Mental Health Act + Adults With Incapacity

Question 1

What are the 5 criteria for detention under the MHA?

Answer 1

1. likely mental disorder
2. significantly impaired decision making ability (SIDMA)
3. determining treatment required (giving treatment STD + CTO)
4. significant risk to health/safety/welfare of patient or safety of others
5. informal/voluntary care not appropriate

Question 2

What is the difference between SIDMA and incapacity?

Answer 2

SIDMA applies to mental illness only

Incapacity includes organic brain disease, impaired cognition etc

Question 3

What are the different types of detention in the MHA?

Answer 3

Emergency detention
Short term detention
Compulsory treatment order

Question 4

How long can a patient be held under emergency detention?

Answer 4

72 hours

Question 5

Who can carry out emergency detention?

Answer 5

Full registered doctor –> FY2 and above

Where possible, MHO should also agree to it

Question 6

How long can a patient be detained under a short term detention?

Answer 6

Up to 28 days

Question 7

Who is a short term detention approved by?

Answer 7

Approved medical practitioner (AMP) - usually psychiatrist

AND a mental health officer (MHO)

Question 8

Can a short term detention be extended?

Answer 8

Can be extended by 3 days if need to apply for CTO

Or 5 days once CTO application submitted

Question 9

How long can a patient be detained under a CTO?

Answer 9

Initially up to 6 months

Question 10

How in a CTO granted?

Answer 10

Reports from 2 independent doctors (2 AMPs or AMP + GP), a care plan + MHO report
–> application to tribunal services

Question 11

When is a CTO reviewed?

Answer 11

Renewed at 6 months, then yearly

Question 12

Which types of detention can be appealed?

Answer 12

Short term + CTO

can’t appeal an emergency detention

Question 13

Can treatment be given under emergency detention?

Answer 13

Only emergency treatment

Question 14

In which emergency circumstances can treatment be given under an emergency detention?

Answer 14

To save patients life
To prevent serious deterioration
To alleviate serious suffering
To prevent danger to patients or others

Question 15

Which form must be completed if giving treatment under emergency detention?

Answer 15

T4

Question 16

What are the guidelines for giving treatment under a short term detention or CTO?

Answer 16

2 months medication can be given, but exceptions:

• ECT
• nutrition
• vagal nerve stimulation
• transcranial magnetic stimulation
• any medications with purpose of reducing sex drive
• neurosurgery

Question 17

Which section of the MHA is emergency detention?

Answer 17

section 36

Question 18

Which section of the MHA is short term detention?

Answer 18

section 44

Question 19

What is an advanced statement?

Answer 19

Written statement, signed by the patient when they are well

Detailing how they would prefer/prefer not to be treated

Question 20

What is a named person?

Answer 20

Person chosen by patient to support them and protect their interests

Question 21

Can nurses detain patients against their will?

Answer 21

Yes - nurses holding power

registered mental health nurse or intellectual disability nurse

Question 22

How long can a patient be detained with a nurses holding power?

Answer 22

Up to 3 hours

- patient must be in hospital + receiving treatment

Question 23

What powers do the police have to detain people under the MHA?

Answer 23

If person appears to have a mental disorder + in need of care/treatment:
- can remove to place of safety from a public place

Question 24

How long can a person be detained with policing powers?

Answer 24

Up to 24 hours

Question 25

What are the criteria for valid consent?

Answer 25

``` Given freely without duress or coercion Legally capable of consenting Cover the intervention/procedure Informed Enduring ```

Question 26

What are the three requirements for having capacity to consent?

Answer 26

1. Understand and retain information 2. Weigh that information to make a decision 3. Communicate that decision

Question 27

What are the 3 main components of the Adults with Incapacity (AWI) Act 2000?

Answer 27

Section 47 Certificate of Incapacity Power of Attorney Guardianship

Question 28

When is a Section 47 Certificate used?

Answer 28

To authorise treatment of a physical disorder in someone without capacity to consent to that treatment

Question 29

What is the difference between Power of Attorney and Guardianship?

Answer 29

POA --> granted by patient while they still have capacity | Guardianship --> applied for by another person/authority once the patient has lost capacity

Question 30

When is MHA used over AWI and why?

Answer 30

MHA if actively resisting treatment for a mental health disorder (or physical consequences of a mental health disorder) --> provides more protection for the patient than AWI

Question 31

What is the age of legal capacity in Scotland?

Answer 31

16 | --> presumed to have capacity to make most decisions

Question 32

Can a child under 16 have capacity to consent?

Answer 32

Yes - based upon ability to understand and weigh up options, rather than age

Question 33

What should be done if a young person lacks capacity to make a decision about their care?

Answer 33

Ask one parent for consent | - if parents disagree, seek legal advice

Question 34

Can the MHA be used for children?

Answer 34

Yes - no lower age limit

Question 35

In which circumstances should the MHA be used for children, rather than parental consent?

Answer 35

Use of force Use of IM injection Certain treatments e.g. NG tube feeding, ECT Detrimental impact on relationship with carer