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NUR2225 > Wk1: mental health nursing > Flashcards

Wk1: mental health nursing Flashcards

1
Q

What is WHOs definition of Mental health?

A

“A state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in “(WHO, 2022a, para. 1)

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2
Q

Define mental disorders (or mental illness but this is on the way out)

A

“a clinically significant diagnosable disorder that significantly disturbs individual’s cognition, emotional regulation, or behaviour. It is usually associated with distress or impairment in important areas of functioning.”

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3
Q

What is the DSM V definition of mental disorder

A

“a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or development processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g. political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above” (American Psychiatric Association, 2013)

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4
Q

Define mental health problem

A

interfere with how a person thinks, feels and behaves, but to the
extent that diagnostic criteria for mental illness are met (lesser extent than a mental
illness/disorders)
- usually less sever
- temporary reaction to daily life stressors
- more common than mental illness
- can develop into a mental illness
e.g. substance disorder, anxiety disorder

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5
Q

What are the components if the biopsychosocial model of health?

A
  • Biological
  • Social
  • Psychological

Often conditions are a result of multiple components
- these can impact their physical health

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6
Q

Can mental health impact physical health?

A

yes, all the areas of the biopsychosocial model can effect a persons mental health.
Can cause

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7
Q

What causes poor mental health?

A
  • we don’t know
  • this is why we need a wholistic approach to treatment
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8
Q

Define protective factors and list an example for poor mental health.

A

Protective factors act to ‘protect’ or
reduce the risk/severity of mental
illness/problems:

e.g. supportive
family/school environment, resilience,
easy temperament, social
competence/skills, access to
housing/education/health resources

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9
Q

What are some risk factors for poor mental health?

A
  • Drug and alcohol use
  • Problems in personal relationships
  • Loneliness or isolation
  • Changes in seasons
  • Stress, sleep deprivation
  • Recent death of a loved one
  • Chronic illness
  • Carer role/s
  • Refugee status/detention
  • Financial/housing difficulties
  • note it can be a complex mix of multiple factors and ranges of experiences
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10
Q

How can mental ill health effect people?

A

Effect depends on severity, social determinants and resources/support

  • effects work force participation and productivity
  • Greater likelihood of poverty and welfare support
  • Ongoing disability as a result of mental and physical illness
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11
Q

What are people with mental health disorders disproportionately at an increased risk of?

A
  • Disability
  • Morbidity
  • mortality
  • Poorer physical health associated with greater exposure to known risk factors, lifestyle behaviours,
    reduced access to care and treatments for mental illness
  • Higher rates of suicide, cancer, cardiovascular disease, respiratory illness
    - 3 x more likely to have diabetes
    - 6 x more likely to die from cardiovascular disease (across all ages, regardless if smoking)
  • Lower life expectancy (approx. 20 years or 30%)
  • Higher chance of dying prematurely than the general population (40-60% higher in people with depression
    and schizophrenia)

These can be related to the medication they are on (Bolanzapine= psychosis= linked to weight gain= risk of CVD, diabetes and thus increase risk of mortality)

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12
Q

What are some population groups that are more likely to experience mental health problems?

A
  • Low SES (people living in poverty)
  • People with chronic health conditions
  • Infants/children exposed to maltreatment/neglect (early trauma=strong link)
  • Adolescents exposed to substance use early
  • Minority groups and indigenous populations
  • Older people
  • LGBTIQ
  • People experiencing discrimination/human rights violations
  • People experiencing natural disasters/war/conflict
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13
Q

What are some reasons certain. population groups are at an increased risk of mental health problems?

A
  • discrimination
  • living rural and remote
  • poor health literacy
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14
Q

What is cultural sensitivity, cultural safety and competence and why are they important in mental health important?

A

Cultural safety/competence= the ability for health professionals to understand, communicate and effectively interact with people across cultures.

Cultural sensitivity= the knowledge, awareness and acceptance of other cultures.

  • We work with a variety of people from different backgrounds/groups and experiences
  • in order to reduce inequalities access
    and improving care
  • Can improve the health and well-being of people by creating environments of trust and inclusiveness
  • Can improve access to services, thus reducing health disparity
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15
Q

Who is involved in creating cultural safety and competence in mental health care and why?

A
  • service/organisation as a whole
  • clinicians
  • those creating attitudes and policies

This is to provide an integrated and holistic approach to the delivery of care

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16
Q

Define a stereotype

A

widely held but fixed, over‐simplified beliefs about particular people or things

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17
Q

Define stigma?

