Mental Health Law Presentation PDF

Mental Health and Crisis Management Theory Week 2 – Mental Health Law  These principles were developed from a comparative analysis of national mental health laws in 45 countries worldwide conducted by the World Health Organization....

Mental Health and Crisis Management Theory Week 2 – Mental Health Law  These principles were developed from a comparative analysis of national mental health laws in 45 countries worldwide conducted by the World Health Organization. The selection of principles drew from the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care adopted by the UN General Assembly Resolution 46/119 of December 17, 1991. Mental 1. Promotion of mental health and prevention of mental disorders Health 2. Access to basic mental health care Care Law: 3. Mental health assessments in accordance with internationally accepted principles Ten Basic 4. Provision of the least restrictive type of mental health care Principles 5. Self-determination 6. Right to be assisted in the exercise of self-determination 7. Availability of review procedure 8. Automatic periodical review mechanism 9. Qualified decision-maker 10. Respect of the rule of law  The Mental Health Act sets out the powers and obligations of psychiatric facilities in Ontario It governs the admission process, the different categories of patient admission, as well as The directives around assessment, care and treatment Ontario The Act also outlines the powers of police Mental officers and Justices of the Peace to make orders for an individual, who meets certain Health Act criteria, to undergo psychiatric examination by a physician Patient rights are also referred to, including procedural details such as rights of appeal to the Consent and Capacity Board (CCB) Who is being detained against their will  Part XX.1 Mental Disorder is a section of the Criminal Code which addresses the criminal liability of accused persons affected by a “mental disorder” in the commission of a criminal offence Criminal Among other things, it describes a court’s Code of powers to order assessments and make determinations regarding fitness to stand Canada trial, and rendering a verdict of “not criminally responsible” (NCR) It also prescribes the composition and powers of Review Boards (the ORB in Ontario) Assessment and Hospitalization Under the Mental Health Act (MHA)  Appear in both French and English Provide authorization to temporarily take away a person’s rights under the Canadian Charter of Rights and Freedoms Temporarily takes away a persons rights Introduction Can hold someone for 72 hrs against their will Intent is to act in another person’s best interest, when they are incapable of doing so Great risk of abuse/misuse The provisions of the MHA apply only to patients in a psychiatric facility. Such a patient may be admitted to a psychiatric facility in one of the following ways: Schedule 1 ( any facility that has a psychiatric unit) Voluntary patient – A person who has agreed to be admitted to the psychiatric facility for care, observation and treatment; Informal patient – A person who has been admitted pursuant to a substitute decision maker’s consent under section 24 of the replace with Health Care Consent Act (“HCCA”); Youth ( under age of 11) Neurocognitive impairment Involuntary patient (person who is the subject of a Form 3, 4) – A person who has been assessed by a psychiatrist and found to meet certain criteria set out in section 20 of the MHA, following which the person is admitted and detained as an involuntary patient; or Imminent risk to self Risk to others Inability to care for self due to mental health Patients admitted under court order (Form 6 or 8). Forensic program  1. Risk of harm to Three self criteria for mental health act 2. Risk of harm to that would others allow for assessment: 3. Unable to care for self due to a mental illness  Form 2 remains valid for a period of 7 days from and including the day it was signed and dated by the Justice of the Peace Known mental illness Form 2: Police is called for a “wellness check” Police can apprehend patient under the mental health Order for act The family or anyone who knows the person well go to Examination the justice of the peace and swear under oath. Police will bring the person to a schedule 1 by a Justice psychiatric facility and must remain with the person until the facility has accepted custody of the Peace Police also may apprehend a person under Section 17 of the Mental Health Act where police have reasonable cause and police believe it would be dangerous to wait to proceed before a Justice of the Peace  Allows the police to bring a person to an appropriate place for Form 2: psychiatric assessment Order for Examination Patient must be assessed upon arrival, and either: by a Justice Placed on Form 1 of the Peace Admitted as a voluntary patient Leave without admission (with supports) Family informs the police if there is anything they need to know  Any physician in Ontario has authority to sign a Form 1 Form 1: Physician has personally examined the person within 7 days prior to signing the Form Application 1 and on the basis of this exam and information provided by others (friends, by Physician relatives, hospital staff, police, EMS) can form an opinion about a mental disorder, the type for and degree of risk Psychiatric Assessment Form 1 remains valid for a period of 72 hours or up to 72 hours from and including the day it was signed and dated Schedule 1 psychiatric facility Form 1: Prior to the end of the 72-hour period, a Application Psychiatrist will assess patient by Physician In collaboration with patient, for interdisciplinary team including nursing Psychiatric assessments and family, decision will be made whether patient will continue Assessment hospitalization/admission as a voluntary (cont’d) patient, involuntary patient or