Mental Health Act

Question 1

WHat is the mental health act (MHA) used for?

Answer 1

Ensure patients with mental disorders impairing their judgement receive effective treatment

Question 2

What are the 10 Millan Principles upheld in the Mental Health Act (MHA)?

Answer 2

• Non Discrimination
• Equality
• Respect for Diversity
• Reciprocity
• Informal Care
• Participation
• Respect for Carers
• Least Restrictive
• Benefit
• Child Welfare (no lower age limit on mental health act)

Question 3

WHat are the 5 criteria which must be met for detainment under the MHA?

Answer 3

1. (Likely) Mental Disorder
2. Significantly Impaired Decision Making Ability
3. Determining treatment required (Giving treatment – STD and CTO)
4. Significant risk (safety of patient or others)
5. Informal/voluntary care not appropriate

Question 4

What IS considered a mental disorder that would allow detainment under the MHA?

Answer 4

Mental Illness
Learning Disability
Personality Disorder

Question 5

What is NOT considered a mental disorder that would allow detainment under the MHA?

Answer 5

• Sexual orientation/deviancy
• Transsexualism/Transvestism
• Alcohol/drug dependence
• Behaviour likely to cause harassment, alarm or distress
• Acting as no other prudent person would act

Question 6

Why is incapacity different from “Significantly Impaired Decision Making Ability” (SIDMA)?

Answer 6

SIDMA = mental disorder alone

Incapacity = also disease of the brain, physical disability, impaired cognition

Question 7

HOw should SIDMA be documented properly to prove their decision making is impaired?

Answer 7

• Explain symptoms they are experiencing
• What mental disorder this links to
• How this impairs their decision making

Question 8

Aside from medical treatment, what other treatment can be given under the mental health act?

Answer 8

Nursing care
Psychological interventions
Rehabilitation
ECT
Refeeding
Specialist intervention (OT, SALT, Dietetics)

Question 9

What would indicate that a patient is a risk to themself?

Answer 9

• Suicide
• Self harm
• Wandering (e.g. in dementia)
• Vulnerability
• Deterioration in mental state
• Physical health – starvation, dehydration
• Poor self care
• Retaliation from others due to aggressive behaviour

Question 10

What would make you concerned that a patient is a risk to others?

Answer 10

Aggression
Violence
Sexual assault
Intimidation
Arson

Question 11

WHen would hospital admission be seen as the “least restrictive option”?

Answer 11

If patient is:

• refusing to remain in hospital
• Incapable of making a decision about remaining in hospital
• Unable to be treated in the community due to level of risk
• Community treatment failed

Question 12

What is an Emergency Detention Order?

Answer 12

Patient with a likely mental disorder can be detained for up to 72 hours (should be reassessed every 24 hours or so to make sure this is still appropriate)

Does NOT authorise DR to give any treatment

No right of appeal => patient cannot contact solicitor for legal action

Question 13

Who can issue an Emergency Detention Order?

Answer 13

Fully registered doctor (FY2 and above)

Where possible, a mental health officer (MHO)
should also agree to it

Question 14

What is a Short Term Detention?

Answer 14

A patient with a likely mental disorder can be detained for up to 28 days for assessment/treatment

Patients have the right to appeal => can get a lawyer involved if they wish

Question 15

For how long can a Short Term Detention be extended?

Answer 15

3 days if extra time needed to put together CTO application

OR 5 days once CTO application submitted

Question 16

How long does an initial Compulsory Treatment order last and what happens after it is reviewed?

Answer 16

Initially 6 months, then patient is reviewed

If CTO requires renewal, then this is completed at the 6 month mark, and then annually going forward.

Question 17

Who and what reports are required to issue a compulsory treatment order (CTO)?

Answer 17

• Approved Medical Practitioner + Mental Health Officer
• Reports from 2 independent doctors (2 AMPs or AMP+ Patient’s GP)
• Care plan
• MHO report
• MHO makes application to the tribunal service as a tribunal is mandatory

Question 18

How long is treatment authorised for during a CTO and Short Term Detention?

Answer 18

Treatment authorised for up to 2 months of detention

Question 19

When may urgent treatment be given under an Emergency Treatment Order (aka where you are not authorised to give treatment) ?

Answer 19

• To save the patient’s life
• To prevent serious deterioration in patient’s condition
• To alleviate serious suffering
• To prevent the patient from being a danger to themselves or others

Question 20

What certificate must be completed after 7 days of Emergency Treatment?

Answer 20

T4 certificate

Question 21

What treatments cannot be given under an STD or CTO

Answer 21

ECT
Nutrition (e.g. NG tube feeding)
Vagus Nerve Stimulation
Any medicine to reduce sex drive 
Neurosurgery

Question 22

What is an Advance Statement?

Answer 22

• Paperwork signed when the person is well
• How they would prefer to be treated if they were to become ill in the future
• Witnessed and dated

Question 23

An Advance Statement can’t be overruled. TRUE/FALSE?

Answer 23

FALSE

it can be overruled

Question 24

What are the rights of a named person?

Answer 24

• Patients choose person to support them and protect their interests
• They have the same rights to be notified of, attend be and represented at Tribunal hearings as the patient does
• they also gain a copy of detainment paperwork on the patient’s behalf

Question 25

What is an independent advocate and why do some mental health patients choose to have one?

Answer 25

Every mental health patient has a right to an independent advocate should represent their wishes without judging or giving a personal opinion

Question 26

Who MUST be present on the panel at a Mental Health Tribunal to authorise a CTO, and where do they take place?

Answer 26

Panel – a psychiatrist, a convenor (solicitor) and a third person with other experience (e.g. MH patient or MH nurse)

Take place in hospital

Question 27

Who else is allowed to be present at a Mental Health Tribunal?

Answer 27

Patient + their solicitor
Approved Medical Practitioner + solicitor
Mental Health Officer (MHO)
Named person + solicitor
Curator Ad Litem (Legal representative from court to represent best interest of patients who lack capacity)
Nursing Staff

Question 28

Who can issue a Nurse’s Holding Power to keep a patient admitted whilst waiting on a doctor to complete a detention order?

Answer 28

Registered mental health nurse OR intellectual disability nurse

Question 29

How long can patients be held under “Nurses Holding Power” ?

Answer 29

Up to 3 hours

Question 30

What is involved in Policing Powers and how long can this be in place?

Answer 30

• Removal to a place of safety from a public place
• Patient appears to have mental disorder and is in need of care and treatment
• Held for up to 24 hours to allow assessment to be carried out

Question 31

When would it be appropriate to use Section 47 of the Adults with Incapacity act instead of an Emergency or Short Detention order under the mental health act?

Answer 31

If a patient was in very ill health and needed immediate treatment

• using the MHA involves documentation and the presence of certain people (e.g. MHO/ psychiatrist)
• EDO also doesnt allow for treatment but AWI does