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Medical Ethics & Law > Mental Health Legislation > Flashcards

Mental Health Legislation Flashcards

1
Q

What are the main laws of mental health legislation?

A
  • Mental Health (Care and Treatment)(Scotland) Act 2003
  • Adults with Incapacity (Scotland) Act 2000
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2
Q

Why would involuntary treatment occur?

A
  • Treatment of small group of patients
    • Severely unwell, lost touch with reality (psychotic)
    • Risk to self or others
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3
Q

How is involuntary treatment allowed?

A

Normally, involuntary treatment would constitute assault and breach laws of consent, mental health legislation provides a legal mechanism

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4
Q

What are some critisisms of involuntary treatment?

A
  • General
    • Ill-liberal
    • Poorly compatible with human rights normal
    • Practical problems with administering treatments
  • Ethical
    • Non-maleficence
    • Autonomy
    • Paternalism (ignores patients views)
    • Non-discrimination (physical vs mental illness)
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5
Q

What are the ethical justifications for involuntary treatment?

A
  • Beneficence
  • Autonomy (may promote reasoned autonomy)
  • Right to treatment
  • Paternalism
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6
Q

What is the mental health legislation in: Scotland, England and Wales, and Northern Ireland?

A

Scotland:

  • Mental Health (Care and Treatment)(Scotland) Act 2003

England and Wales:

  • Mental Health Act 1983 [amended by Mental Health Act 2007]

Northern Ireland:

  • Mental Health (Northern Ireland) Order 1986
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7
Q

Why is mental health law important?

A
  • Power to provide compulsory treatment to people with mental disorder
  • Safeguards to make sure used appropriately
  • Duties on NHS board to provide range of services for people with mental health disorder
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8
Q

What are some of the principles of the Mental Health (Care and Treatment)(Scotland) Act 2003?

A
  • Non-discrimination
  • Equality
  • Respect for diversity
  • Reciprocity
  • Informal care
  • Participation
  • Respect for carers
  • Least restrictive alternative
  • Benefit
  • Child welfare
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9
Q

What does the MH(S)A stand for?

A

Mental Health (Care and Treatment)(Scotland) Act 2003

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10
Q

What does the MH(S)A define mental disorder as?

A
  • Any mental illness or
  • Personality disorder or
  • Learning disability
  • However caused or manifested
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11
Q

The MH(S)A gives powers to what?

A
  • Civil compulsory powers
  • To detain
  • To assess
  • To treat
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12
Q

People who the MH(A)S applies to is determined by?

A
  • An approved medical practitioner
  • Mental Health Officer (MHO)
  • The court
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13
Q

What ages can be detained by the MH(S)A?

A

Anyone can be detained, but if under 18:

  • Need child/adolescent specialist
  • Use specialist resources wherever possible
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14
Q

What are the different civil compulsory powers of the MH(S)A?

A
  • Emergency detention certificate (EDC)
  • Short term detention certificate (STDC)
  • Compulsory treatment order (CTO)
  • Nurses holding power
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15
Q

What does EDC stand for?

A

Emergency detetion certificate

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16
Q

How long does an emergency detention certificate allow detention for?

A

Up to 72 hours

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17
Q

What does an emergency detention certificate allow?

A

Assessment and ER treatment only

Transfer to psychiatric hospital

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18
Q

Do patients have a right to appeal an emergency detention certificate?

A

No

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19
Q

Who can administer an emergency detention certificate?

A

Fully registered practitioner

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20
Q

When can an emergency detention certificate be used?

A

Patient is significant risk to self or others

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21
Q

How long does a short term detention certificate allow detention for?

A

Up to 28 days

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22
Q

Do patients have a right to appeal a short term detention certificate?

A

Yes

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23
Q

What does a short term detention certificate allow?

A

Assessment and treatment

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24
Q

What is the criteria for a short term detention certificate to be used?

A
  • Mental disorder
  • Ability to make decisions about medical treatment impaired (known as SIDMA)
    • Meaning lack of insight, cognitive impairment, psychosis, severe depressive syndrome or learning disability
  • It is necessary for purpose of treatment
  • Significant risk to own or others
25
Q

Who must a short term detention certificate be used by?

A

Approved medical practitioner (AMP)

26
Q

What does AMP stand for?

A

Approved medical practitioner

27
Q

What does CTO stand for?

A

Compulsory treatment order

28
Q

What does STDC stand for?

A

Short term detention certificate

29
Q

How long does a compulsory treatment order allow detention for?

A

Up to 6 months

30
Q

What is the criteria for a compulsory treatment order to be used?

A

Same as STDC:

  • Mental disorder
  • Ability to make decisions about medical treatment impaired (known as SIDMA)
    • Meaning lack of insight, cognitive impairment, psychosis, severe depressive syndrome or learning disability
  • It is necessary for purpose of treatment
  • Significant risk to own or others
31
Q

Who can use a compulsory treatment order?

A
  • Application by MHO to the MHTS
32
Q

Nurses holding power allows detention for how long?

A

Up to 2 hours

33
Q

What is SIDMA?

A

“significant impairment of decision making ability about medical treatment for mental disorder”

34
Q

What does MHTS stand for?

A

Mental health tribunal for Scotland

35
Q

Mental Health Tribunal for Scotland considers what?