A

– a negative stereotype; a sign of disgrace associated with particular circumstance, quality or people

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18
Q

What are the two forms/senses of stigma?

A

Public stigma= is the reaction that the general population has to people with mental illness

Self-stigma= is the prejudice which people with mental illness turn against themselves”

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19
Q

Define discrimination

A

unjust or prejudicial treatment of a group or class of people – also recognition & understanding of differences (positive discrimination or preferential treatment)

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20
Q

Where does stigma arise from? and what created them?

A
  • Based on fear of those experiencing mental health problems
  • Dangerous? Unpredictable? Violent?
  • Incompetent
  • Socially inappropriate
  • Always have a poor prognosis
  • Evident in popular culture and perpetuated in everyday language
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21
Q

What are the impacts of stigma on a person experiencing a mental health problem?

A
  • Avoiding help
  • Isolation
  • Social avoidance
  • Diminished self-esteem and worthiness
  • Impact on symptoms
  • Reduces recovery and personal empowerment
  • The “why try” effect – self stigma (I am not worthy…I am not able..)
  • impacts carers and famlies too
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22
Q

Why is langue so important?

A

= is reflective of our attitudes and understanding, and our value and respect of a person and their experience

= is important in working with people with mental health problems, their families and carers.

= powerful and feeds directly into stigma

  • Language often feeds directly into stigma
  • Language can diminish personhood by labelling e.g. “The schizophrenic” rather than person diagnosed
    with schizophrenia
  • we would never say ‘the asthmatic’
  • Affects how people or groups of people are seen
  • May affect the person’s health and well-being
  • Affects other’ perception of people and mental health as a whole
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23
Q

What is positive mental health language?

A

consumer/client/person > patients
person experiencing mental illness > mentally ill

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24
Q

Define trauma informed care and practice

A

= Acknowledges that all people seeking a mental health service has experienced significant trauma at some stage during their lives.
- strengths based approach to care

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25
Q

What are the 5 care principles of trauma informed care/practice?

A
  • safety
  • trustworthiness
  • choice
  • collaboration
  • empowerment
  • respect for diversity
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26
Q

Describe considerations for trauma informed care and how to reduce re-traumatisation?

A
  • ensure treatment is not re-traumatising people

Ways clinicians can do this:
* Realises the effect of trauma on the person and potential path to recovery
* Recognises signs and symptoms of trauma in consumers, families/carers, staff
* Strives for a therapeutic relationships that develop trust and safety
* Accepts and respects the person and their safety
* Focuses on the person’s strengths
* Maximizes the individual’s choice and control over their recovery
* Actively seeks to resist re-traumatisation

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27
Q

What are two key points of running trauma informed care?

A
  • collaborative care approach
  • ensuring shared decision making. This promote
    * Autonomy and empowerment
    * Informed choice and decision making
    * Mutual participation
    * Recovery
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28
Q

How does one establish and maintain a therapeutic relationship when caring for a patient with a mental health problem?

A
  • partnering with t he client and carers
  • consideration of context of their presenting illness
  • consideration of psychological circumstances e.g. drug induced psychosis/ living away from home/ studying at university/ unsupportive partner
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29
Q

How does one undertake a holistic assessment when caring for a patient with a mental health problem?

A
  • consider their age
  • consider population group
  • Consider their cultural traditions and religious practise and how these may be impacting the clients presentation, therapeutic engagement and treatment plan.
    e.g. i.e., use of elders in clients of Torres Strait Island decent, need to access to a prayer room, refusal of some medications due to pork derivatives
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30
Q

How does one work collaboratively with clients and their carers with a mental health problem?

A
  • ascertain their health care preferences
  • incorperate preferences where relivant
  • empower clients and carers
  • help them identify their strengths
  • support their recovery
  • aim in decreasing their resistance to services
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31
Q

What are some key plans mental health nurses may ingauge in making?

A
  • recovery plans
  • management plans
  • behavioural plans
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32
Q

What are some key roles of mental health nurses?

A
  • provide psychoeducation
  • implement therapeutic engagement approaches
  • administer medications
  • document mental status examinations
  • document risk assessments
  • activley monitor physical health
  • educate clients and carers of legal rights
33
Q

What is an important consideration regarding carers of those with mental health problems?

