The Mental Health Act

This Viva covers your knowledge of the basic elements of the Mental Health Act, including the ethical principles that underpin care for those suffering mental illness.

Please refer to this post for more detail.

LEARNING OBJECTIVES TESTED:

1. Ability to explain Mental Health Act NSW (2007)
2. Ability to perform common functions of the Mental Health Act NSW (2007)
3. Understanding of ethics and rights of patients in relation to involuntary admissions

FORMAT:  VIVA STATION

Instructions to the Candidate:

Reading time: 5 minutes

Please Read the material below.

In the next station you will be asked to answer a series of questions by the examiner.

Background:

You are the intern covering a general mental health ward one Saturday.

You have been asked to review a patient who has been admitted Mentally Disordered under the Mental Health Act.

Your Task is:

To read the attached information and be prepared to answer questions of the examiner.

Further history

You are accompanied by the nurse to review a 26-year-old male involuntary patient.

The background is that he has had 3 previous involuntary admissions for drug-induced-psychosis.  There appears to be a pattern of risky behaviour prior to admission as well as some aggression in hospital.

The man was found yesterday by the police wandering along the highway, disrupting traffic and placing themselves and drivers in danger.  He was only wearing jeans and underwear at the time.

Attached is a copy of the form completed by the admitting doctor yesterday.

When you speak to the man he appears to be a little bit more coherent.  He tells you that he is hearing voices which tell him that people are inserting microchips in his brain to control him.  He is busily writing some notes for a new television pilot which he tells you he has been recently commissioned to be the head writer and producer.  If he does not get the project emailed off today he will miss out on his commission of $200,000.

He does not give you any indication that he is going to harm himself or other people.  However he asks you if you could please discharge him from hospital so he can email his television series to Channel Nine or if this is not possible borrow a computer and prescribe him some “ice”.

AdvanceMed-Mental-Health-Act-form-01-signed-1

candidates seek clarification please repeat the question for them.  Secondary probing questions are permitted.

Candidates are permitted to return to a question if time permits at the end

Question 1 

What are the legal requirements for detaining a person admitted as Mentally Disordered under the Mental Health Act NSW (2007)?

Question 2 

What is your role in reviewing & assessing the patient?

Supplementary: How would you go about this?

Question 3 

What would you do after assessing the patient?

Question 4 

What is the difference between a Mentally Disordered and Mentally Ill patient under the Mental Health Act NSW (2007?)

Question 5

What rights do patients have as involuntary patients in hospital in NSW?

Nil

Nil

CHECKLIST – MEANT AS GUIDE ONLY

QUESTION 1 – THE LEGAL REQUIREMENTS FOR MENTALLY DISORDERED

• Indicates patient must be displaying irrational behaviour
• Indicates risk of serious physical harm indicates or discusses the need to justify hospital as least restrictive environment
• Other factors that should be considered for e.g. certain behaviours are specifically excluded e.g. sexual preferences, limit to how many times someone can be detained mentally disordered in a month

QUESTION 2 – DOCTOR’S ROLE IN REVIEWING A PATIENT ADMITTED MENTALLY DISORDERED

• Patient must be reviewed daily
• Patient must be discharged if no longer disordered or ill
• Role in explaining why patient is being detained in hospital
• Broader role in assessing the patient’s mental state Interns should seek advice from someone more senior if uncertain
• Assessment of patient Includes
  • seeking information to confirm whether patient remains disordered
  • Considers information that might alter legal status to mentally ill or no longer requiring involuntary admission
  • Establishes rapport with patient and discusses potential anxieties or reaction of patient, offers to answer patients questions
  • Outlines approach to assessment, including interview with patient and review of notes and discussion with staff and others present (e.g. family)
  • Consider other issues, particularly of immediate risk

QUESTION 3 – AFTER ASSESSING PATIENT

• Decide on legal status
• Document appropriately
• Review treatment (particularly prn medications)
• Seek senior advice

QUESTION 4 – DIFFERENCE BETWEEN MENTALLY DISORDERED AND MENTALLY ILL

• There are differences in both definitions and consequences
• Different definitions
  • 1. Mentally disordered person. Already defined under question 1
  • 2. Mentally Ill person Is suffering from mental illness and owing to the illness there are reasonable ground for believing care is necessary for protection for the person or others from serious harm Mental Illness has a definition under the act that requires there to be a condition characterised by at least one of: Delusions, hallucinations, serious thought disorder, serious mood disorder or behaviour indicative of the above
• Different outcomes
  • 1. Mentally Disordered is meant to invoke a daily medical review and be a short period of admission
  • 2. Mentally Ill should result in a review by the Tribunal “as soon as practicable” and is intended for persons needing more lengthy stays for treatment.

QUESTION 5 – RIGHTS OF INVOLUNTARY PATIENTS IN HOSPITAL

• There are several rights. In particular, patients generally have the right to liberty as described by the principle of least restrictive care whether in or out of hospital (e.g. CTO)
• Right to review by medical officers and medical superintendent
• Right to external review (e.g. by Tribunal)
• Right to apply for discharge Right to procedural fairness and access to legal advice and representation
• Right to be informed of rights
• Right to dignity e.g. wear own clothes, access to money, make phone calls, see friends and family
• Right to have a primary carer notified
• Right to interpreter
• Right to access medical records
• Restricted rights in relation to medications and right to be involved in treatment decisions