legal aspects of psychiatry

Question 1

why do we have mental health law

Answer 1

power to provide compulsory care and treatment for people w/ mental disorder

rights and safeguards to make sure those powers are used appropriately

duties on NHS boards and local authorities to provide a wide range of services for people w/ a mental disorder

Question 2

mental health care and treatment act 2003 - principles

Answer 2

non-discrimination
equality 
respect for diversity 
reciprocity 
informal care
participation
respect for carers
least restrictive alternative 
benefit 
child welfare

Question 3

what is a mental disorder defined as but the MH(C+T) act 2003

Answer 3

any mental illness, personality disorder or learning disability however caused or manifested

if it is only one of these things it is not a mental disorder:
- sexual orientation, sexual deviancy, transsexualism, transvestism, dependence on/use of drugs or alcohol; behaviour that causes/is likely to cause harassment/alarm/distress to any other person; acting as no prudent person would

Question 4

who can be detained under the MH (C+T) act

Answer 4

> 18yrs

> 18yrs

• can still be detained
• need child/adolescent specialist
• use specialist resources wherever possible

Question 5

overview of key civil compulsory power

Answer 5

emergency detention certificate (EDC) - detention for up to 72hrs
short term detention certificate (STDC) - detention for up to 28 days, has to be done by a specialist
compulsory treatment order (CTO) - detention for up to 6mths, renewable on an annual basis
nurses holding power - detention for up to 3hrs, allows holding until assessment by a doctor

Question 6

EDC - who can do it

Answer 6

registered medical practitioner

Question 7

what must be considered likely to give an EDC

Answer 7

the patient has a mental disorder, and

because of that mental disorder the patient’s decision making ability with regard to medical treatment for that mental disorder is significantly impaired

Question 8

what must you also be satisfied that when giving an EDC

Answer 8

it is necessary as a matter of urgency to detain the patient in hospital in order to determine what medical treatment should be provided to the patient for the suspected mental disorder

there would be a significant risk to the health, safety or welfare of the patient or to the safety of another person if the patient were not detained in hospital and

making arrangements w/ a view to granting a short-term detention certificate would involve undesirable delay

Question 9

who can give a STDC

Answer 9

approved medical practitioner -someone who has special recognition under the law as a specialist e.g. consultant, specialty trainee etc

Question 10

what must be considered likely when giving an STDC

Answer 10

the patient has a mental disorder

because of that mental disorder, the patients ability to make decisions about the provision of medical treatment is significantly impaired

it is necessary to detain the patient in hospital for the purpose of determining what medical treatment should be given to the patient or giving medical treatment to the patient

if the patient were not detained in hospital there would be a significant risk to the health, safety or welfare of the patient or to the safety of any other person, and

the granting of a STDC is necessary

Question 11

getting a CTO

Answer 11

applicatio to mental health tribunal made by mental health officer for the granting of a CTO

tribunal considers evidence and makes decision

mental health reports - GP and approved medical practitioner or 2 approved medical practitioners

Question 12

what must you be satisfied of when granting a CTO

Answer 12

the patient has a mental disorder

medical treatment is available and would be likely to prevent deterioration or alleviate symptoms

w/o treatment there would be significant risk to health, safety or welfare of patient or safety of others

mental disorder significantly impairs decision making ability

making of compulsory treatment order is necessary

Question 13

criteria for detention

Answer 13

some differences between the orders but overall:

mental disorder

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

significant risk to health, safety or welfare of the person or the safety of any other person

treatment available

order necessary

Question 14

what is a named person

Answer 14

a right to be a party to proceedings

must be nominated by the patient and witnessed and the name person must have witnessed acceptance

patient thinks their opinion would be important to the tribunal and to the professionals looking after them

Question 15

what is access to advocacy

Answer 15

right of every person with a mental disorder

Question 16

what does incapable mean

Answer 16

the person is incapable of

acting or 
making decisions or 
communicating decisions or 
understanding decisions o r
retaining the memory of decisions 

• has to be by reason of mental disorder or an inability to physically communicate those decisions

adult - person who has attained the age of 16yrs

Question 17

principles of adults with incapacity act

Answer 17

intervention must benefit the adult

any intervention shall be the least restrictive in relation to the freedom of the adult, consistent with the purpose of the intervention

account must be taken of the past and present wishes of the adult

where practicable, account should be taken of:

• views of relatives and carers
• views of relevant others - guardians, attorneys etc

Question 18

when is capacity presumed present

Answer 18

capacity is presumed to be present unless proven otherwise

Question 19

capacity and situation

Answer 19

capacity depends on the situation

may have capacity for some decisions but not others

Question 20

decision specific capacity - 3 areas

Answer 20

property
welfare (medical)
financial

Question 21

what is an intervention order

Answer 21

one off power required

application to the court

Question 22

what is a guardianship order

Answer 22

someone else is appointed to make decisions on behalf of the adult - financial, welfare or both