A

They have a unique role in the recovery journey

Their feelings, experiences and questions may vary considerably as they encounter unexpected situations that they have little experience of and no preparation for.

Experience strong emotions of:
- fear
- confusion
- grief and loss
- wondering how they will cope
wondering what the cause of their loved one’s mental illness is
- wondering why they in - particular have been affected by mental illness
- wondering what other people will think
- wondering what the situation means for their family.

34
Q

What can be a carers role in compulsory treatment?

A

In accordance with the Victorian Mental Health Act (2014)
- a person can nominate another person prior to admission, on admission or at any time to receive information and provide support in the event that they become unwell and require compulsory treatment.
- In most cases, the nominated person is a carer or family member.
- However, where a person nominates someone other than a carer to be their nominated person, a carer must still receive information and have their views considered.

35
Q

What info can be disclosed to families and carers?

A
  • person must always consent
  • key events and information about treatment that will be necessary for effective participation in a consultation or action taking in care.
  • if a patient is unable to consent or refuses to consent to sharing information, carers can be given information if they need the information to provide care to a patient and to prepare for their caring role. - A person disclosing information in these circumstances must have regard to the patient’s views and preferences, including any preferences expressed in an advance statement.
36
Q

What are the aims of a therapeutic relationship?

A

The aims of the therapeutic relationship are;
- To facilitate the communication of distressing thoughts and feelings, inclusive of the carer’s perspectives
- Assist the client with problem solving & help facilitate activities of daily living.
- Help clients examine self-defeating behaviours and test alternatives.
- Promote self-care and independence, in collaboration with their carer.

37
Q

What are the phases of developing a therapeutic engagement?

A

Orientation phase
- in which the client and nurse mutually identify the issues / problems. (carers are an invaluable source of knowledge in this phase of the relationship)

Identification phase
- in which the client / carer identifies with the nurse, thereby accepting help

Exploitation phase
- in which the client and carer make use of the nurses help

Resolution (termination) phase - the client accepts new goals and the therapeutic relationship is terminated

38
Q

Define congruence

A

A display of genuineness, transparency and self-disclosure.

Other characteristics
- Relating in a sincere and honest manner
- Matching your body language, gestures, expressions and tone to the sentiment that you are expressing
- Not pretending to be an expert
- acknowledging that the client knows more about themselves than you do
- making it clear that you are only knowledgeable in particular areas, not everything
- admitting that you may need to find out more about something or admitting that you don’t understand
- making referrals to other professionals or seeking help from other nurses if needed
- Being honest with the client about your own feelings
- Appropriately using self-disclosure e.g. to help the client develop new insight into a problem
- Promoting autonomy
- Being transparent in motives and intentions
- agreeing on goals together
- telling clients if confidentiality has to be broken

39
Q

Define unconditional positive regard

A

The following are things you would be doing if you were demonstrating unconditional positive regard.
- Awareness of prejudice toward the client
- Avoiding imposing your views on the client
- Avoiding using judgemental expressions e.g. “should, must, ought”
- Avoiding stereotyping and assuming
- Remembering that different does not mean wrong

40
Q

How is recovery different in mental health?

A
  • its active
  • unique to the person and what they want.
  • can be with or without mental health problems and be in recovery
  • they may need to continue with medication or support and this is recovery
  • it may include recovery
    Personal recovery= supporting people the way they wish to be supported
  • it cannot be assessed by anyone but the person
41
Q

What is recovery orientated mental health services?

A

= underpins mental health policy/practice and
refers to the application of capabilities that support people to recognise and take control of
their own recovery

  • Embracing the possibility for recovery, focusing on the strengths of the person
  • Maximising self-determination and self-management of mental health
  • Assisting families/carers to understand challenges and opportunities related to the person’s
    experiences
42
Q

What are some principles of recovery orientated practice?

A

Uniqueness of the individual
- Real choices
- Attitudes and rights
- Dignity and respect
- Partnership and communication
- Evaluating recovery

43
Q

What are some models/frameworks to support recovery?

A

Recovery model
- grounding and implementing principles of recovery

Wellness Recovery Action Plan (WRAP)
- Tools to support self-management with a focus on recovery-oriented mental health services
- helps people self manage and identify and mange things that make their mental health better or worse
- promotes use of wellness toolbox

Strengths Model (strengths-based approach)
- Moves away from focuses on a person’s deficits or ‘what’s wrong’ to focus on the person’s strengths and resources (Slade et al. 2014)
- focused on what they can build on

CHIME recovery framework (connectedness, hope and optimism about the future, identity, meaning in life and empowerment)
- Focuses on upholding principles of recovery = and the ‘CHIME factors’

44
Q

What can mental health nurses do to uphold principles of mental health nursing?

