what is the purpose of the MHA
(1983) (updated in 2007)
provides a legal framework for keeping patients in hospital against their wish for assessment and treatment of a mental health disorder
- this is called being detained or sectioned under the Mental Health Act
what is it called when a patient with capacity agrees to be admitted to hospital voluntarily
voluntary or informal admission
informal admission does not involve detention under the MHA
which section of the MHA explains that patients can be admitted without involving the MHA
131
state 5 different people involved in MHA
- Approved Mental Health Professional (AMHP) is a specially qualified professional (e.g., social worker or mental health nurse) that helps organise and contribute to Mental Health Act assessments.
- Section 12 doctor is a qualified and approved doctor (usually a psychiatrist) who can undertake Mental Health Act assessments
- Responsible Clinician is the person with overall responsibility for the patient’s care (generally the consultant)
- Nearest Relative is someone close to the patient who is responsible for looking out for the patient’s interests
- Independent Mental Health Advocate (IMHA) is an independent person allocated to a patient being detained under the Mental Health Act - role is to support the person, help them understand the situation, and express themselves.
what are the stages of completing a mental health act assessment
MHA assessment involves detailed evaluation to determine whether to detain someone or not
- AMHP is primary person making application and organising admission (nearest relative can also make application)
- decision must be recommended by 2 registered medical practitioners: section 12 doctor + another i.e. GP
assessment can result in compulsory admission under Section 2 or Section 3
section 2 MHA
compulsory admission for assessment following a Mental Health Act assessment, with a maximum period of 28 days
- cannot be renewed
- ends in either discharge or further detention under Section 3.
section 3 MHA
compulsory admission for treatment
- maximum period is six months, after which the Responsible Clinician can arrange to renew it for further treatment
- treatment can be given against a patient’s wishes
- Detention under Section 3 requires a Mental Health Act assessment. Patients that are well-known to mental health services may be detained under Section 3 straight from the community. Alternatively, patients may be detained under Section 3 following assessment under Section 2
section 4 MHA
used to detain patients for up to 72 hours in urgent scenarios where other procedures cannot be arranged in time
- requires an AMHP and one doctor.
- followed by a Mental Health Act assessment
section 5(2) MHA
used in an emergency to detain patients who are already in hospital voluntarily
- lasts up to 72 hours and requires only one doctor
- followed by a Mental Health Act assessment
section 5(4) MHA
used in an emergency to detain patients who are already in hospital voluntarily
- lasts up to 6 hours and requires only one nurse
- followed by a Mental Health Act assessment.
section 136 MHA
used by the police to remove someone that appears to have a mental health disorder from a public place and take them to a place of safety where they can be assessed
- lasts up to 24 hours
- followed by a Mental Health Act assessment
Mental health hospitals often have 136 suites that act as a place of safety and are used for assessment
what are the 5 key principles of the MCA
- A person must be assumed to have capacity unless it is established that he lacks capacity
- A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
- A person is not to be treated as unable to make a decision merely because he makes an unwise decision
- An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests
- Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action
what are the 2 components of assessing whether a patient has capacity or not
what 4 factors should be considered when assessing what is in in someone’s best interests
what are the different types of consent
- implied
- withdrawn
- verbal, non-verbal or written
what are the 2 specific features of capacity
- time specific: capacity may fluctuate e.g. delirium, intoxication
- decision specific: people may lack capacity for some decisions but not others
what are the 4 criteria for implementing the MHA
- presence of a mental disorder as defined by law
- disorder is of a certain nature or degree
- significant risk to persons health, safety or safety of others
- no alternative to hospital admission to safeguard that risk
section 135 MHA
warrant (applied for in court) allowing forced entry to private home of a person with suspected mental disorder and sufficient risks to allow police to remove them to place of safety for further assessment
what is a CTO
community treatment order
- patients on section 3 can be considered for a CTO, if well enough to leave hospital but high likelihood they may disengage from treatment (and risks are high enough to justify this)
- Allows patient to be recalled to hospital if they do not comply with criteria (e.g. attend follow up, take medication) without mental health having yet deteriorated to the point of meeting criteria for a Section 2 or 3
- allows right to appeal
what is section 17 leave
inpatients e.g. on S2 or S3, may be granted leave off the ward by their consultant
- Form must define where to, time allowed, if escorts needed
