Week 1 - E - Capacity/consent - Adults with incapacity 2000 (Section 47), Mental health act 2003 (E.D, S.T.D,C.T.O), Guardianship/Power of Attonrney

Question 1

What is the capacity to give consent defined as?

Answer 1

This is where the patient has the ability to make a decision to give somebody permission to let something happen

Question 2

What are the three aspects of somebody being shown to have capacity?

Answer 2

* They understand and retain the relevant information

* They can use and weigh this decision to make a relevant decision

* They can then communicate this decision

Question 3

Capacity should be assumed until proven otherwise. What are the three components of capacity again?

Answer 3

The patient should be able to understand and retain the information provided

The patient should be able to use and weigh the information provided to make a decision

The patient should be able to communicate that decision (doesn’t have to be verbal communication)

Question 4

In a medical emergency, deal with the situation then deal with the legal paperwork What is the act that authorises medical treatment for people who are unable to give or refuse consent, except in emergencies?

Answer 4

This would be the adults with incapacity act (scotland) 2000

Question 5

When needing to authorise the treatment of a physical disorder in a patient without capacity to consent to that treatment, what is the section of the adults with incapacity act that is used here?

Answer 5

To authorise the treatment of a physical disorder in a patient without capacity to consent to the treatment - would need to use the

Adults with incapacity Act (scotland) 2000 under section 47

Question 6

What are the 5 different principles of the adults with incapacity act?

Answer 6

* The intervention must benefit the adult

* Such benefit cannot be reasonably achieved without intervention

* Take account of past and present wishes

* Consult with relevant other persons

* Encourage the adult to use residual capacity

Question 7

State what capacity is? State the 5 principles of the adults with incapacity act?

Answer 7

Capacity

• * Need to be able to understand & retain information
• * Need to use & weigh up the information to make a decision
• * Need to be able to communicate the decision

Adults with incapcity

• * Treatment needs to benefit the patient
• * Such benefit cannot be reasonably achieved without intervention
• * Take into account the patients past &present wishes
• * Consult with any relevant others
• * Encourage the patient to use the residual capacity

Question 8

There are a few principles (the 5 discussed) for adults with incapacity ie cant get somebody to donate a kidney under the act cause that benefits someone else, not the patient What is the difference between power of attorney and guardianship order?

Answer 8

Power of attorney is appointed by the patient whilst they still have capacity

A guardianship is something applied to a court for once the patient has lost the capacity to make the decision and therefore cannot elect someone power of attorney

Question 9

Use AWI section 47 to authorise treatment of a physical disorder in someone without capacity to consent to that treatment

What does the mental health (Care and treatment) act (scotland) 2003 allow for?

Answer 9

The mental health act 2003 allows for the treatment of a mental disorder or physical consequences of a mental disorder in someone without capacity to consent to treatment

Question 10

The different components of the mental health act 2003 (that we need to know are)

• * Emergency detention certificate
• * Short term detention certificate
• * Compulsory treatment order
• * Advance statement
• * Nurses’ holding power

What is an emergency detention certificate? Who can it be done by and what does it allow? What section of the MHA 2003 does it come under?

Answer 10

An emergency detention certificate can be done by anyone who is an FY2 and above and allows the patient to be detained for 72 hours so that they can undergo further evaluation

It does not allow for treatment and the patient cannot appeal it

It comes under section 36 of the MHA 2003

Question 11

What are the criteria for the emergency detention certificate?

Answer 11

1. Likely to have a mental disorder
2. Significantly impaired decision making ability regarding treatment, due to the mental disorder
3. Detention in hospital is an emergency to determine what treatment is needed
4. Risk to health, safety or welfare of the person, or others
5. Making arrangements for section 44 would involve undesirable delay

Question 12

What is section 44 of the MHA Scotland 2003?

Answer 12

This is the short term detention

Question 13

State again what an emergency detention is and the criteria for it?

Answer 13

This is a detention that allows a patient to be assessed by a doctor for up to 72 hours - patient cannot appeal it, doesn’t allow for treatment and can be carried out by FY2 and above

1. Patient is likely to have a mental disorder
2. Significantly impaired decision making regarding treatment due to the mental disorder
3. Detention in hospital is urgent to determine what treatment may be necessary
4. Risk to health, safety and welfare of the person or safety of others
5. Making arrangements under sec 44 would take too much time

Question 14

Who can apply for the short term detention? How long does it last? What does it allow for?

Answer 14

A short term detention can be applied for by an approved medical practitioner and requires the consent of a medical health officer

It lasts for 28 days and allows for treatment of the patient but can be appealed

It comes under section 44 of the mental health acts 2003

Question 15

What is the criteria for a short term detention disorder?

