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Development of Mental Health Law


Title: Development of Mental Health Law Author: Anthony Zigmond Last modified by: David Turner Created Date: 10/5/2011 2:09:55 PM Document presentation format – PowerPoint PPT presentation

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Title: Development of Mental Health Law

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Magna Carta
  • No freeman shall be seized or imprisoned or
    stripped of his rights or possessions .. Nor
    will we proceed with force against him, or send
    others to do so, except by the lawful judgement
    of his equals or by the law of the land.

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  • Everyone has the right to liberty of person. No
    one shall be deprived of their liberty save in
    the following cases and in accordance with a
    procedure prescribed by law
  • 1.e the lawful detention of persons for the
    prevention of the spreading of infectious
    diseases, of persons of unsound mind, alcoholics
    or drug addicts or vagrants.

Article 5
  • (3) Everyone arrested or detained in accordance
    with the provisions of paragraph 1(c) of this
    article shall be brought promptly before a judge
    or other officer authorised by law to exercise
    judicial power and shall be entitled to trial
    within a reasonable time or to release pending
  • (5) Everyone who is deprived of his liberty by
    arrest or detention shall be entitled to take
    proceedings by which the lawfulness of his
    detention shall be decided speedily by a court
    and his release ordered if his detention is not

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Physical disorder v Mental disorder
  • MCA
  • MHA
  • Enhances autonomy
  • All help to make decision
  • Best interest (as defined by the patient)
  • Lasting power of attorney
  • Advance decisions
  • Removes autonomy
  • Overrides capacitous refusal
  • Best interest ish (as defined by RC)
  • Role of NR
  • Removes authority of AD
  • Note s141 etc

Rosie Winterton Minister of State 2004
  • Of course, they do address two quite separate
    issues, one dealing with people who have lost the
    capacity to consent to treatment and the other
    dealing with people who do not wish to consent to
    treatment but for whom treatment is felt to be a

  • The patient has a mental disorder
  • That because of the mental disorder the patients
    ability to make decisions about the provision of
    medical treatment is significantly impaired
  • That it is necessary to detain the patient in
    hospital for the purpose of determining what
    medical treatment should be given to the patient
    or giving medical treatment to the patient
  • That if the patient were not detained in hospital
    there would be significant risk to the health,
    safety or welfare of the patient or to the safety
    of any other person
  • That the granting of a short-term detention
    certificate is necessary.

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  • Emergency - grievous and instant danger against
    his safety and life and against safety and life
    of others, or against properties OR incapable of
    looking after himself due to the gravity of the
    psychiatric disorder.
  • Non-emergence - severe psychiatric disorder AND
    grievous and imminent danger to the patient
    himself, to others or to properties AND necessary
    for treatment to avert an imminent and
    significant deterioration of the mental condition
    AND treatment available and the patient is not

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  • Has recently threatened or attempted or is
    threatening or attempting to cause bodily harm to
    himself or herself AND/OR
  • has recently behaved or is behaving violently
    towards another person or has caused or is
    causing another person to fear bodily harm from
    him or her AND/OR
  • has recently shown or is showing a lack of
    competence to care for himself or herself to a
    degree that places the individual at risk of harm
    to himself or herself

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Re B
  • A competent patient has an absolute right to
    refuse to consent to medical treatment for any
    reason, rational or irrational, or for no reason
    at all, even when that decision may lead to his
    or her death.
  • Dame Elizabeth Butler-Sloss Re B 2002

  • Never again may a clinician administer treatment
    against the will of a mentally competent patient

The Rule of Law
  • Most British people today would, I think,
    rightly regard equality before the law as a
    cornerstone of our society. But we would also
    accept that some categories of people should be
    treated differently.
  • Children.
  • Prisoners.
  • The mentally ill who may have to be confined if
    they present a danger to themselves or others.
  • Lord Tom Bingham

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Number subject to MHA March 31st
  • 2008 15,181
  • 2009 16,073 1,755 CTO
  • 2010 16,622 3,325 CTO
  • 2011 16,647 4,291 CTO

Rosie Winterton Minister of State 2003
  • "The intention of the legislation is not to
    increase the numbers of people who are subject to

Compulsion - treatment
  • 1983-5 4,000 statutory second opinions
  • 2008-10 18,000 (of whom over 5,000 were
    recorded as capacitous refusing medication).
  • CTO patients, over 55 were described as having
    insight and 20 were described as refusing
    medication .