discharged  Companion to Form 1 Once the person is at or arrives to the Schedule Form 42: Notice 1 facility and the Form 1 is completed, the to person of attending Physician notes the date and time on Application for the Form 1 and must promptly give the person a Form 42 Psychiatric Assessment (Form 1) The date and time the Form 42 is delivered is also indicated on the Form 1 Failure to provide the Form 42 can negate the legal authority provided by the Form 1  Prior to the end of the 72-hour period of a Form 1, a Psychiatrist will assess the patient If the patient remains a risk to self, others or unable Form 3: to care for self due to a mental illness Certificate A Psychiatrist will complete a Form 3 (NOTE: the of Physician MUST be different from the one who completed the Form 1) Involuntary Only psych doctor can fill out form 3 It has to be a different psych doctor to fill out Admission form 3 than the admitting psych doctor The Form 3 (Certificate of Involuntary Admission) is valid for 14 calendar days, minus 1 including the day upon which it was signed For example: if a form 3 was completed today January 29th, it would expire February 11th at midnight After midnight its expired  Promptly after a Form 3 or Form 4 is signed a Form 30 (Notice to patient under subsection 38(1) of the Act) must be given to the patient Form 30: Within 24 hours the rights advice need to see the patient Patent advocate office (PPAO) need to be notified as soon Notice to as form is given and completed Rights: patient  Can stay in hospital  Or contest form which creates a review board - rights advice notifies CCB to create a tribuninal ( with a psychiatrist, lawyer, admitter under taker, patient) subsection The interdisciplinary team (either clerk or nursing staff) process Form 3 and Form 30, notify the Officer In-Charge 38(1) of the ( director of the mental health facility or charge nurse) of facility and Rights Advisor Act The Rights Advisor must meet with the patient and explain the significance of the certificate and the right to have it reviewed by the Consent and Capacity Board (CCB)  At the end of the 14 days of the Form 3 (Certificate of Involuntary Admission) a Psychiatrist will assess the patient - If the patient remains a risk to self, others or unable to care for self due to a mental illness A Psychiatrist will complete a Form 4, a Certificate of Renewal, continuing with involuntary admission Form 4: With the first Form 4: Certificate of Renewal, the patient can be Certificate involuntarily admitted for up to one month of Renewal With the second Form 4: Certificate of Renewal, the patient can be involuntarily admitted for up to two months With the third Form 4: Certificate of Renewal, the patient can be involuntarily admitted for up to three months Each time the Form 4 is renewed the patient must be given a Form 30 and patient has the right to apply for a review by the CCB (After third renewal an automatic CCB occurs)  When a patient is Certified on a Form 3 or 4 and they no longer meet the criteria of Form 5 - the Mental Health Act, the Psychiatrist cannot simply write, “discontinue the Form Change to 3 or Form 4” Informal or A Form 5 must be completed by the Voluntary Psychiatrist documenting the patents improvements Status The Form 5 is faxed by either the clerk or Subsection Nurse to the Consent and Capacity Board 20(7) of the NOTE: The Form 5 must be completed and Act faxed prior to the patient being discharged, going out for a privilege or leaving the ward on a pass  The patient is involuntary but absent without leave from hospital The Form 9 can be signed by any hospital Form 9: staff member, who has been delegated to do so by the Officer-in-Charge of the Order for hospital/facility Return The police are authorized to return the patient to the nearest Schedule 1 facility to the place of apprehension An order for return provides authority for one month from when the Form 9 is signed  HOW DOES A PERSON GET ADMITTED TO A PSYCHIATRIC FACILITY? oVoluntarily oUnder the order of someone else: oForm 1 oForm 2 oIndependent Statutory Authority of Police –section 17 oForm 47  A MHA form does suspend an individual’s civil liberties MHA forms detain people, that is all. All treatment occurs with Key Points consent ONLY Treatment is facilitated by the use of the therapeutic relationship – observation and empathic listening are your most valuable skill Some Potential Legal/Ethical Considerations in Mental Health Nursing AUTONOMY RESTRAINTS AND SECLUSION CONFIDENTIALITY  According to law, all individuals have the right to decide whether to accept or reject treatment It is important that psychiatric mental health nurses know that the presence of psychotic thinking does not mean that the patient is mentally incompetent or incapable of understanding; he or she is still able to provide or deny consent Autonomy A health care provider can be charged with assault and battery for providing life-sustaining treatment to a client when the client has not agreed to it The client should receive information such as what treatment alternatives are available; why the most responsible practitioner believes this treatment is the most appropriate; outcomes; risks and adverse effects  There are some conditions under which treatment may be performed without obtaining informed consent. A client’s refusal to accept treatment may be challenged under the following circumstance: When a client is mentally incompetent to make a decision and treatment is Autonomy necessary to preserve life or avoid serious harm When refusing treatment endangers the life or health of another During an emergency in which a client is in no condition to exercise judgement When the client is a child (consent is obtained from parent or surrogate)  The principle of informed consent is based on a person's right to self-determination and the ethical principle