scholarly journals Consent to treatment and clinical decision analysis

1989 ◽  
Vol 13 (2) ◽  
pp. 79-81 ◽  
Author(s):  
Ernest P. Worrall
Keyword(s):  
Mental Health ◽  
Drug Treatment ◽  
Decision Analysis ◽  
Medical Practice ◽  
Clinical Decision ◽  
Second Opinion ◽  
England And Wales ◽  
Mental Health Act ◽  
Consent To Treatment ◽  
First Time

The 1984 Scottish Mental Health Act (and its counterpart in England and Wales) invoked unique restrictions in medical practice in this country. For the first time certain standard treatments could not be given to particular patients unless an independent second opinion doctor authorised that treatment. Fortunately, in respect of drug treatment and ECT the second opinion doctors are themselves practising clinicians. Second opinion doctors are asked to give their opinion about the suitability of a proposed treatment using the following guidelines: “the appointed doctor will have in mind his/her understanding of practice accepted as proper by a responsible body of medical men skilled in this particular art in Scotland at this time and should avoid any idiosyncratic view of treatment however firmly held”.

scholarly journals Medical treatment under Part IV of the Mental Health Act 1983 and the Human Rights Act 1998: review of Article 3 and 8 case law

2009 ◽  
Vol 33 (3) ◽  
pp. 111-115 ◽  
Author(s):  
Martin J. R. Curtice
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Medical Treatment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Case Law ◽  
Mental Health Act ◽  
Consent To Treatment ◽  
Human Rights Act ◽  
Human Rights Act 1998

Since the introduction of the Human Rights Act 1998, all courts and tribunals are obliged to interpret all laws and statute consistently and compatibly with the Human Rights Act. This includes the Mental Health Act 1983 (and the 2007 amendments) and mental health review tribunals. Mental health case law has evolved with regard to medical treatment under Part IV (Consent to Treatment) of the Mental Health Act being compliant with the Human Rights Act. Review and analysis of such case law can aide everyday clinical decision-making as well as improving knowledge of the Human Rights Act.

scholarly journals Haematological monitoring for clozapine: do patients know why?

1995 ◽  
Vol 19 (9) ◽  
pp. 536-537 ◽  
Author(s):  
Carol Paton ◽  
Paul Wolfson
Keyword(s):  
Mental Health ◽  
Side Effects ◽  
Small Proportion ◽  
Second Opinion ◽  
Treatment Resistant ◽  
Blood Tests ◽  
Mental Health Act ◽  
Education Of Patients ◽  
Consent To Treatment

Clozapine is effective in treatment resistant schizophrenia, but unfortunately is associated with a 3% incidence of neutropenia. Regular haematological monitoring is mandatory for all patients. We asked forty patients who had been taking clozapine for more than six months why they thought they had to have regular blood tests. Almost half did not know and only a small proportion were subject to a Mental Health Act (MHA) second opinion for consent to treatment. Initial explanations of the potentially serious side effects of clozapine may not be understood or retained. Ongoing education of patients is essential. The wider use of MHA second opinion doctors should also be considered.

The Informal Patient in England and Wales

2000 ◽  
Vol 40 (2) ◽  
pp. 147-155 ◽  
Author(s):  
Benjamin Andoh
Keyword(s):  
Mental Health ◽  
England And Wales ◽  
Mental Patients ◽  
Mental Health Act ◽  
House Of Lords ◽  
The Status ◽  
Consent To Treatment ◽  
Health Trust ◽  
Generally True

The informal status of a patient is a very important topic because the vast majority of mental patients in hospital are informal. The origins of the status are traced to the Royal Commissions of 1924–6 and 1954–7 which recommended voluntary admissions and informal admissions, respectively. It is pointed out, inter alia, that it is only generally true to say the informal patient has consented to admission and cannot be treated without his or her consent because exceptionally he or she can be given such treatment, e.g. on the grounds of necessity, as held by the House of Lords in R v Bournewood Community and Mental Health Trust (1998) and that today there are two types of informal patients: those who can, and do, consent to admission, and those who cannot consent to admission, but do not show willingness to leave hospital. It is argued that there is only a power under the Mental Health Act 1983 to admit patients informally. Finally, the informal patient's consent to admission, consent to treatment, other rights, leaving hospital, and how his or her position can be improved are looked at.