  • 35 (12 2 or more)
  • Housing
  • Criminal justice
  • Finance
  • Child care
  • MH v Physical Health

The OCTET study - CTO research
  •  A randomised controlled trial examining the
    efficacy and cost-effectiveness of the new
    supervised Community Treatment Orders (CTOs).
  • Research question
  • Do CTOs reduce time to readmission, the rate and
    duration of readmission to hospital?

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Eliza Manningham-Buller
  • If we ourselves are to be free, and to feel
    secure in our freedom, its important to keep a
    rational perspective on terrorist risk. The world
    is full of risks and dangers, only some of which
    can be reduced. Why then, when we in this country
    know that, for example, hospital-acquired
    infections and road traffic accidents both kill
    many more than terrorism, do we react as we do?
  • Politicians lose their way if they become too
    apprehensive about how the media will react to
    terrorism when it happens. We compound the
    problem if we use it as a reason to erode the
    freedom of us all.

Violence to others
  • How much?
  • Screening - how predictable?
  • What population?

Physical illnesses
  • Heart-attack
  • Breast Cancer
  • Diabetes
  • Obesity
  • Alcohol
  • Smoking
  • Physical Mental illness

  • Chronic illness with no cure but much positive
  • It is both progressive and potentially life
  • Primarily risks to self
  • higher risk of heart disease
  • stroke
  • kidney failure
  • eye disease (which can lead to blindness)
  • foot ulceration (which can lead to amputation)
  • Risks to others

The Downside
Some adverse effects
  • Parkinsonism, dystonia, akathisia, tardive
    dyskinesia, hypotension, hypothermia,
    hyperthermia, neuroleptic malignant syndrome
    (which may be fatal), drowsiness, apathy,
    agitation, excitement, insomnia, convulsions,
    dizziness, headache, gastro-intestinal
    disturbances, nasal congestion, dry mouth,
    blurred vision, difficulty with micturition,
    acute urinary retention, urinary incontinence,
    constipation, tachycardia, arrythmias, (including
    sudden death), menstrual disturbances,
    galactorrhoea, gynaecomastia, impotence, weight
    gain, diabetes, agranulocytosis or leucopenia,
    (both of which may be fatal), photosensitization,
    contact sensitisation, rashes, jaundice, corneal
    and lens opacities, and pigmentation of the skin,
    cornea, conjunctiva and retina (which may cause

Some losses
  • Responsibility
  • Medical confidentiality
  • Fresh air
  • Exercise
  • Bedtime
  • Watch whatever you want on the television
  • Drink alcohol
  • Make love/have sex

The Spectator 1839
  • A lunatic, in law language, is civilitus
    mortuus. If committed unduly, he receives in his
    single person nearly all the civil liberties that
    can be afflicted for not only is his liberty
    thereby taken away and his property removed from
    his control but he suffers an imputation which
    operates with all the force of a libel A party
    detained on a charge of insanity may be acquitted
    and restored to liberty but we all know that
    this is a question of such a nature that it
    cannot even be raised without attaching suspicion
    ever after to the individual to whom it relates.

The Choice and who decides?
  • Taking medication
  • Stopping medication
  • Staying mentally symptom free and out of hospital
    but obese and impotent
  • Relapsing twice a year requiring two weeks in
    hospital each time but feeling fit and
    functioning well the rest of the time

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UN Convention on the Rights of Persons with
  • Legislation authorizing the institutionalization
    of persons with disabilities on the grounds of
    their disability without their free and informed
    consent must be abolished.

UN Convention on the Rights of Persons with
  • This should not be interpreted to say that
    persons with disabilities cannot be lawfully
    subject to detention for care and treatment or to
    preventive detention, but that the legal grounds
    upon which restriction of liberty is determined
    must be de-linked from the disability and
    neutrally defined so as to apply to all persons
    on an equal basis.

A thought
  • What good is it making someone safer if it merely
    makes them miserable?
  • Lord Justice Munby
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