of autonomy Proper orders for specific therapies and treatments are required and must be documented in the patient's medical record Autonomy – Consent for surgery, electroconvulsive treatment, or the Informed use of experimental drugs or procedures must be obtained Consent Patients have the right to refuse participation in experimental treatments or research and the right to voice grievances and recommend changes in policies or services offered by the facility without fear of punishment or reprisal For consent to be effective, it must be informed  Generally, the informed consent of the patient must be obtained by the physician or other health care provider before a treatment or procedure is performed Autonomy – Patients must be informed of the following: ◦ The nature of their problem or Informed condition ◦ The nature and purpose of a proposed Consent treatment ◦ The risks and benefits of that treatment ◦ The alternative treatment options ◦ The probability of success of the proposed treatment ◦ The risks of not consenting to treatment  The nurse’s role in obtaining informed consent is usually defined by agency policies A nurse may sign as a witness on a consent form, however, legal liability for informed consent lies with the physician Autonomy – The nurse acts as client advocate to ensure that the Informed following three major elements of informed consent have been addressed: Consent 1. Knowledge: the client has received adequate information on which to base his or her decision 2. Competency: the individuals cognition is not impaired to an extent that would interfere with decision making or, if so, that the individual has legal representation 3. Free will: the individual has given consent voluntarily without pressure or coercion from others  The capacity to understand the consequences of one's decisions Patients must be considered legally competent until they have been declared incompetent through a legal proceeding If found incompetent, the patient may be appointed a legal guardian or representative, who is legally responsible for giving or refusing consent for the patient while always considering the patient's wishes Competenc Guardians are typically selected from among family members y The order of selection is usually: 1. spouse 2. adult children or grandchildren 3. parents 4. adult siblings 5. adult nieces and nephews If a family member is either unavailable or unwilling to serve as guardian, the court may also appoint a court-trained and court- approved social worker, representing the province or territory, or a member of the community  Many procedures nurses perform have an element of implied consent attached For example, if you approach the patient with a medication in hand, and the patient indicates a willingness to receive the medication, implied consent has occurred Implied The fact that you may not have a legal duty to be the Consent person to inform the patient of the associated risks and benefits of a particular medical procedure, however, does not excuse you from clarifying the procedure to the patient and ensuring his or her expressed or implied consent When providing care, via implied consent, the nurse must be confident that the person understands, to the best of their abilities, the procedure, risks, and benefits  An individual’s privacy and personal security are protected by the Patient Self-Determination Act of 1991 This legislation includes a set of patient rights, on of which is an individual’s right to freedom from restraint or seclusion except in an emergency situation Restraints & The use of the least restrictive means of Seclusion restraint for the shortest duration is always the general rule The use of seclusion and restrain as a therapeutic intervention for psychiatric patients has been controversial and many efforts have been made through federal, provincial regulations and standards set forth by accrediting bodies to minimize or eliminate use  Psychological inability to tolerate Box 7-7 the experience of confinement or Contraindica isolation tions to Physical condition that may be exacerbated by restraint application Seclusion Desire for punishment of patient or and convenience of staff Restraint Restraints In psychiatry, the term restraints generally refers to a set of leather straps that are used to restrain the extremities of an individual whose behaviour is out of control and who poses an immediate risk to the physical safety and psychological well-being of the individual and others ◦ Environmental restraint – locked area ◦ Chemical restraint – Medication **Note: most facilities utilize pinel restraints (see picture) Seclusion Seclusion is another type of physical restraint in which the client is confined alone in a room from which he or she is unable to leave The room is usually minimally furnished with items to promote the client’s safety and comfort **Note the green blanket is a safety blanket in this picture- which makes it difficult near impossible to rip – it is made of special fibers/materials. Typically (although not always) in a seclusion room there is a bed frame bolted/locked or chained to floor  The Joint Commission, an association that accredits health-care organizations, has established specific standards regarding the use of seclusion and restraint – some examples of current standards include: Seclusion or restraint is discontinued at the earliest possible time regardless of when the Restraints & order is scheduled to expire An in-person evaluation by a physician must be Seclusion conducted within 1 hour of initiating restraint or seclusion Patients cannot be simultaneously restrained and restrained Nurses who are involved in restraining and secluding patients must monitor the physical and psychological well-being of the patient including (but not limited to) respiratory and circulatory status, skin integrity, and vital signs