scholarly journals Ethics and Section 58 of the Mental Health Act (1983)

1993 ◽  
Vol 17 (8) ◽  
pp. 481-483
Author(s):  
Femi Oyebode
Keyword(s):  
Mental Health ◽  
Drug Treatment ◽  
Medical Officer ◽  
Present Form ◽  
British National Formulary ◽  
National Formulary ◽  
Code Of Practice ◽  
Mental Health Act ◽  
Consent To Treatment

Section 58 is in the part (Part IV) of the Act which is largely concerned with consent to treatment by patients detained on Sections 2, 3, or 37 of the Mental Health Act (1983). It applies to drug treatment if three months or more have elapsed since drugs were first given during the period of detention. It also applies to ECT at any time during the period of detention. Where a patient consents to treatment which comes under Section 58, and which the responsible medical officer (RMO) has proposed and explained to the patient, the RMO is required to certify in writing, on Form 38, that the patient is capable of understanding the nature, purpose and likely effect of the treatment and that the patient has consented (DOH, 1987). The Code of Practice (DOH, 1990) advises that the RMO should indicate on the certificate the drugs proposed, by the classes described in the British National Formulary (BNF), indicating the dosages if they are above BNF advisory maximum limits. The method of administration should also be indicated. This paper will argue that Section 58 in its present form does not strengthen the patient's right to consent to treatment and that the form of words advised in the Code of Practice with respect to Form 38 is faulty in conception.

The Mental Health Act 1983

2017 ◽  
Vol 10 (11) ◽  
pp. 638-643
Author(s):  
Jonathan Mills ◽  
Jaspreet Phull
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Problems ◽  
Legal Framework ◽  
Health Problems ◽  
Practical Application ◽  
England And Wales ◽  
Mental Health Act ◽  
Consent To Treatment ◽  
Insight Into

Mental health problems constitute a significant demand on the caseload of GPs. Although most patients can be managed with joint understanding and agreement as to treatment, GPs will encounter patients deemed to have mental illness of such severity that the patients’ ability to consent to treatment, admission or ongoing management in the community is brought into question. Patients may refuse necessary treatment, or lack insight into their condition and the necessary treatment. The patient may not accept that they are unwell. This can put great demands on caregivers and also requires knowledge of the legal framework necessary to ensure treatment of patients safely, legally and ethically. This article aims to outline the Mental Health Act 1983 as it applies in England and Wales, and to give advice on its practical application.

Consent to Treatment, Second Opinion Appointed Doctors and Code Compliance - an Audit?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Qureshi ◽  
G. Kirk
Keyword(s):  
Mental Health ◽  
Treatment Plan ◽  
Medical Officer ◽  
Second Opinion ◽  
Care Plan ◽  
Code Of Practice ◽  
Mental Health Act ◽  
Legal Perspective ◽  
Wide Range ◽  
Consent To Treatment

Aim:Ensuring standards of section 58 documentation and associated communication complies with the code of practice of the Mental Health Act 1983 UK.Method:Case note review of detained patients under section 3 of Mental Health Act (MHA) 1983, requiring either a certificate of consent to treatment (form 38) or a certificate of second opinion authorising treatment (form 39), beyond first three months of medication. A standard checklist was devised, based on recommendations of MHA commission and code of practice.Results:Form 38 (5 Patients), 100% completion of names, dosage, route of adminstration of medication and proposed number of ECT treatments. Only 60% completion of documentation regarding treatment plan explanation and stating whether clozapine was included excluded.Form 39 (7 patients) completed correctly in 100% cases with recommendation by second opinion appointed doctor (SOAD) in 85% cases. No documentation by SOAD in case notes and contact with the responsible medical officer (RMO) was only by phone (should have face to face contact). Only in 28% of cases RMO documented the SOAD visit and outcome.Conclusion:This audit has highlighted wide range of implications from the medico-legal perspective. The statutory documents, form 38 and 39, were completed correctly in majority of cases except for minor omissions. Adequate documentation was lacking with regards to discussion about the care plan and outcome of the SOAD visit. SOAD contact with the RMO was only on the phone (should only be in emergency) and no documentation of the second opinion in the case notes apart from filling the form 39.

