Knowledge & Understanding of Psychiatry

22/12/2013 by admin | Psychiatry


  • Autonomy: the duty to protect a patient’s freedom to choose

  • Beneficence or non-malfeasance: the duty to do no harm

  • Honesty and justice

  • Respect

  • Informed consent: The seven elements of informed consent (as defined by Beauchamp) include threshold elements (Competence and Voluntariness), information elements (Disclosure, Recommendation, and Understanding) and consent elements (Decision and Authorization).

  • Confidentiality:Legal protections prevent physicians from revealing certain discussions with patients, even under oath in court. The rule only applies to secrets shared between physician and patient during the course of providing medical care.

  • Right to receive and refuse treatment: everyone has a right to receive and refuse treatment

Describe the key features of section 2, 3 and 5(2), 5(4), 136, and 137:

  • S-135: police enter private property if suspect mental illness. Requires court application, and lasts for 72/24. Will then need a mental health assessment = informal admission or forced S-2
  • S-136: if person thought to be mentally unwell in a public place, police use S-136, then require MHA can have an informal admission or forced S-2.
  • S-2: an assessment section. 2 drs are required, one who is approved (ie psychiatrist) and the other should know the pt personally, the AMHP will thenn take on the recommendeation and apply for the section. Section 2, lasts 28/7, and tx can be commenced during this time. Pt can appeal against a S-2 and this must be heard within 7/7. Or physician can discharge from an S-2.
  • S-3: if issue still present once S-2 expires, a S-3 can be granted, valid for 6/12, pt will receive Tx. The exact mental disorder must be stated.
  • S-5(2): temporary holding powers used by Drs if a pt is an in-pt in the hospital, equivalent to polices S-135/6, convert this into an S-2 and assess.
  • S-5(4): is a nursing equivalent of an S-5(2), and can hold pt for only 6/24. During this time the nurse should try and find a dr to authorise a S-5(2).
  • S-4: is an emergency section, which is valid for 72/24, can be used if MHA team short of a 3rd member but a section is necessary.
  • S-117: is the entitled aftercare given to all longer term detention pt, specifically S-3 pts. It involves annual CPAs to look at pts needs.


Summarise the features of community treatment orders = section 17a:

  • A Community Treatment Order (CTO) is an Order imposed on certain categories of psychiatric in-patients on a section 3, especially those with chronic MH illnesses which are prone to relapse, at the point when they are discharged from hospital. The Order is designed to ensure that these patients continue with their treatment when they resume living in the community.

  • Conditions commonly discharged from hospital on a CTO: Schizophrenia and Bi-polar Disorder.

  • CTO ensures the pt will have on-going care in the community after their discharge. It will start once the pt is discharged from hospital and must be agreed by the responsible clinician (consultant) and the Approved Mental Health Practitioner (AMHP).

  • A CTO will stipulate that the pt makes themselves available if the RC, AMHP, or a second opinion doctor, want to examine the pt. Also, the pt must agree to tx, if deemed necessary – otherwise they may be sectioned to allow tx.

  • The RC may then impose other conditions, but only if they are NECESSARY or APPROPRIATE to:

  • CTOs last initially, for six months, they can then be extended for a further six months, and then for a period of twelve months at a time.

Describe the components of the Mental Capacity Act and outline the arguments for its incorporation into British legislation.

MCA 2005, came into effect in UK in 2007.  Its primary purpose is to provide a legal framework for acting and making decisions on behalf of adults who lack the capacity to make particular decisions for themselves.

The five statutory principles

The five principles are outlined in the Section 1 of the Act. These are designed to protect people who lack capacity to make particular decisions, but also to maximise their ability to make decisions, or to participate in decision-making, as far as they are able to do so.

1. A person must be assumed to have capacity unless it is established that they lack capacity.

2. A person is not to be treated as unable to make a decision unless all practicable steps to help him/her to do so have been taken without success.

3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

4. 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.

5. 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. 

Summary of other key elements of the Act

  • The Act makes provision for people to plan ahead for a time when they may need support. This introduces advanced decisions to refuse treatment.
  • The Act is ‘decision specific’ in that it deals with difficulties a person may have with a particular issues and capacity therefore should be reassessed for each issue separately.
  • The Act upholds the principle of Best Interest for the individual concerned.
  • An Independent Mental Capacity Advocate (IMCA) service will provide help for people who have no intimate support network.
  • The Act makes it a criminal offence to wilfully neglect someone without capacity.
  • The Act generally applies only to those over the age of 16 years, although may apply to some younger people if it is supposed that their capacity will continue to be impaired into adulthood.

Explain the legislative requirements for compulsory admission:

The patient must have a mental disorder, i.e. any disorder or disability of mind, but alcohol or drug addiction are insufficient on their own to detain a person under the Mental Health Act. The patient’s mental disorder must require hospital detention for assessment or treatment, and the detention must be necessary in the interests of the patient’s health or safety, or with a view to the protection of others. 

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