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Legalities (Care Programme Approach (2 types (Complex needs - most at risk…
Legalities
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
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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.
Mental Health Act
Section 2
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"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
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Section 3
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"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
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
May be for a duration of <6 months, including the day of admission, although this can be extended.
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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
Other sections
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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
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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
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Observation Levels
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1
Continuous Observation
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
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- 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
Mental Capacity Act
Admissions
Informal Admission
Requires a patient to consent and not to object to entering hospital and receiving care or treatment
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Legal rights
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Decline or recieve aspects of care or treatment, or bring an advance decision detailing their wishes
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These 2 options are commonly seen in in-patient and care home situations, particularly DOLS in dementia
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”
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"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)