Psychiatry and Law

Question 1

The mental health act (2007) matches which of the following:

1 - civil law of compulsory admission for up to 28 days for assessment and treatment
2 - civil law relating to the involuntary treatment and admission of patients with mental health disorders
3 - civil law relating to consent, capacity and deprivation of liberty
4 - criminal law as it relates to mental health

Answer 1

2 - civil law relating to the involuntary treatment and admission of patients with mental health disorders

Question 2

The mental health act (2007) relates to the civil law relating to the involuntary treatment and admission of patients with mental health disorders. It has 3 purposes, which of the following is NOT one of these purposes?

1 - ensure essential treatment
2 - protect individuals from going to prison
3 - protect other people
4 - protect individuals from wrongful detention

Answer 2

2 - protect individuals from going to prison

Question 3

Ensuring essential treatment is one of the 3 key purposes of the mental health act. Which of the following criteria are used to decide if a treatment is essential for a patient?

1 - safety of the patient
2 - safety of others
3 - prevent deterioration in health that could lead to unsafe for the patient or others
4 - all of the above

Answer 3

4 - all of the above

Question 4

According to the mental health act (2007), what is the definition of a mental disorder?

1 - impaired ADLs
2 - unable to work
3 - disorder or disability of the mind
4 - all of the above

Answer 4

3 - disorder or disability of the mind

• dependence on alcohol and drugs is NOT included
• learning difficulty, UNLESS accompanied by abnormal aggression is NOT included

Question 5

Typically what % of patients with mental health disorders are sectioned under the mental health act (2007)?

1 - 1-5%
2 - 10-15%
3 - 20-30%
4 - >55%

Answer 5

2 - 10-15%

Question 6

Are the majority of mental health patients admitted under MHA (2007) or admitted voluntarily?

Answer 6

• voluntarily

Question 7

The mental capacity act (2005), including deprivation of safeguarding (DoLS) matches which of the following?

1 - civil law of compulsory admission for up to 28 days for assessment and treatment
2 - civil law relating to the involuntary treatment and admission of patients with mental health disorders
3 - civil law relating to consent, capacity and deprivation of liberty
4 - criminal law as it relates to mental health

Answer 7

3 - civil law relating to consent, capacity and deprivation of liberty

Question 8

Is the mental capacity act generic that covers everything?

Answer 8

• no
• questions must be specific to time and decision specific
• e.g. do you want some cake = yes
• do you want a bypass? This is much more complex and requires further brain function

Question 9

What is section 2 of the MHA (2007)?

1 - treatment for up to 6 months
2 - admitting/assessing a patient for 28 days
3 - police can remove a patient with mental health disorder form public area and take to place of safety
4 - patient can be detained for up to 6 hours by a psychiatric nurse

Answer 9

2 - admitting/assessing a patient for 28 days

Question 10

At the end of a section 2 of the MHA, do patients automatically get discharged?

Answer 10

• some can
• OR the section 2 is converted to a section 3 for treatment

Question 11

Who is required to apply for a section 2 of the MHA (2007)?

1 - approved mental health professional (AMHP)
2 - a doctor with section 12 approval (special expertise in diagnosing mental health disorders)
3 - one clinical doctor with experience in mental health disorders (MHD)
4 - all of the above

Answer 11

4 - all of the above

• patient must be suffering with MHD and warrant assessment for MHD
• person is detained for their own and/or others safety

Question 12

What is section 3 of the MHA (2007)?

1 - treatment for up to 6 months
2 - admitting/assessing a patient for 28 days
3 - police can remove a patient with mental health disorder form public area and take to place of safety
4 - patient can be detained for up to 6 hours by a psychiatric nurse

Answer 12

1 - treatment for up to 6 months

• can be extended to a year following this
• BUT if no longer requiring voluntary treatment, patients can be discharged

Question 13

Who is required to apply for a section 3 of the MHA (2007)?

1 - approved mental health professional (AMHP)
2 - a doctor with section 12 approval (special expertise in diagnosing mental health disorders) who has seem the patient in last 24h
3 - one clinical doctor with experience in mental health disorders (MHD) who has seem the patient in last 24h
4 - appropriate medial treatment must be available to keep the patient admitted
5 - all of the above

Answer 13

5 - all of the above

Question 14

In a section 3 (detention for treatment for 6 months), can patients bet treated against their own will?

Answer 14

• yes for 1st 3 months
• after 1st 3 months the patient must provide consent, OR a second doctor csan review and override this
• Electro-convulsive therapy has its own separate guidelines

Question 15

Can patients appeal against a section 2 or 3?

Answer 15

• yes
• referred to a mental health review tribunal
• needs a lawyer, psychiatrist and lay member

Question 16

Advocacy is a part of the MHA (2007). What is this?

1 - patients have a right to appeal against a section 2 or 3
2 - a civil servant who acts on behalf of the patient
3 - member of the medical team who acts in the best interests of the patient
4 - all of the above

Answer 16

2 - a civil servant who acts on behalf of the patient

• makes sure human rights are ok
• ensures the patient understands everything
• can help the patient appeal against a section 2 or 3

Question 17

A section 4 of the MHA (2007) allows for emergency admission of patients, without all the logistics of section 2. How long can a section 4 last for?

