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33 Cards in this Set
- Front
- Back
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What should be guiding principles in every Mental Health Act assessment
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1. Purpose Principle:
minimise illness, maximise safety & well being, recovery and protection of others 2. Least restriction principle: minimum 3. Respect principle: diverse needs and values 4. Participation principle: involve in care and treatment 5. Effectiveness, efficiency and equity principle: use of resources to meet their needs |
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How to communicate
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.Clear & understandable
.Overcome language barriers .Aid communication- sign/ Makaton .Interpreter- maintain confidentiality .Relatives as interpretors only exceptionally .Independent advocates- invaluable |
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Who is responsible to provide information to hospital and SCT detained patients
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.Hospital Managers- soon inform how Act applies to them
.Inform orally and written .Make sure it's understood .inform- section used, rights of nearest relative to discharge .SCT- effect of the order,duration, required conditions,circumstances of recall, will end if not required, no automatic renewel .Inform legal and factual reasons for detention .Written info, if needed remove 3rd party info |
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What information to provide about consent to treatment
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.Circumstances in which they could be treated without consent
.Circumstances in which they have right to refuse .Role of SOADs .Where relevant, rules on ECT |
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Information about review of detention and SCT
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.Rights of RC, Hospital Managers and Secretary of State for Justice to discharge them
.Their right to ask Hospital Managers to discharge them .Hospital managers must consider discharging them when renewal due .NHS pts in independent hospitals- relevant NHS body to discharge them .Right to apply to tribunal, rights of nearest relative to apply to tribunal, role of tribunal, how to apply to tribunal .Hospital Managers-assist in making application, how to contact suitable legal representative, free legal aid possibility, other organisations ESP for SCT patients .Revoked SCT & Recalled patients-inform automatic referral to Tribunal |
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Information about Commission
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.Role of the Commission, when visiting
.Complaint process to commission .Hospitals own complain procedure |
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Inform patients of their rights
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.Rights and effects of Act- esp when applying to tribunal, requests discharge, regained capacity, significant treatment change, CPA review, renewal of detention or SCT
.When discharged from detention or SCT, what follows on including section 117 aftercare |
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Information for nearest relative
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.Same written info to nearest relative unless patient objects
.At the time of detention, inform that same written information will be given to their nearest relative .Inform neatest relative of discharge unless pt objects .Inform of other events i.e. detention renewal, SCT extension and transfer from one hospital to another IF PT OBJECTS DONT SHARE |
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Information for nearest relative
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.Dont inform if detrimental effect to patient outweighs benefits
.If disclosure without consent consider- - if any physical or financial harm to patient - emotional distress - any other detrimental effect on health and well being |
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Communication with other individuals nominated by the patient
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.Patient may want to nominate friend, carer or independent MH advocate
.Its benefiscial .Agree to it, if don't then inform pt- such as due to unreasonable delay, not in best interests, other person unwilling .Find out if pt lacks capacity has deputy or attorney, if present inform as above |
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Involvement of Carers
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.Assess carers need through SS
.Encourage pt to involve carers .If pt lacks capacity- involve carers in best interests. Decide on individual merits .For carers participation- provide practical and emotional help, access to information .If not possible to give full info, provide general info into nature and treatment of disorder and the Act |
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Who is ultimately responsible for informing patients and their carers
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Hospital Managers
KEEP DOCUMENTATION |
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Should informal inpatients need to be informed of their status
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YES
If they mistakenly believe that they cannot leave the ward it comes under unlawful deprivation of liberty |
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Information for those on Guardianship
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.LSSAs are required
.Ensure that they understand their rights to Tribunal and rights of nearest relative |
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Defination of Mental Disorder
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Any disorder or disability of the mind
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Mental health conditions within Acts defination
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.affective disorders
.schizophrenia and delusional disorders .neurotic, stress related and somatoform disorders .organic mental disorders- delirium and dementia, however caused .personality and behavioural change due to brain injury .personality disorders .mental and behavioural disorders due to substance use .eating disorders, non organic sleep disorders and non organic sexual disorders .learning disabilities .Autistic spectrum disorders including Aspergers .behavioural and emotional disorders of children and adolescents |
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Dependence on Alcohol and Drugs
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.Not disorder or disability of mind
.No grounds for detention for alcohol and drugs alone including solvents and other psychactive substances .If associated with a mental disorder it falls into the category of ACTs defination, even if mental disorder results from alcohol or drugs .withdrawal states- delirium, psychotic reactions, acute intoxication, organic mental disorder due to alcohol or drugs come under the Act .medical treatment of alcohol and drugs under the Act is allowed as a treatment of mental disorder |
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Learning Disabilities and Autistic Spectrum Disorders
