Back to: Psychiatry
Mental Health Act
The main piece of mental health legislation in England is the Mental Health Act 1983. This was amended by the Mental Health Act 2007.
Who it applies to?
The Mental Health act applies to people with a “mental disorder” – any disorder/disability of mind
– However, it excludes anyone with dependence on drugs or alcohol
– Also excludes patients with learning disability, unless their condition causes abnormally aggressive or seriously irresponsible conduct
– Applies to people of any age, but children are usually treated with consent of their parent.
Sectioning (compulsory admission to hospital)
This part allows admission of a patient to a hospital using sections for assessment or treatment.
– For Sections 2,3 and 4, the section is recommended by doctors but then needs approval by an approved mental health professional (AMHP) to confirm the section.
– In order to safeguard patients, patients are allowed an independent review tribunal to review their section.
To section for assessment:
- The patient is suffering from mental disorder
- The disorder is of a nature or degree warranting detention for assessment
- They need to be detained in the interests of their health or with a view to the protection of others.
To section for treatment: (In addition to previous 3 criteria)
- The treatment needed cannot be effectively provided unless the patient is detained.
- Appropriate medical treatment is available to them.
The main sections are summarised in the table below:
Consent to Treatment
As a general rule, once a patient is detained under S2, 3, 35, 36 or 37 of the MHA, consent is not required for the administration of psychiatric treatment.
– The justification for treatment is provided by S63 which states that:
“The consent of a patient shall not be required for any medical treatment given to him for the mental disorder from which he is suffering”
Treatments are Covered by S63
All medical treatment for the mental disorder, including:
- Treatments for the disorder itself (e.g. antipsychotics for schizophrenia)
- Treatments for conditions causing the disorder (e.g. hypothyroidism causing depression)
- Treatments for the physical consequences of the disorder (e.g. NG in anorexia)
- Safe holds and physical control and restraint (when necessary)
In order to safeguard patients who are having compulsory treatment, some treatments require approval from a secondary doctor.
– These are known as second opinion approved doctors which will usually be another psychiatrist.
– They will be involved in some treatment which are more invasive or restrictive of freedom
Specific Treatments in the Mental Health Act
- Seclusion –> confinement of a patient in a room with the sole aim of preventing harm to others
– Needs review within 1 hour then every 4 hours by doctor
- Long-term segregation –> patient is not confined to one room but is kept apart from other patients
- Psychosurgery –> Covered by section 57, and needs patient consent and SOAD authorisation
- ECT –> Covered by section 58. If the patient has capacity, then you must accept refusal.
- Psychotropic medication –> S63 allows treatment with psychotropic medications for up to 3 months
- Emergency treatment –> S62 provides limited authorisation for treatment in the absence of consent or SOAD authorisation
Risk Assessment
Risk is the probability that a particular harmful or adverse event occurs during a period of time.
– All psychiatric patients should have a risk assessment to see risk both to themselves and to others
– Past behaviour is the best indicator of future behaviour
– Good tool is HCR-20 – this is a 20-instrument item with 10 Historical, 5 clinical and 5 risk management items used to assess risk
There are two approaches to risk assessment, actuarial and clinical which are combined together:
- Actuarial – this is based on statistical calculations of probability based of groups of people
– It is more accurate than clinical assessment but only deals with group factors
– Includes age, gender, number of previous convictions/sentences and type of offence
- Clinical – This is applied to individuals and assesses their personal and situational factors
– It is based on detailed information from patients records and interviews
– This is used to assess the patient’s attitude, thought and past behaviours
– Aim is to identify the specific situational and psychological factors precipitating the risky behaviour and aim to avoid these triggers
– Good tool is HCR-20 – this is a 20-instrument item with 10 Historical, 5 clinical and 5 risk management items used to assess risk