Answer 15

1. Likely to have a mental disorder
2. Significantly impaired decision making regarding treatment due to the mental disorder
3. Detention in hospital is necessary for the assessment of treatment
4. Risk to health, safety or welfare of the person or safety of others.
5. Cannot be treated voluntarily

Question 16

How is a compulsory treatment order acquired?

Answer 16

For a compulsory treatment disorder - the diagnosis of a mental disorder has to have been made

You need to apply to a tribunal to acquire this and it comes under section 63 of the MHA 2003

Question 17

What section of adults with incapacity act 2000 to authorise treatment of a physical disorder in someone without capcity? What section of the mental health act to detain a patient for 72 hours? 28 days? 6 months? What are these detentions called? Who can authorize them?

Answer 17

Adults with incapacity 2000 - under section 47 to treat someone with a physical disorder who does not have capacity to make the decision

* MHA section 36 - emergency detention which detains for up to 72 hours- FY2 and above

* MHA section 44 - short term detention certificate - detained for 28 days - approved medical practitioner with consent of medical health officer

* MHA section 63 - applying to a tribunal for a compulsory treatment order -detain up to 6 months

Question 18

What is the nurses holding power? What is an advanced statement?

Answer 18

Nurses holding power -if the doctor is not available, a psychiatric nurse can withhold a patient for 2 hours so a doctor can detain them

Advanced statement -a general statement about anything that is important to you in relation to your future treatment and wellbeing.

You can use it to express your preferences for care or to detail any values or beliefs that inform the decisions you make.

Question 19

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Answer 19

The nurse should use the nurses holding power where they can withhold a patient for 2 hours until a doctor can come and assess the patient

Question 20

What options does the duty doctor have?

Answer 20

Can let steve leave

Can either issue an emergency detention - allows assessment of steve for up to 72 hours

Can issue a short term detention disorder where treatment is allowed and lasts up to 28 days

Question 21

What criteria would Steve require to meet for an Emergency detention?

Answer 21

1. Likely to have a mental disorder
2. Significantly impaired decision making regarding treatment due to a mental health disorder
3. Detention in hospital urgently is necessary to determine whether and what treatment may be necessary
4. Risk to health, safety or welfare of person or safety of other
5. Making arrangements for a section 44 (short term order) would result in an undesirable delay

Question 22

The duty doctor detains Steve on an Emergency detention What does ‘Emergency detention’ mean (ie what section, under what Who can carry out an Emergency detention? How long can Steve be detained for under an Emergency detention? Does this authorise treatment? Does Steve have a right to appeal his emergency detention?

Answer 22

Emergency detention is section 36 of the mental health (care and treatment) act (Scotland) 2003

It can be authorized by an FY2 and above and lasts 72 hours

It does not authorize treatment and steve cannot appeal this decision

Question 23

When should Steve be reviewed next, by whom and what decisions need to happen?

Answer 23

As soon as possible by an AMP (approved medical practioner-generally registrar or above).

Need to decide whether Steve needs to be kept in for further assessment/treatment outwith the 72h of the emergency detention.

Question 24

If the decision is made steve needs to be kept for more than the 72 hours to recieve treatment, what needs to be authorised?

Answer 24

A short term detention needs to be authorized

Question 25

What criteria would Steve require to meet for a short-term detention?

Answer 25

1. Likely to have a mental disorder
2. Significantly impaired decision-making ability regarding treatment, due to mental disorder
3. Detention in hospital is necessary for assessment or treatment
4. Risk to health, safety or welfare of the person, or safety of others
5. Cannot be treated voluntarily

Question 26

He is placed on a Short-term detention order after his review. What does ‘Short-term detention’ mean (ie what section, under what act?) How long is this for? Who can perform a short-term detention and whose consent is required? Does this authorise treatment? Does Steve have a right to appeal his short-term detention?

Answer 26

This is under section 44 of the mental health act 2003

It lasts for up to 28 days

Can be performed by an approved medical practitioner but requires the consent of a medical health officer

It does authorize treatment and he can appeal this

Appeal to Tribunal and Mental Welfare Commission

Question 27

He has been in hospital for 2 weeks and has accepted some medication. This has helped and although still suspicious the intensity of his psychotic experiences has become less. It is coming up to 14 days since his short-term detention and the decision needs to be made about further treatment. What options does the team have in terms of both formal and informal treatment?

Answer 27

Can apply for a compulsory treatment disorder - keeps patient for up to 6 months

Can discharge into the community, and arrange to be seen by community mental health team.

Can see if he’ll stay in hospital for treatment voluntarily.

Question 28

What is a Compulsory Treatment Order (ie what act, what section) How long is this for?

Answer 28

This is section 63 of the mental health act 2003

Lasts for up to 6 months and patient has a mental disorder (no longer likely)

Question 29

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Answer 29

1. C - is the correct answer - must apply to the tribunal for a CTO
2. H - is the right answer