A
  • Promote optimal quality of life, autonomy, hope
  • Support inclusion
  • Challenging stigmatising attitudes and discrimination
  • Involve the person/client in all decisions regarding their care and treatment (and
    carers/families, nominated person)
  • Care and treatment should be tailored to meet the specific needs of the person/client
  • Be responsive to Aboriginal and Torres Strait Islander people, people from different cultural
    backgrounds, immigrant and refugee backgrounds, lesbian, gay, bisexual, transgender and
    intersex people
  • Focus on strengths
  • Less restrictive practice - reduce coercion, seclusion and restraint
45
Q

LO: Explain the purpose of the Mental Health Act 2014 and the relevance to nurses and midwives

A

Purpose:
Relevance:

46
Q

What are the objectives of the mental health act?

A
  • to guide treatment and diagnosis of people with mental health problems
  • to ensure the least restrictive treatment is provided e.g. community over hospital
  • To provide for the assessment of persons who appear to have mental illness and the treatment of persons who have mental illness; and
  • To provide for persons to receive assessment and treatment in the least restrictive way possible with the least restrictions on human rights and dignity; and
  • To protect the rights of persons receiving assessment and treatment; and
  • To enable and support persons who appear to or have mental illness & their ability;
    (i) to make, or participate in, decisions about their assessment, treatment and recovery;
    (ii) to exercise their rights under this Act; and
  • To provide oversight and safeguards in relation to the assessment of mentally ill persons; and
  • To promote the recovery
  • To ensure that persons who are assessed and treated under this Act are informed of their rights under this Act;
  • To recognise the role of carers in the assessment, treatment and recovery of persons who have mental illness.
47
Q

What are some principles of the mental health act

A
  1. Persons receiving MH services should:
    a) Be provided treatment in the least restrictive ways possible (voluntary admission preferred)
    b) Be provided with the aim of best therapeutic outcomes, promoting recovery and full participation
    c) Be involved in all decisions about their assessment, treatment and recovery, and supported to participate
    and make decisions with their preferences respected
    d) Be allowed to make decisions that involve a degree of risk
    e) Have their rights, dignity and autonomy respected and promoted
    f) Have their other health needs (including physical health, and AOD) recognised and responded to
    g) Have individual needs recognized and responded to (culture, language, communication, age, disability,
    religion, gender, sexuality or other)
    h) Ensure Aboriginal persons have their distinct culture and identity recognised and responded to
    i) Ensure children and young people have their best interest recognized and promoted as primary
    consideration
    j) Ensure children, young people and other dependent of people receiving MH services have their needs,
    well-being and safety recognised and protected
    k) Ensure carers (incl. children) for people receiving MH services should be involved in decisions about
    assessment, treatment and recovery whenever possible
    l) Ensure carers (incl. children) for people receiving MH services should have their role recognised,
    respected and supported
  2. A MH service provider must have regard to the MH principles
  3. A person must have regard to the MH principles in performing any duty or function or excerising any
    power under or in accordance with the MHA
48
Q

What are some safe guards that are from the MHA?

A

= to protect the rights and dignity of patients

Communication: patients have the right to communicate lawfully.

Mental Health Tribunal: makes and reviews orders and determines treatment applications.
e.g. use of ECT

Statement of rights: patients must be given a statement of rights at key points in their
assessment/treatment.

Restrictive interventions: are strictly regulated. e.g. exclusion or restraint

Electroconvulsive therapy: ECT is a safe and effective treatment for some mental illness.

Neurosurgery: can only be performed with the patient’s informed consent and mental health tribunal approval.

49
Q

MHA definition of mental illness

A

= condition that is characterised by a significant disturbance of
thought, mood, perception or memory

Note: no mention of behavioural disturbances

50
Q

When may a person be considered NOT-mentally ill as per the MHA?