A
  • Considers
    • Civil applications and review of civil and criminal orders
    • CTO applications
    • Appeals
    • 2 year mandatory reviews
    • Cross border transfers
    • Excessive security
36
Q

Does the MH(S)A authorise treatment of all a patients problems?

A

No, does not authorise treatment for an unrealted physical disorder

37
Q

What are police powers under the MH(S)A?

A
  • Removal from public place
  • Appears to be in immediate need of treatment for safety
  • Detain up to 24 hours
  • Mental health nurses have holding powers until assessment by a doctor
38
Q

Under the MH(S)A, police can detain for how long?

A

Up to 24 hours

39
Q

What does AWIA stand for?

A

Adults with Incapacity (Scotland) Act 2000

40
Q

AWIA describes “adult” and “incapable” as what?

A
  • Adult
    • Person 16 or over
  • Incapable
    • Incapable of acting or making decisions or communicating decisions or understanding decisions or retaining the memory of decisions
41
Q

What are some principles that must be considered when applying the AWIA?

A
  • Intervention benefit the adult
  • Intervention least restrictive as possible
  • Account of past and present wishes of adult
  • Where practical, account taken of relatives and carers
42
Q

Under the AWIA, is capacity presumed to be present or not present?

A

Capacity is presumed to be present unless proven otherwise:

  • Is decision specific, may have capacity for some decisions but not others
43
Q

What can be done to assess a patients capacity?

A
  • Gather information
    • History
    • Notes
    • Previous assessments
    • Carers/family
  • Clinical assessment
    • Focus on criterial for capacity (communication, understanding, retention of information, decision)
    • Can barriers be overcome
      • Communication with aids
      • Understanding with more information
      • Retention ask questions like “what did I tell you” and “ can you explain it to me”
      • Decision, is it clear what the decision is and is it consistent
44
Q

What is the criteria for capacity?

A
  • Communication
  • Understanding
  • Retention of information
  • Decision
45
Q

What are some different areas that the AWIA addresses?

A

Areas of things the act allows us to do:

  • Property
  • Welfare (medical)
  • Financial
46
Q

What are some powers of the AWIA?

A
  • Intervention order
    • Application to court
  • Guardianship order
    • Two doctors (one approved)
    • MHS application
    • Can be financial or welfare or both
    • Registered with the office of the public guardian
47
Q

What medical treatment is allowed under the AWIA?

A
  • Always treat emergencies
  • Cannot treat anything else unless person has capacity, or welfare guardian authorises or go through courts with a certificate of incapacity
  • If people disagree, will end up at Court of Session where must implement the judge’s decision
48
Q

When using a AWIA, if people disagree about treatment what must happen?

A
  • If people disagree, will end up at Court of Session where must implement the judge’s decision
49
Q

Under the AWIA, a certificate of incapacity does not authorise what?

A
  • Use of force or detention unless immediately necessary and only for as long as required in circumstances
  • Action which would be inconsistent with any decision by a competent court
  • Placing an adult in a hospital for treatment of mental disorder against their will
50
Q

What is the choice of which legislation to use determined by?

A

Is determined by aetiology:

  • Mental disorder
  • Physical disorder
  • Both

Or by treatment needs:

  • AWIA
    • Welfare
    • Financial and property
    • Physical illness
  • MH(S)A
    • Psychiatric
      • Can encompass secondary physical issues such as NG feeding
51
Q

What is the aetiology of delirium and incapacity?

A
  • Chest infection
  • Sepsis
  • Alcohol
  • BDZ withdrawal
52
Q

What are some treatment options for delirium and incapacity?

A
  • Abs
  • Hydration, thiamine, parvolex, diazepam
  • BDZ
53
Q

Summarise an advanced directive and an advanced statement?

A

Advanced directive:

  • Not statue
  • Treatment you don’t want when incapacitated
  • Has to be specific to the situation
  • In writing
  • Still valid

Advanced statement:

  • Treatment for medical disease that do or do not want when incapacitated
  • If override, write to the MWC with reason
54
Q

What legislation guides adult protection?

A

Adult Support and Protection (Scotland) Act 2007

55
Q

The Adult Support and Protection (Scotland) Act 2007 definds “adults at risk” as?

A
  • Unable to safeguard own well-being, property, rights or other interests
  • At risk of harm and
  • Because they have disability, mental disorder, illness or physical or mental infirmity are more vulnerable to being harmed than unaffected adults
56
Q

Under the Adult Support and Protection (Scotland) Act 2007, harm could be?

A
  • Conduct that causes physical or psychological harm (such as fear, alarm or distress)
  • Unlawful conduct
  • Conduct which causes self-harm
57
Q

What do you do if you suspect an adult at risk?

A
  • Discuss with senior
  • Document concerns
  • Report to relevant local authority
58
Q

What are local authorities duties after you report a suspected adult at risk, under the Adult Support and Protection (Scotland) Act 2007?

A
  • Make inquires to decide if action required
  • Apply to sheriff for grant of protection order, could be
    • Assessment order
    • Removal order
    • Banning order
    • Temporary banning order
  • Requires consent of vulnerable adult (and therefore capacity)

Medical Ethics & Law (14 decks)

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