Mental Health Law

• When is sectioning under the Mental Health Act used?

  Someone who will not be admitted voluntarily

  Excludes pt who are under the influence of alcohol/drugs
• What is Section 2?

  Admission for assessment for up to 28 days (not renewable)

  Approved Mental Health Professional (AMHP) or the nearest relative (rare) makes application on recommendation of 2 doctors

  • 1 of the doctors should be 'approved' (usually a consultant psychiatrist)
  • 1 doctor must have seen pt within previous 14 days

  Treatment can be given against pt's wishes
• What is Section 3?

  Admission for treatment for up to 6 months (can be renewed)

  Application made by AMHP along with 2 doctors (both have to have seen the pt within the past 24 hours)

  Treatment can be given against pt's consent for 3 months, after this approval is required by a second opinion approved doctor (SOAD)
• What is Section 4?

  Lasts 72 hours or until Mental Health Act assessment is arranged or have sufficient doctors for a Section 2

  Used as an emergency when a section 2 would involve an unacceptable delay

  Applied by a GP and an AMHP or nearest relative

  Often changed to a section 2 upon arrival at hospital
• What is a Section 5 (2)?

  A patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

  Can only be used by a fully registered doctor (FY2 & above)

  Cannot be renewed or extended

  Written report must be submitted to hospital managers

  Should not treat without consent on a section 5, only if there is significant risk to self or other
• What is a Section 5 (4)?

  Similar to section 5 (2)

  Allows a nurse to detain a pt who is voluntarily in hospital for 6 hours, cannot be renewed

  Only used by a trained mental health or learning disability nurses if no doctor is available

  Can only be used in a psychiatric hospital

  Section terminates as soon as docotor arrives on the ward
• What is a Section 17a?

  Supervised Community Treatment

  Can be used to recall a pt to hospital for treatment if they do not comply with conditions of the order in the community (e.g. complying with medication)
• What is a Section 135?

  Court order

  Allows access to a private address without permission (inc necessary property damage)

  Can be used to take to a Place of Safety

  Can be kept under section for up to 36 hours
• What is a Section 136?

  Someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety (can be home, friend/relative's home, hospital or police station)

  Can only be used for up to 24 hours (whilst Mental Health Act assessment is arranged)
• What is consent?

  The voluntary and continuing permission of a patient to be given a particular treatment, based on a sufficient knowledge of the purpose, nature, likely effects and risks of that treatment, including the likelihood of its success and any alternatives to it.  

  Permission given under any unfair or undue pressure is not consent.
• Consent should be sought for each aspect of a person’s treatment as and when it arises.
• What are the implications of treating without consent?

  Criminal & civil consequences

  Potential breaches of Human Rights Act (HRA)
• What is the Mental Capacity Act (2005)?

  Applies to all people age 16 years & over

  Provides legal framework to empower & protect people who may lack capacity to make some decisions for themselves
• What is the Deprivation of Liberty Safeguards (DoLS)?

  An addition to the Mental Capacity Act (MCA)

  Due to physical condition rather than a mental health condition

  Safeguards provide positive protection for adults in hospitals or care homes in circumstances that amount to a deprivation of their liberty, but who lack capacity to the care or treatment they need

  Reviewed every 7 days
• What are the 5 key principles of MCA?

  1. Presumption of Capacity - every adult has right to make own decisions & must be assumed capacity unless proven otherwise
  2. Individuals being support to make their own decisions - give all practicable help before deciding pt does not have capacity
  3. Unwise decisions - if pt makes an unwise decision, they should not be treated as lacking capacity 
  4. Best interests - act/decision made under MCA, must be done in their best interests 
  5. Least restrictive option - anything done under MCA should be least restrictive of basic rights of freedoms
• What is the 2 stage test of capacity?

  Does the person have an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind works? (does not matter whether the impairment or disturbance is permanent or temporary)

  If yes, does the impairment/disturbance mean that the person is unable to make a specific decision at the time it needs to be made?
• What must pts be able to do to have capacity?

  Understand the information relevant to the decision (inc resonably forseeable consequences of making or not making decision)

  Retain information (for long enough to make the decision)

  Use or balance/weigh up the information (as part of the decision making process)

  Communicate the decision (in any recognisable way)

  Failure in any of these, means person lacks capacity
• Decision Algorithm

  
• Does capacity always mean the patient has insight?

  No
• What is the Mental Health Act?


  Legal framework for detaining & treating patients with psychiatric illness

  Used when pts are unwilling or lack capacity to consent
• What are the 3 main criteria for the Mental Health Act?


  Mental disorder of a nature or degree which makes it appropriate for them to receive treatment in hospital

  Risk to self or others

  Appropriate treatment is available
• What are the 2 notable exclusions of the Mental Health Act?


  Dependence on drug or alcohol

  Learning disabilities

  (if in isolation, with no additional mental disorder or risk)
• What is Section 5?


  Used to stop patients from leaving hospital if they are in hospital voluntarily

  Any pt voluntarily on a locked ward must either be allowed to leave when asking or stopped under Section 5

  Section 5 should only be used when sections 2, 3 & 4 are not possible or safe to be used
• When is Section 2 chosen over Section 3?


  If pt has never been assessed, or it has been a long time since the last assessment
• What is an informal hospital admission?


  If a person has capacity to consent, and is consenting to an admission, they can (and should) be admitted informally (as the least restrictive option)

  If they lack capacity or are not consenting, providing they meet the criteria for detention, they must be detained under the MHA for admission
• What happens if a patient does not agree with their section?

  Section 2 & 3 can be appealed, via;

  • hospital managers OR
  • mental health tribunal

  Section 2 -> can appeal within first 14 days

  Section 3 -> can appeal within first 3 months
• You cannot treat physical health conditions unless they are as a direct consequence of mental health condition