1 - 24h
2 - 48h
3 - 72h
4 - 96h

Answer 17

3 - 72h
- non-renewable
- needs 1 doctor (not section 12 approved)
- generally converted to a section 2 upon arrival at hospital

Question 18

Which 2 of the following can request an application of section 4 of the MHA (2007)?

1 - nearest relative
2 - section 12 doctor
3 - approved mental health professional (AMHP)
4 -police

Answer 18

2 - section 12 doctor
3 - approved mental health professional (AMHP)

Question 19

Which of the following are important in a section 5 (2) of the MHA (2007)?

1 - any doctor has capacity to detain a patient
2 - patient can be in any type of hospital
3 - does not include emergency department
4 - can detain the patient for up to 72 hours
5 - all of the above

Answer 19

5 - all of the above
- doctor should liaise with a psychiatrist within the 72 hour window

Question 20

Which of the following are important in a section 5 (4) of the MHA (2007)?

1 - any psychiatric nurse has capacity to detain a patient
2 - approved mental health professional (AMHP) can detain a patient
3 - patient is attempting discharge
4 - can detain the patient for up to 6 hours
5 - all of the above

Answer 20

5 - all of the above

Question 21

What is section 136 of the mental health act?

1 - treatment for up to 6 months
2 - admitting/assessing a patient for 28 days
3 - police can remove a patient with mental health disorder form public area and take to place of safety
4 - patient can be detained for up to 6 hours by a psychiatric nurse

Answer 21

3 - police can remove a patient with mental health disorder form public area and take to place of safety

Question 22

What is section 135 of the mental health act?

1 - treatment for up to 6 months
2 - admitting/assessing a patient for 28 days
3 - police can remove a patient with mental health disorder form public area and take to place of safety
4 - approved mental health professional (AMHP) requests warrant for police to enter premises and detain individual at a safe location

Answer 22

4 - approved mental health professional (AMHP) requests warrant for police to enter premises and detain individual at a safe location

Question 23

The MHA (2007) states that patients can only be treated for their mental health problems, and not physical problems. However, there are 2 exceptions to this rule, which 2 of the following?

1 - enforced feeding for anorexia nervosa
2 - if a police warrant is issued
3 - treatment following suicide if attempt is linked to mental health disorder
4 - if patient is on a section 3

Answer 23

1 - enforced feeding for anorexia nervosa
- this is deemed to be a mental health disorder

3 - treatment following suicide if attempt is linked to mental health disorder

Question 24

Which of the following are important aspects of consent?

1 - must be voluntary
2 - given voluntarily without undue force
3 - consent must be informed
4 - all of the above

Answer 24

4 - all of the above

Question 25

The mental capacity act (2005) relates to whether all patients can provide consent. Which of the following underpin this act?

1 - adult is assumed to have capacity until proven otherwise
2 - patient should not be treated until all practical steps have been taken to help them
3 - unwise decisions should not be misunderstood with lack of capacity
4 - treatment is based on the patients best interests
5 - treatment should be the least restrictive option for the patient
6 - all of the above

Answer 25

6 - all of the above

Question 26

To have capacity a patient must have how many of the following:

• understand the information they have been given
• retain information they have been given
• weight up information given to make a decision
• communicate their decision

1 - all 4
2 - >3
3 - >2
4 - 1

Answer 26

1 - all 4

Question 27

What is an advance decision to refuse treatment?

1 - a legal document giving a name individual power over their healthcare
2 - acting in the best interest of the patient, regardless of what they want
3 - decision make when patient had capacity to decline further treatment
4 - all of the above

Answer 27

3 - decision make when patient had capacity to decline further treatment

Question 28

What is a lasting power of attorney?

1 - a legal document giving a name individual power over their healthcare
2 - acting in the best interest of the patient, regardless of what they want
3 - decision make when patient had capacity to decline further treatment
4 - all of the above

Answer 28

1 - a legal document giving a name individual power over their healthcare

• can relate to health, welfare, financial and property

Question 29

In criminal law there is something called the defence of insanity. Which of the following must be true for a patient to be acquitted of their crimes under insanity?

1 - patient must have disease of the mind
2 - disease of mind must be present prior to offence
3 - disease of the mind led to offence and defect of reason
4 - patient is unaware what they were doing was wrong
5 - all of the above

Answer 29

5 - all of the above

Question 30

In criminal law there is diminished responsibility. Which of the following is the only time this can be used?

1 - homicide
2 - assault
3 - assisted suicide
4 - armed robbery

Answer 30

1 - homicide
- jury need to be convinced that an underlying mental health disorder led to crime
- charge can then be reduced to manslaughter

Question 31

Common law essentially means that touching a patient without valid consent may constitute the civil or criminal offence of battery. Does this always hold true?

Answer 31

• no
• common law doctrine of necessity states that in urgent settings that a patient can receive treatment if there is not time for a MHA or MCA assessment

Question 32

If a patient is injured and as a result of their injuries they have developed delirium and they are refusing treatment, would this require a MHA or MCA assessment?

Answer 32

• mental capacity act
• this is because the patients delirium and therefore ability to give consent is caused by the patients injuries and needs treating