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. Are forms of mental disorder
. Learning disability alone not detainable. Only if with abnormally aggressive/ seriously irresponsible conduct . 'L.D qualification'- doesn't apply to sec. 2 . 'L.D qualification'- doesn't apply to ASD . ASD without other mental illness or witout aggressive/ irresponsible conduct can meet criteria for compulsory detention |
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Personality disorders
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• Act applies to personality disorders of all types
• Decide on- Needs of individual Risks Managing risks in short and long term |
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Grounds for making application for detention
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• Section 2
- nature and degree of mental disorder is unclear & require assessment - their own health, safety and protection of others - to formulate treatment plan or reach judgement whether accepts informal admission • Section 3 - already detained on section 2 - nature and degree of mental disorder requires treatment - for health and safety of person and protection of others - essential elements of treatment plan to be followed • Appropriate treatment is available Nature: particular disorder, it's chronicity, it's prognosis, previous response to treatment Degree: current manifestation of disorder • look into alternative means of care • always consider wishes, age, health, impact on self & family |
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Factor- health and safety of patient
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Risk of
- suicide - self harm - self neglect - reckless, accidental or unintentional risk to health or safety • evidence that MH will deteriorate • reliable evidence/ past history • views of carers about possible outcome of their illness course • pts own skills in managing • benefits vs adversve effects • whether other methods of managing risks are available |
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Factor- protection of others
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• nature of risk
• likelihood • severity • reliablity of evidence, past history, criminal history • willingness of carers to cope with those risks • other methods of managing those risks Harm to others includes physical as well as psychological |
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Alternatives to detention if capacity to consent
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• try informal admission, if feasible
• compulsory admission- Current MS Past experience Likelihood of change if mind and risks involved • never use threat of detention |
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Alternatives to detention if lacks capacity
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• consider alternative ways of care
• consider MCA in best interests if > 16 • if > 18, deprivation of liberty for treatment in hospital or care home is authorised in best interests in DoLS • use MHA if- MCA safeguards can't be used MCA alone can't deliver required assessment and treatment |
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Use MCA if
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• atleast 18 years old
• has mental disorder • lacks capacity • deprivation of liberty is in best interests and a proportionate response • not eligible to MHA • no advance directive of patient or refusal from deputy/ attorney |
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When to use MHA instead
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• < 18
• valid advance refusal to treatment required • use of safeguards conflicts with deputy/ attorney or court of protection • meets section criteria and is objecting to admission (unless attorney consents) • consider pts behaviour, wishes, feelings, views, beliefs and values both present and past. If reasons to think that pt would object- consider objection • lacks capacity on care but retains capacity about admission- either refused or likely going to • lack of capacity fluctuating and likely will refuse i.e. acute psychotic, manic or depressive episodes • justified restraint but cannot said to be proportionate • risk of not receiving required treatment with MCA |
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The assessment process
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• AMHP applies and preferable
• 2 medical recommendations • refer request to AMHP, LSSA to arrange one • first must look into - alternate ways of treatment - CRS and Home treatment teams |
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Responsibility of LSSA
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• 24 hrs AMHP availability
• LSSA must act requested by nearest relative • check 4.35 and 4.36 |
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How to set up assessment
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• use most appropriate AMPH and doctors
• where particular expertise required use atleast one doctor • if not possible atleast consult via phone AMPH- overall responsibility of coordinating • aid communication where needed • independent decisions but mutual cooperation • preferably joint assessment • if not possible discuss via phone • involve police- risk of physical harm • joint risk assessment tool |
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Role of AMHP
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•Make application only
- when interviewed - satisfied that criteria is met - detention is most appropriate • introduce self & others, explain process • if asked assist in securing carer, unless time constraints • if asked speak alone, unless risks • interview through window only when serious physical risks • apply section 135 warrant, to enter • unde effect of alcohol- wait • if risks- do assessment and document. Use reliable evidence and info |
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AMHP and nearest relative
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• attempt to identify nearest relative
• inform section 2 application and their right for discharge • section 3 - must contact before unless not practical- not contactable, their own health issues • detrimental impact, violation of article 8 • significant safeguard to involve • look if patients wishes not to involve is to conceal info regards their health • if not involved- document reasons Inform- reasons for detention and their rights •••If nearest relative objects to section 3, application can't go ahead••• • if needed apply to county court for relatives displacement under section 29 |
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Should AMHP contact other people?
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• not specific but helpful to contact carers and family
• < 18- consult parents/ parental responsible • consider - pts wishes - nature of relationship - evidence of hostility or abuse • other services if known to them • contact if attorney or deputy |
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Section 2
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Admission for assessment of mental disorder
up to 28 days Pt suffering from mental disorder Nature or degree warrants detention for assessment or assessment followed by treatment Detained for health or safety or protection of others |