A
  1. A person is not to be considered to be mentally ill by reason only of any one or more of the following:
    a) that the person expresses or refuses or fails to express a particular political opinion or belief;
    b) that the person expresses or refuses or fails to express a particular religious opinion or belief;
    c) that the person expresses or refuses or fails to express a particular philosophy that the person expresses or refuses or fails to express a particular sexual preference, gender identity or sexual
    orientation;
    (e) that the person engages in or refuses or fails to engage in a particular political activity;
    (f) that the person engages in or refuses or fails to engage in a particular religious activity;
    (g) that the person engages in sexual promiscuity;
    (h) that the person engages in immoral conduct;
    (i) that the person engages in illegal conduct;
    (j) that the person engages in antisocial behaviour;
    (k) that the person is intellectually disabled;
    (l) that the person uses drugs or alcohol;
    (m) that the person has a particular economic or social status or is a member of a particular cultural or racial group;
    (n) that the person is or has been involved in family conflict; *
    (o) that the person has been previously treated for mental illness.
51
Q

What is a presumption of capacity and informed consent (s68)?

A

= a presumption of capacity to make treatment decisions regardless of age or MHA legal status.

A patient has capacity to give informed consent if the person:
a) understands the information he or she is given
b) is able to remember the information
c) is able to use or weigh information
d) is able to communicate the decision he or she makes

Includes principles to provide guidance around determining capacity (s 68(2))
a) Capacity to give informed consent is specific to the decision that needs to be made
b) A person’s capacity to give informed consent may change over time
c) It should not be assumed that a patient lacks capacity to give informed consent based only on their age, appearance,
condition or behaviour
d) A determination that a patient lacks capacity to give informed consent should not be made because the patient makes a
decision that could be considered unwise
e) A capacity assessment should occur at a time and in an environment in which a patient’s optimal level of capacity can be most
accurately assessed

52
Q

What is the meaning of informed consent as per the MHA?

A

A person gives informed consent if the person has:
a) The capacity to give informed consent to the treatment
b) Been given adequate information to make an informed decision
c) Been given a reasonable opportunity to make the decision
d) Given consent freely without undue pressure or coercion
e) Not withdrawn consent or indicated any intention to withdraw consent

If the patient is incapable of informed consent &/or lacks capacity to decide (s71):
* Authorised psychiatrist can make a treatment decision (except ECT & Neurosurgery for Mental Illness) if there is no less
restrictive way for the person to be treated

In determining least restrictive treatment authorised psychiatrist must consider:
* Patient’s views and preferences (including in advance statement)
* Views of nominated person, guardian, carer, parent of patient <16
* Likely consequences for the patient if proposed treatment is not performed
* Any second psychiatric opinion

53
Q

Outline supportive decision making

A
  • Supported decision making is viewed under the Act as central to recovery-oriented practice
  • The Mental Health Act 2014 (Vic) enables compulsory patients to make decisions about
    their treatment and to determine their individual path to recovery
  • Nurses are encouraged under the Act to support patients to make or participate in decisions
    about their treatment
54
Q

Describe how the MHA supports decision making

A

The Mental Health Act 2014 (Vic) promotes supported decision making through:
* Advance statements (s.20) – gives patients greater control over treatment and informs about patients treatment preferences
* Nominated Person – receives information and supports patients as per s.23 which outlines the role of the nominated person
* Second psychiatric opinion – promotes patient self-determination and a dialogue between clinicians and patients about treatment options. The right to a second opinion is s.79

Other initiatives to promote supported decision making:
* Advocates – assist patients to participate in decisions about their assessment, treatment
and recovery

55
Q

Define and describe an advanced statement (s20)

A

Advanced statement= enables a patient to record their treatment preferences in the event that they become unwell and require compulsory mental health treatment.

This is stored on the CMI database for MHS’s to access.

Changes to patient preferences are discussed later

Advance statements:
* Has an explanation provided in section 19
* Can be made at any time provided a patient understands what an advance statement is and the consequences of making it. The nominated person can withdraw consent to be the nominated person and needs to take reasonable steps to inform the patient under section
27 of the Mental Health Act 2014 (Vic)
* Must be signed, dated and witnessed by an authorised witness which includes registered
medical practitioner, mental health practitioner or any person authorised to witness
statutory declarations

Can be revoked or have contents renewed as per section 21 of the Mental Health Act 2014
(Vic) either by:
* making a revocation; or
* making a new advance statement
* must be considered whenever a substitute treatment decision is made
* Can be overridden if the preferred treatment is not clinically appropriate or not ordinarily provided by the mental health service. Consider how this would effect the persons’ trust in the health care service.
* Written reasons for overriding an advance statement must be provided within 10 days of a
request for such reasons

