Week 3 MMHA/MSE Flashcards
what is the manitoba mental health act (MMHA)?
sets out in law the admission and treatment requirements for patients in psychiatric facilities
What two principles does the act try to strike a balance?
- canadian charter of rights and freedoms
- societies obligation to care and provide treatment for those who may not understand their need for treatment d/t their mental illness
What two status’ can someone have who is admitted to a psychiatric facility?
- voluntary
- involuntary
What is the first step (form) that can be filled out on the pathway to involuntary psychiatric assessement and who fills it out?
- Form 1 - application for an order of Involuntary medical examination
concenred family/friend/support
What is the second step (form) that can be filled out on the pathway to involuntary psychiatric assessement and who fills it out?
- Form 2 - judicial order
- order of involuntary medical examination
a judge (gives it to police via form 3)
What is the third step (form) that can be filled out on the pathway to involuntary psychiatric assessement and who fills it out?
- Form 3 - Notice to person in custody (it’s given to the person)
provided by police
- reason for detained
- where they are going and why
- right to retain counsel
When someone is in the ER, what form are they under?
Form 2 (judicial order)
How many hours must someone be examined after they arrive at the ER under form 2?
within 24 hours
If criteria is met for an involuntary assessment what form gets filled out?
- Form 4
by the doctor
how long is form 4 (doctor given) valid for after admission to psych ward?
72 hours
What is form 6 and when is it used?
- Form 6 is when someone is involuntarily admitted to psych ward (due to form 4, the psych evaluation)
What are the 3 options after psych evaluation (form 4)
- involuntary admission (form 6)
- Voluntary admission
- Discharge
Can the person who signs form 4 also sign form 6?
no. must be a psychiatrist/not the same one as form 4
how long does form 6 last?
21 days
Can form 6 be renewed or changed?
Yes, can be renewed after 21 days.
status can change to voluntary or be discharged as well
- patients can appeal
What is the job of the nurse when it comes to involuntary admission?
- ensure patients know their rights
- have a legal responsiblity to provide patients with information and forms required to appeal the desicion if they want
What is form 9 and who signs it?
- Certificate of incompetence to make treatment decisions.
- doctor and files with medical director
Where does a form 9 take place?
only in hospital
What happens if a form 9 is written?
Person is deemed incompetent to make treatment decisions.
SDM named and patient and them are informed via writing
- they have a right to appeal
if there is no form 9, can a patient refuse treatment?
Yes
What determines whether someone is allowed to deny their medications?
competency whether they are involuntary or voluntary
competent= right to decline meds
incompetent= SDM decides
if staff or patient safety is at risk, is it ok to administer medication against patients will without form 9?
yes
patient and staff safety is priority
- contact the psychiatrist for reassessment of competence.
What 3 things are needed to give medication against a patients wishes in non-emergent situations?
form 9 + SDM consent+ doc order
What is form 13 and who fills it out?
- Voluntary patient request for discharge AMA
- must be assessed by psychiatrist
- request verbally or via form 13 (bumps up timeline)
How many hours must a person be assessed when they request discharge?
24 hours
Can someone who is being held voluntarily leave anytime they want if they sign the AMA?
no. They still need to be assessed by a psychiatrist
- granted, not-granted, or changed to involuntary if appropriate
What is form 14 and who can fill it out?
- Form 14 Order for return of an individual absent without permission
- AWOL
- psychiatrist
- allows police to go find them
-voluntary must be assessed about their status
What is form 18 and who fills it out?
- Form 18 is the individual’s application to mental health review board
- Individual can fill this out to have status reviewed under the MMHA
What are the rights of patients in a psych ward?
- know why they’re being detained
- communicate - provincial ombudsman, patient rep and mental health advocate
- retain lawyer asap
- apply to mental health review board
- appeal any decision made by the review board (apply to MB court)
Who is on the review board?
- lawyer who presides at meetings at the panel
- psychiatrist
- person who is not lawyer or psychiatrist
What does it mean when someone is not criminally responsible?
- suffering from a mental disorder and were incapable of knowing it was wrong
- incapable of appreciating the nature and quality of the act
Is the law of not criminally responsible under the criminal code of Canada or the mental health act?
Criminal code of Canada
What is Bill 5?
Allows medical staff to let third party (like family ) know when someone is at risk of harming themselves or another person in order to reduce the risk
- resolves responsibility of HCP to follow MHA and PHIA
What is the purpose of the mental health act?
To help people when their illness makes it so they can’t see their need for medical assistance and/or ability to seek it
What are the 6 components of trauma-informed care?
- safety
- Trustworthiness and transparency
- Peer support
- Collaboration and mutuality
- Empowerment, voice and choice
- Cultural, historical and gender issues
In TIC, what questions do we ask right when they are admitted?
- what helps/doesn’t help you stay calm?
- how can we avoid revisiting past traumatic experiences?
- What upsets you?
- What are some signs that you are getting upset?
- are you willing to talk to one of the staff if you feel upset?
what are the components of the MSE?
general observations
speech characteristics
mood and affect
thoughts (content and process)
Perception
sensorium/cognition
insight
judgement
is mood self report or clinician observation?
mood- self report
what is affect, self report or clinician observiation?
clinician observation
what is through process?
is the way thoughts are formed and expressed. The manner in which the patient links ideas and words together.
What is thought content?
refers to the subject matter occupying a person’s thoughts. The patient’s beliefs, ideas and interpretations of their surroundings.
ideas of reference
the news broadcast is about me
thought broadcasting
they can hear what i’m thinking
Ideas of influence
my mother is making me swear at my roommate
illusion
misinterpreting sensory input
electrical cords are snakes
hallucinations
false sensory perceptions
there’s nothing there but there is to the person
- auditory
- visual
- olfactory
- gustatory - taste
- tactile