scholarly journals Misunderstandings on Consent to Treatment in the Mental Health Act 1983

1984 ◽  
Vol 8 (7) ◽  
pp. 136-137
Author(s):  
P. M. Jefferys
Keyword(s):  
Mental Health ◽  
Second Opinion ◽  
Mental Health Act ◽  
Consent To Treatment

Part IV of the 1983 Mental Health Act (Sections 56–64) introduces new safeguards and procedures relating to Consent to Treatment for detained patients and in limited situations to informal patients. Many psychiatrists have expressed misgivings about these provisions and many are unfamiliar with the new requirements. One medical member of the Mental Health Act Commission visited twenty different hospitals for the purposes of issuing a Certificate of Second Opinion during a four-month period between October 1983 and February 1984. This paper discusses some of the practices and misunderstandings encountered.

Legal issues

2013 ◽  
pp. 865-906
Keyword(s):  
Mental Health ◽  
Common Law ◽  
Legal Issues ◽  
Health Law ◽  
Mental Health Law ◽  
England And Wales ◽  
Mental Health Act ◽  
Consent To Treatment

Introduction 866 The development of mental health law 868 Consent to treatment 870 Treatment without consent 872 Common law 874 Incapacity Act: England and Wales 876 Incapacity Act: Scotland 878 Mental Health Act: England and Wales 1 880 Mental Health Act: England and Wales 2...

scholarly journals Rise in the use of section 136 of the Mental Health Act 1983 in England and Wales: A viewpoint on Loughran (2018)

2019 ◽  
Vol 60 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Mark Cresswell
Keyword(s):  
Mental Health ◽  
Recent Work ◽  
Theoretical Perspective ◽  
Causal Analysis ◽  
England And Wales ◽  
Mental Health Act ◽  
The Law

This article provides a critical viewpoint on Loughran’s recent work in Medicine, Science and the Law on the causes of the rise in the police’s use of section 136 (s136) of the Mental Health Act 1983 (Loughran M. Detention under section 136: why is it increasing? Med Sci Law 2018; 58: 268–274). The rate of this rise seems significant: by 2014, it was five times more likely that a person in England would be detained in a hospital under s136 than it was in 2000, and the trend has continued to the present day. This viewpoint considers the significance of the s136 rise from the theoretical perspective of causal analysis.

scholarly journals Mental Health Act reform

1999 ◽  
Vol 23 (10) ◽  
pp. 578-581 ◽  
Author(s):  
Trevor Turner ◽  
Mark Salter ◽  
Martin Deahl
Keyword(s):  
Mental Health ◽  
Medical Profession ◽  
Medical Model ◽  
Chief Executive ◽  
Radical Change ◽  
Medical Decision ◽  
Mental Health Act ◽  
Consent To Treatment ◽  
Mental Treatment ◽  
Health Legislation

Psychiatrists have been complaining about mental health legislation for over a century (Smith, 1891), usually in terms of the delays engendered, paperwork and bureaucracy, and the impositions on clinical practice. As a result they have gained more powers, and perhaps much-needed status within the medical profession, to the concern of some commentators (e.g. Fennell, 1996). Thus, the ‘triumph of legalism’ (Jones, 1993) of the Lunacy Act 1890 was modified by the Mental Treatment Act 1930, whereby outpatients and voluntary patients were encouraged and ‘asylums' became ‘mental hospitals'. Then came the radical change of the Mental Health Act (MHA) 1959, making compulsory detention an essentially medical decision and removing the routine of the courts, but retaining a theme of requiring ‘treatment in hospital’. The Mental Health Act 1983, however, was a touch anti-medical, since it strengthened the role of the approved social worker (ASW) and enhanced the importance of a patient's consent to treatment. “The primacy of the medical model and the paramountcy of the psychiatrist are certainly subject to greater limitations and external review”, was the opinion of William Bingley, then Mind's Legal Director, now Chief Executive of the Mental Health Act Commission – reviewing the Act in its early days (Bingley, 1985).

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