56
Q

Define and describe a nominated person (s23)

A

A person can nominate another person to receive information and support them while they are a compulsory patient

A nominated person:
- Must be willing, available and able to fulfil the functions and responsibilities of the nominated person. The
nominee may be under 18 years of age
Role includes:
- Providing the patient with support and help represent their interests
- Receive information about the patient
- Be consulted about the patient’s treatment
- Assist the patient to exercise their rights

A nomination:
- Must include a statement from the nominated person saying they agree to be the nominated person & a
nominated person may decline the nomination at any time
- Must be in writing, signed and dated by the person making the nomination and witnessed by an authorised
witness which includes persons set out previously and authorised to witness statutory declarations
- Can be made or revoked at any time provided the patient understands what a nomination is and the
consequences of making or revoking it (s.26)

57
Q

In reference to compulsory assessment and treatment pathway definitions define: an authorised person

A

An ambulance paramedic, police officer, medical practitioner employed by a designated mental health service or mental health practitioner (See below)

58
Q

In reference to compulsory assessment and treatment pathway definitions define: an authorised psychiatrist and their role

A
  1. Any power, duty or function of the authorised psychiatrist to a consultant psychiatrist except the power to
    further delegate.
  2. The powers, duties and functions of an authorised psychiatrist relating to Assessment Orders to a
    registered medical practitioner including:
    1. Power to examine a person and extend the duration of an Assessment Order (AO)
    2. Power to assess a person subject to an Assessment Order (AO) and to make a Temporary Treatment Order (TTO)
    3. Power to revoke an Assessment Order (AO).
59
Q

In reference to compulsory assessment and treatment pathway definitions define: a designated mental health service (DMHS)

A

approved mental health service

60
Q

In reference to compulsory assessment and treatment pathway definitions define: Mental health practitioner

A

= is a registered nurse, registered psychologist, registered
occupational therapist or social worker employed by a designated mental health service

61
Q

Describe the ideal treatment pathway of the mental health act 2014 (Vic) and the types

A

One that
- Promotes voluntary treatment in preference to compulsory treatment
- Seeks to minimise the use and duration of compulsory treatment to ensure that the
treatment is provided in the least restrictive and least intrusive manner possible

  • Establishes compulsory treatment orders comprising of:
    - Assessment Orders (commence s.28)
    - Temporary Treatment Orders (commence s.45)
    - Treatment Orders (commence s.52)
62
Q

Define and describe an assessment order (s28)

A

= is the first step in initiating compulsory treatment
- used to assess the person to determine whether they have a mental illness and need compulsory treatment
- registered medical practitioner or a mental health practitioner may make an Assessment order if
they have examined the person and are satisfied that the criteria for an Assessment order apply to the
person

Criteria (all 4 must be met for a person to be placed on an assessment order)
- The person appears to have a mental illness
- Due to mental illness, the person requires immediate treatment to prevent:
- Serious deterioration in the person’s mental or physical health
- Serious harm to the person or another person
- If the person is made subject to an Assessment order, the person is able to be assessed
- There is no less restrictive means reasonably available for the person to be assessed

*when under an assessment order they can’t be given treatment without consenting if its urgent, risk to themselves or other, or if they have immediate health issues

63
Q

What else does the MHA mandate about an assessment order?

A

= the of an Assessment order (s.34):
- Community Assessment order: maximum 24 hours (can stay home and receive treatment)
- Inpatient Assessment order: maximum 72 hours (to allow for transport), 24 hours once the person is received at the MH service
- Variation of Assessment orders can be made (s.35) (e.g. community to in-patient and visa
versa)
- Once made, the authorised psychiatrist will either revoke the Assessment order (criteria no longer applies) or make the person subject to a Temporary Treatment Order

64
Q

Define and describe a temporary treatment order (s45)?

A

= A Temporary treatment order can be made by an Authorised Psychiatrist after assessing a person (with an Assessment order) that enables the person to be compulsorily treated (for a maximum of 28 days)
- In the community; or
- Taken to, and detained and treated in a designated mental health service

The Authorised Psychiatrist who makes a person subject to a Temporary treatment order must be satisfied that the person meets the criteria (same as AO)

65
Q

Define and describe a treatment order (s52)

A

The Mental Health Tribunal is responsible for making a person subject to a Treatment order must be satisfied that the person meets the criteria (same as AO)
- would look at someone going to be on one of these if they are nearing the end of the 28 day temporary treatment order and the person still requires treatment.