Question 23

adults with incapacity - medical treatment

Answer 23

Question 24

exclusions to incapacity

Answer 24

use of force or detention, unless it is immediately necessary and only for so long as it is necessary in the circumstances

action which would be inconsistent with any decision by a competent court

placing an adult in hospital for the treatment of a mental disorder against his will - has to be properly done under mental health act

Question 25

what powers do police have

Answer 25

removal from a public place appears to be in immediate need to care or treatment to a place of safety detain for up to 24hrs purpose to allow assessment and make arrangements for their care and treatment

Question 26

criminal responsibility and mental disorder

Answer 26

a person isn't criminally responsible for conduct resulting in an offence if they were at the time of the offence unable by reason of mental disorder to appreciate the nature or wrongfulness of the conduct and should be acquitted of the offence they don't lack responsibility for such conduct if the mental disorder is only a personality disorder which is characterised only/mainly by abnormally aggressive or seriously irresponsible conduct

Question 27

when is a person unfit for trial

Answer 27

if they are incapable by reason of physical/mental illness to participate effectively in the trial consider the ability of the person to - understand the nature of the charge - understand the requirement to tender a plea to the charge and the effect of such a plea - understand the purpose of, and follow the course of the trial understand the evidence that may be given against the person - instruct and otherwise communicate w/ the person's legal representative

Question 28

disposal in case of insanity

Answer 28

Question 29

diminished responsibility

Answer 29

culpable homicide = manslaughter

Question 30

restricted pts

Answer 30

aka first minister pts ~1/2 aren't managed by forensic psychiatrists

Question 31

orders that confer restricted status

Answer 31

``` compulsion order and restriction order assessment order treatment order interim compulsion order transfer for treatment direction hospital direction ```

Question 32

what is the effect of being restricted

Answer 32

you are subject to special restrictions special provisions for leave - MAPPA, SGMHD oversight by scottish ministers duties on ministers and RMO to review at certain points specific functions for the tribunal

Question 33

assessment order

Answer 33

court satisfied that there are reasonable grounds (one registered medical practitioner)- mental disorder, detention in hospital is necessary, civil risk criterion met, treatment, suitable bed available within 7 days, assessment could not be undertaken if not in hospital court also has to consider - all the circumstances incl. offence - any alternative means of dealing w/ the person

Question 34

treatment order

Answer 34

lasts until final disposal or another order is granted court satisfied on the basis of evidence from 2 RMP (one must be approved) - mental disorder, treatable, civil risk suitable bed available within 7 days - reasonable alternative? necessity need to consider all of above treatment may be given (under STD but not ECD)

Question 35

compulsion order

Answer 35

court satisfied on the basis of evidence from 2 RMP (one must be approved) - mental disorder, availability of medical treatment, significant risk, necessary to be in hospital need to consider the level of scrutiny need to consider if a restriction order is necessary

Question 36

restriction order

Answer 36

court must hear ORAL evidence from at least one medical practitioner court must be satisfied that the criteria are met - having regard to the nature of the offence of which he is charged - the antecedents of the person - the risk that as a result of his mental disorder he would commit offences if set at large that it is necessary for the protection of the public from serious harm person shall be subject to the special restrictions w/o limit of time

Question 37

effect of a restriction order

Answer 37

w/o limit of time cf 6mths RMO must review annually MWC can initiate a review scottish ministers have a duty to review patient and named person can make an application for a review by a tribunal automatic hearing if no hearing in last 2yrs MHO has responsibilities as CO and are set out in MOP

Question 38

what is a state hospital

Answer 38

for people subject to detention under the criminal procedure act or the mental health (C+T) act who require treatment under conditions of special security on account of their dangerous, violent or criminal propensities 1 in scotland - high secure care for scotland and NI; rigorous physical, relational and procedural security

Question 39

what is a medium secure unit

Answer 39

step down from high security or step up from low security 3 in scotland, all function slightly differently less security that the state hospital but maintains a higher degree of procedural, relational and physical security than low secure units

Question 40

what is a low security unit

Answer 40

lower level of security pts in general will have more access to the community relatively lower level offenders or step down through the pathways of care transferred prisoners not NO security

Question 41

presence of mental illness in prison

Answer 41

4% M and W - psychotic illness 10% M, 14% W - major depression 18-30% M, 10-24% W - alcohol misuse 10-48% M, 30-60% W - drug misuse

Question 42

mental illness and violence

Answer 42

people w/ severe mental illness more likely to have a hx of violence severe mental illness not at higher risk of serious violence (deadly weapons, forced sexual acts etc), also not more likely to be bizarre US pop survey - 75% viewed those w/ mental illness as dangerous, 60% believed people w/ sz were likely to commit violent acts

Question 43

what affects risk of violence in mental illness

Answer 43

risk of violence will fluctuate depending on contextual factors dynamic factors may be an intervention target - work, diagnosis, marital conflict, anxiety management to combat stress

Question 44

mental illness and violence - UK populaiton attributable risk

Answer 44

the reduction in frequency of people committing 5 or more violent incidents in 5yrs that would occur if the risk factor in question was removed entirely from the population ``` psychosis - 2% ASPD - 20% personality disorder - 33% hazardous drinking - 55% drug dependence - 21% ```