Legalities
Observation Levels
Mental Capacity Act
Mental Health Act
Admissions
Section 2
Section 3
Informal Admission
3
2
1
Low-level Intermittent Observation
High-level intermittent observation
Continuous Observation
Once every 30-60 minutes
Usually if a service user is at risk of becoming violent or aggressive but does not represent an immediate risk
Once every 15-30 minutes
Usually when a service user presents an immediate threat and needs to be kept within eyesight or at arm's length of a designated one-to-one nurse
Immediate access to other members of staff if needed
- Take an active role in engaging positively with the service user
- Appropriately briefed
- Staff member doesn't undertake a continuous period of observation above 2 hours
Capacity vs Insight
"His mental illness had so coloured his comprehension of the information that he was not able to process
it at a cognitive level. For the Court of Appeal, it was plain that “a patient will lack that capacity if he is
not able to appreciate the likely effects of having or not having the treatment”
Deprivation of Liberty Safeguards (DOLS)
Principles of the Capacity Act
Person is 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 practical 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 or on behalf of a person who lacks capacity, must have been done, or made, in his best interests
Before the act is done, or decision 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
"a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain"
Under the act, a person is regarded as being unable to make a decision if, at the time the decision needs to be made, he or she is unable:
- To understand the information relevant to the decision
- To retain the information relevant to the decision
- To use or weigh the information
- To communicate the decision (by any means)
Complex area of law and practice where doctors identify individuals who may be, or who may need to be, deprived of their liberty.
Authorisation for the deprivation of liberty should be sought if:
- The person is subject to continuous supervision and control
- The person is not "free to leave"
- The person lacks capacity to consent to their care and treatment in those circumstances
Types of Authorisation
Standard
Supervisory body has to decide within 21 days whether the person can be deprived of their liberty.
The person does not have to be deprived of liberty for the period of authorisation - the restrictions should stop as soon as they are no longer necessary.
Urgent
Managing authority can itself issue urgent authorisation that can last up to 7 days with an option to extend it for a further 7 days if the supervisory body is in agreement.
When issuing an urgent authorisation the managing authority must also request a standard authorisation
These 2 options are commonly seen in in-patient and care home situations, particularly DOLS in dementia
Discharge
Community Treatment Orders
These are for patients who have been admitted under section 3 or 37 the MHA and means they have supervised treatment when they leave hospital.
Section 17A
Forced treatment
Criteria
Mental condition that needs medical treatment
Treatment for their health or safety, or to keep other people safe
You can get the same treatment in the community
They can show why they need to bring you back to hospital if necessary
Patients can refuse treatment under this order, however they may be called back to hospital by the responsible clinician
If patients lack capacity, treatment decisions can be made by a lasting power of attorney or Court of Protection appointed deputy.
Treatment may be refused if:
- Valid advanced statement that says they don't want the treatment
- LPA for welfare doesn't think they should have treatment
- Court appointed deputy doesn't think you should have the treatment
1st CTO can last up to 6 months - this will then be reviewed by the RC and can be extended for a further 6 months and then 1 year at a time
Example conditions
- Where you will live
- Where you will go for treatment
- Staying away from things that can make you unwell (e.g. alcohol or drugs)
Care Programme Approach
= a way that services are assessed, planned, co-ordinated and reviewed for someone with mental health problems or a range of related complex needs
Patients should be involved in the assessment of their needs and in the development of the plan to meet those needs
Formal written care plan that outlines any risks
They will have a CPA care co-ordinator to manage their care plan and they will ensure the CPA care plan is reviewed regularly with a formal review once a year
National framework for mental health services assessment, care planning, review, care co-ordination, and service user & carer involvement focused on recovery
2 types
Complex needs - most at risk or have mental health problems compounded by disadvantage, and need support from multiple agencies
Lead Professional Care - people who need secondary mental health services but have more straightforward needs involving contact with only one professional or one agency
Holistic approach to care - patient centred care - sees and supports patients in the roles they have and self-care is promoted and supported where possible.
= Admission for assessment
"A patient may be admitted to a hospital and detained there for the period allowed by subsection 4 (<28 days) in pursuance of an application for admission in accordance with the following:
- Suffering from mental disorder of a nature/degree which warrants detention of the patient in a hospital for assessment for at least a limited period
- He ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons"
Requirements
2 registered medical practitioners
Statement that the opinion of the practitioner the conditions above are complied with
= admission for treatment
"A patient may be admitted to a hospital and detained there for the period allowed by the following:
- they are suffering from a mental disorder of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital
- it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and it cannot be provided unless he is detained under this section
- appropriate medical treatment is available"
Requirements
2 registered medical practitioners
Recommendations shall include:
- Opinion so far relates to conditions
- Statement of reasons why methods of dealing with a patient that are available are not appropriate
Can be made by a relative or AMHP
1 of the medical opinions must be from an approved doctor under section 12 of the act
Section 12
"Practitioner must be approved for the purposes of this section by the secretary of state as having special experience in the diagnosis or treatment of mental disorder, and unless that practitioner has previous with the patient"
Required for sections or guardianship application
"given by practitioners who have personally examined the patient either together or separately"
Appeal to the Mental Health Review Tribunal is allowed within 14 days of admission.
May be for a duration of <6 months, including the day of admission, although this can be extended.
Mental Disorders = "any disorder or disability of the mind"
Exemptions:
- Learning disability - can only be detained if the disability is associated with abnormally aggressive or seriously irresponsible conduct. Applies to 3, 7, 17A
- Dependence of alcohol or drugs - refers only to dependence and does not exclude the effects of substances
Responsible clinician
& a second professional whom is...
- Different professional discipline compared with the RC
- Involved with the care of the patient
- Be able to reach independent decisions
- Sufficient expertise and experience to make a judgement about whether the criteria for detention continue to be met
The patient has the right to appeal to the Mental Health Review Tribunal within the first 6 months and then once a year
Requires a patient to consent and not to object to entering hospital and receiving care or treatment
They have more rights than a patient who is admitted under DOLS
Legal rights
Free to leave the ward
Decline or recieve aspects of care or treatment, or bring an advance decision detailing their wishes
May withdraw consent to any part of proposed treatment plan or recovery action plan at any tiems
The right to discharge themselves from hospital at any time
If the care team don't believe this is in the patient's best interests or there is concerns of safety, they may arrange for assessment under MHA & request a DOLS assessment
Other sections
37/41
Hospital admission by a crown court
Maximum 3 months
Addition of 41 = restriction
This relates to the discharge - requires permission from secretary of state for justice
135
Police or healthcare professional can take you to a place of safety for assessment of mental health from a private place
- Home
- Hospital
- Police station
Maximum 36 hours
135(1) = police can enter private place with a health professional
135(2) = police can enter private place on their own; can search you if they suspect risk of harm to self or others
136
Police or healthcare professional can take you to a place of safety for assessment of mental health from a public place
Can be held for <24 hours
Can extend by a further 12 hours
Section 117