A treatment order is made by the Tribunal and enables a person to be compulsorily treated
- In the community; or
- Taken to, and detained and treated in a designated mental health service/hopsital

The duration of a community treatment order for a person over 18 years is 12 months; under 18 years is 3 months.

The duration of a inpatient treatment order for a person over 18 years is 6 months; under 18 years is 3 months.

Variations can be made, but needs to go back to the Mental Health Tribunal

66
Q

What are some key considerations for assessment, Temporary Treatment & Treatment Orders?

A
  • An Authorised Psychiatrist who made a person subject to an Assessment order cannot make the person subject to a TTO (a safe guard to reduce the likely hood of treatment being restrictive)
  • The patient cannot discharge themselves from compulsory status or hospital.
    - Patients AWOL would be reported to Police and returned to a MHS when located (under s.352)
    - The patient must have any leave from hospital approved by the Authorised Psychiatrist (AP)
  • The Authorised Psychiatrist in making a TTO, or the MHT in making a TO, must take the patient’s and nominated person’s views, beliefs and preferences into account, along with the advance statement (if completed) and wishes of family &/or carers (parent if under theage of 18)
  • A person subject to a TTO/TO can apply to the MHT to have the order revoked at any time
  • If treatment criteria is not met (even just one component), an authorised psychiatrist must revoke an order at any time
67
Q

Describe ones rights to a second opinion

A

Definition provided in s.78 for an “entitled patient” which is any compulsorily detained person subject to TTO/TO, security and forensic patients to access a second opinion
- Can be requested at any time
- Written report of the second opinion will be provided to the patient, authorised psychiatrist, nominated person and others
- Second opinions will continue to be provided by psychiatrists working in public mental health services, however patient can seek the second opinion from any psychiatrist
- Funds committed to second opinions from psychiatrists working in private practice to promote access and choice. To ensure access for all
- Promotes dialogue between clinicians and compulsory patients about treatment

68
Q

Explain the process of someone being subject to an assessment order after being apprehended by police

A

A police officer may apprehend a person if satisfied that:
- The person appears to be mentally ill; and
- The person needs to be apprehend to prevent serious and imminent harm to themselves or others

The police member is not required to exercise clinical judgement and is only required to have reasonable grounds to form the belief that a person is mentally ill and has or is likely to harm themselves/others

No form required for s351

Police must arrange to have the person taken to a registered medical practitioner or mental health practitioner for examination

Assessment order process begins

The Act enables police to release the person from their custody into the care of a hospital
when safe to do so

69
Q

Define and describe the restrictive intervention: seclusion

A

= Seclusion means the sole confinement of a person to a room or any other enclosed space from which it is not within the control of the person confined to leave” (Mental Health Act 2014 (Vic), p. 12)

Seclusion can be used in a designated mental health service in order to prevent imminent and serious harm to the person or another person (s110)

Must be authorised by either an authorised psychiatrist, or if the authorised psychiatrist is not immediately available, a medical practitioner or the most senior registered nurse on
duty (s.111)

70
Q

Explain the monitoring of someone in seclusion (S.112)

A
  1. The person in seclusion must be monitored in accordance with section 112.
  2. Be reviewed as clinically appropriate to his or her condition at intervals of not more than 15 minutes by a
    registered nurse or medical practitioner; and
  3. Subject to sub-section (4), an AP must examine a patient in seclusion as frequently as the AP deems is appropriate in the circumstances, but at intervals not less than 4 hourly; and
  4. If it is not practicable for the AP to examine the patient at a frequency the AP deems appropriate, the patient must
    be examined by a registered medical practitioner as directed by the AP

Additionally, the patient should …
- Be supplied with bedding and clothing which is appropriate in the circumstances
- Be provided with food and drink at the appropriate times
- Be provided with adequate toilet arrangements
- Cease the seclusion when it is no longer necessary

71
Q

Define and describe the restrictive intervention: restraint

A

= “Bodily restraint means a form of physical or mechanical restraint that prevents a person having free movement of his or her limbs, but does not include the use of furniture
(including beds with cot sides and chairs with tables fitted on their arms) that restricts the person’s ability to get off the furniture” (Mental Health Act 2014 (Vic), p. 4)

  • Can only be used in a designated mental health service if it is necessary
    - To prevent imminent and serious harm to the person or another person
    - To administer treatment or medical treatment to the person
  • Must be authorised by either an authorised psychiatrist, or if the authorised psychiatrist is not immediately available, a medical practitioner or the most senior registered nurse on duty (s.114, urgent use s.115)
72
Q

Explain the monitoring of someone in bodily restraint (s.116)

A

Similar to seclusion only that a person under restraint must be continually monitored by a nurse.

