. 6 hours For a patient already admitted to hospital (psychiatric or general) but wanting to leave Duration: 6 hours Renewal: No Purpose: Allows time for MHA assessment Treatment: Cannot be coercively treated Evidence required: It appears that the patient is suffering from mental disorder… to such a degree that it is necessary for his health or safety or for the protection of others for him to be immediately restrained from leaving the hospital Tribunal: No

Answer 89

A court order can be obtained to allow the police to break into a property to remove a person to a place of safety. Police Magistrate/Police officer. 72 hours Allows police to legally enter a private dwelling and remove someone to a place of safety Duration: 24 hours Professionals involved: AMHP Needs a court order (Magistrate) Renewal: No Evidence Required: Reasonable cause to suspect that a person believed to be suffering from mental disorder; and Is being ill-treated; or Is living alone and is unable to care for themselves

Answer 90

What is a private dwelling? Any house, flat or room where that person, or any other person, is living; or Any yard, garden, garage or outhouse that is used in connection with the house, flat or room, other than one that is also used in connection with one or more other houses, flats or rooms.

Answer 91

Allows police to legally detain (not arrest) someone in a public place without a warrant and remove them to a place of safety Duration: 24 hours Professionals involved: Police Renewal: No Evidence Required: A person appears to a constable to be suffering from mental disorder and to be in immediate need of care or control

Answer 92

Mental Disorder What’s included? What’s excluded? Nature / Degree Section 12 Approved Doctor “Special experience in the diagnosis or treatment of mental disorder” Approved Mental Health Professional (AMHP) Social worker, Psychiatric Nurse, OT, Psychologist Nearest Relative Section 26 MHA Listed in terms of priorities Has certain powers and responsibilities Place of Safety ED Police Cell Psychiatric Hospital (‘136 Suite’)

Answer 93

Disorder: “Any disorder or disability of the mind” – Ch 1, MHA Excludes Acute intoxication Autism / ID alone unless accompanied by “abnormally aggressive or seriously irresponsible conduct” (MHA CoP 2.15)

Answer 94

Least Restrictive Option Empowerment and Involvement Respect and Dignity Purpose and Effectiveness Efficiency and Equality

Answer 95

Respect for patients' past and present wishes and feelings Respect for diversity Avoidance of unlawful discrimination Involvement of patients, carers, and other interested parties in planning, developing, and delivering care and treatment appropriate to them Effectiveness of treatment Patient wellbeing and safety Public safety Minimising restrictions on liberty