  1. If bodily restraint is used the person must be monitored in accordance with this section
  2. Must be under continuous observation by a registered nurse or registered medical
    practitioner
  3. A registered nurse or registered medical practitioner must clinically review the use of the
    restraint as often as appropriate, but not less frequently than every 15 minutes
  4. Subject to subsection (5) an authorised psychiatrist must examine the person as
    appropriate, but not less frequently than every 4 hours
  5. If the authorised psychiatrist cannot conduct the examination or it is not practicable, this
    can be delegated to a registered medical practitioner
73
Q

Who is on a mental health tribunal?

A

The Mental Health Tribunal comprises of three members: - - someone of legal background
- community member
- psychiatrist or registered medical practitioner

74
Q

What is the role of the mental health tribunal?

A

The role of the Mental Health Tribunal is to:
- Make TO (s.55) after considering the AP application and views of patient / relevant others
- Revoke a TTO or TO
- Decide the initial setting where treatment will be provided (inpatient or community) or transfer to another DMHS
- Hear and determine applications for ECT on a patient who does not give consent or a person under the age of 18 years
- Hear and determine applications for neurosurgery
* Also hears applications related to Court Secure Treatment Orders and revocation of Secure Treatment Orders (initiated by the patient), applications for leave by security patients, interstate

75
Q

Describe electroconvulsive therapy (ECV)

A

An AP can make an application to the MHT to perform a course of ECT on a patient (who is not a young person) if
- The patient does not have the capacity to consent
- The authorised psychiatrist is satisfied that there is no less restrictive way for the person to be treated

For a young compulsory person, the tribunal must determine
- Does the young person have capacity to give informed consent?
- Yes – tribunal cannot approve ECT without informed consent
- No – is ECT the less restrictive treatment option?

For a young voluntary person the tribunal must determine
- Does the young person have capacity to give informed consent?
- Yes – tribunal cannot approve ECT without informed consent
- No – has the parent provided consent to Tribunal ECT application?

76
Q

What are some other external parties relevant to MHN’s
& DMHS as per the Act and what are their roles?

A

The role of the chief psychiatrist is to:
1. To provide clinical leadership and expert clinical advice to mental health service providers in Victoria; and
2. To promote continuous improvement in the quality and safety of mental health services provided by mental health
service providers; and
3. To promote the rights of persons receiving mental health services from mental health service providers; and
4. To provide advice to the Minister and the Secretary about the provision of mental health services by mental health service providers

The role of community visitors is to:
- Inquire into whether service is being provided in accordance with the MHA (incl. objectives and principles)
- Visit and inquire into the adequacy/standards of services/accommodation and opportunities for recreation,
occupation, education, training
- Help people receiving MH services resolve issues, seek support, make complaints

The mental health complaints commissioner
- “The Mental Health Complaints Commissioner is independent, specialist body established under the Mental Health Act 2014 (the Act) to safeguard rights, resolve
complaints about Victorian public mental health services and recommend improvements”
- an independent body that can investigate complaints
- key for advocacy

77
Q

When must mental health information be disclosed as per the mental health MHA 2014

A

The MHA 2014 mandates when a persons mental health information must be disclosed and to whom, for example:
- To carers where a decision will directly affect the carer or the care relationship
- To carers when it is required for a carers to be able to perform, or prepare for, their caring role
- To nominated persons, guardians and parents of patient under 16 years

Breaches of confidentiality can continue to occur if a duty of care exists, for example:
- A patient making suicidal and/or homicidal threats
- Notifying the police of potential hazards when asked to perform ‘welfare’ checks on patients

78
Q

Explain consumer or carer advocacy workers and their role

A
  • Advocates assist patients to understand and exercise their rights and support them to participate in decisions about their assessment, treatment and recovery
  • Not prescribed in the MHA
  • Advocacy services exist in the form of consumer and carer consultants employed by MHS
  • The Mental Health Complaints Commissioner is established under the Act to safeguard rights and resolve complaints about Victorian Public mental health services and recommended improvements

NUR2225 (9 decks)

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