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Samantha McCabe-Hogan
Samantha McCabe-Hogan
Samantha is a Senior Lecturer in Paramedic Science at Sheffield Hallam University, where she has worked for the last 8 years, after being an Operational Paramedic and Clinical Educator.
Samantha is a Senior Lecturer in Paramedic Science at Sheffield Hallam University, where she has worked for the last 8 years, after being an Operational Paramedic and Clinical Educator.
Samantha lectures in Law, Ethics, Research and Evidence Based Practice. She is also a Dissertation advisor for level 6 and 7 studies. Samantha has a keen interest in Mental Health for service users as well as all ambulance clinicians.
Samantha lectures in Law, Ethics, Research and Evidence Based Practice. She is also a Dissertation advisor for level 6 and 7 studies. Samantha has a keen interest in Mental Health for service users as well as all ambulance clinicians.
Mental Health Act 1983/2007
Mental Health Act 1983/2007
Mental health patients can be complex and difficult to manage in the pre-hospital environment, the social isolation of COVID-19 is likely to increase the volume of mental health emergency calls.
Mental health patients can be complex and difficult to manage in the pre-hospital environment, the social isolation of COVID-19 is likely to increase the volume of mental health emergency calls.
There are planned temporary changes to the Mental Health Act 1983/2007, which may be applied to patients during the corona virus pandemic. These will be discussed under a separate subheading.
There are planned temporary changes to the Mental Health Act 1983/2007, which may be applied to patients during the corona virus pandemic. These will be discussed under a separate subheading.
These are the sections ambulance clinicians may be involved in.
These are the sections ambulance clinicians may be involved in.
· Section 2
· Section 2
· Section 3
· Section 3
· Section 136
· Section 136
Section 2
Section 2
This section is used for the admission to a mental health unit to assess an individual that may have a mental health disorder, where their admission is necessary for their health and safety, and potentially the protection of others/public. This can be for up to 28 days.
This section is used for the admission to a mental health unit to assess an individual that may have a mental health disorder, where their admission is necessary for their health and safety, and potentially the protection of others/public. This can be for up to 28 days.
Section 3
Section 3
This section allows admission for treatment for up to six months, the person would have a mental disorder and it is necessary for that person to be detained in a mental health unit for their health and safety and the protection of other persons.
This section allows admission for treatment for up to six months, the person would have a mental disorder and it is necessary for that person to be detained in a mental health unit for their health and safety and the protection of other persons.
Section 136
Section 136
This is used by the police for a person in public that may be displaying a mental health disorder and are a danger to themselves or others. The police can remove them to a place of safety.
This is used by the police for a person in public that may be displaying a mental health disorder and are a danger to themselves or others. The police can remove them to a place of safety.
Place of safety
Place of safety
A police station is not deemed a place of safety, therefore should not be used unless the below criteria is met
A police station is not deemed a place of safety, therefore should not be used unless the below criteria is met
A. The behaviour of the person poses an imminent risk of serious injury or death to themselves or others,
A. The behaviour of the person poses an imminent risk of serious injury or death to themselves or others,
B. Because of that risk, no other place of safety other than a police station that is in the relevant area can be reasonably expected to detain the person and,
B. Because of that risk, no other place of safety other than a police station that is in the relevant area can be reasonably expected to detain the person and,
C. The decision maker is a police officer with the rank of inspector or above.
C. The decision maker is a police officer with the rank of inspector or above.
For a person to be detained in a police station the police constable must first consult a healthcare professional, which includes paramedics.
For a person to be detained in a police station the police constable must first consult a healthcare professional, which includes paramedics.
Temporary Changes to Mental Health Act 1983/2007
Temporary Changes to Mental Health Act 1983/2007
Why are the government making emergency changes to the Mental Health Act?
Why are the government making emergency changes to the Mental Health Act?
The Mental Health Act must continue to function effectively throughout the Covid-19 pandemic, in order to ensure the safety, care, and treatment of people severely affected by mental illness.
The Mental Health Act must continue to function effectively throughout the Covid-19 pandemic, in order to ensure the safety, care, and treatment of people severely affected by mental illness.
Emergency legislation has been introduced to Parliament which includes temporary measures to change the Mental Health Act. This is because the government is concerned that Covid-19 will reduce the number of mental health professionals available to help people whose mental health places them at risk.
Emergency legislation has been introduced to Parliament which includes temporary measures to change the Mental Health Act. This is because the government is concerned that Covid-19 will reduce the number of mental health professionals available to help people whose mental health places them at risk.
The changes will not apply from the moment the legislation is passed - they may be activated if the crisis worsens.
The changes will not apply from the moment the legislation is passed - they may be activated if the crisis worsens.
If activated these changes will be applicable to Paramedics
If activated these changes will be applicable to Paramedics
Changes to the number of doctors required to detain a person under the Mental Health Act for assessment and treatment
Changes to the number of doctors required to detain a person under the Mental Health Act for assessment and treatment
Usually three people have to agree that you need to be detained.
Usually three people have to agree that you need to be detained.
These are normally an approved mental health professional (AMHP) and two doctors.
These are normally an approved mental health professional (AMHP) and two doctors.
Under the new legislation the number of doctors is reduced to one.
Under the new legislation the number of doctors is reduced to one.
The AMHP has to record the reason why the decision to detain them was made on the recommendation of only one doctor. And they should only take this decision if they believe that staff shortages caused by coronavirus mean it would take too long for a second doctor to assess them.
The AMHP has to record the reason why the decision to detain them was made on the recommendation of only one doctor. And they should only take this decision if they believe that staff shortages caused by coronavirus mean it would take too long for a second doctor to assess them.
Changes to the transfer of prisoners to hospital
Changes to the transfer of prisoners to hospital
Under the Mental Health Act if they are a prisoner they can be transferred to hospital. This happens if two doctors think this is the best thing for them, because of the nature of their mental disorder. The Secretary of State for Justice must consent to the transfer.
Under the Mental Health Act if they are a prisoner they can be transferred to hospital. This happens if two doctors think this is the best thing for them, because of the nature of their mental disorder. The Secretary of State for Justice must consent to the transfer.
This power is covered in section 47 of the Mental Health Act.
This power is covered in section 47 of the Mental Health Act.
The emergency legislation says that only one doctor needs to recommend the transfer of them from prison to hospital. But the Secretary of State for Justice must still consent to the transfer.
The emergency legislation says that only one doctor needs to recommend the transfer of them from prison to hospital. But the Secretary of State for Justice must still consent to the transfer.
Changes to police holding powers
Changes to police holding powers
A person might be in the community or their own home. Police might be concerned about the safety of them or others and that they have a mental disorder.
A person might be in the community or their own home. Police might be concerned about the safety of them or others and that they have a mental disorder.
The Police have powers under the Act to hold a person in a place of safety. Depending on the circumstances, this could be a hospital, their home, the home of another or a police station.
The Police have powers under the Act to hold a person in a place of safety. Depending on the circumstances, this could be a hospital, their home, the home of another or a police station.
The police have these powers under sections 135 and 136 of the Mental Health Act.
The police have these powers under sections 135 and 136 of the Mental Health Act.
A person can usually be held for an initial period of up to 24 hours. Which can be extended for a maximum of another 12 hours. The patient can only be held after that time if a full Mental Health Act assessment is done. And professionals agree to further detain the patient.
A person can usually be held for an initial period of up to 24 hours. Which can be extended for a maximum of another 12 hours. The patient can only be held after that time if a full Mental Health Act assessment is done. And professionals agree to further detain the patient.
This will usually be under sections 2 and 3 of the Mental Health Act.
This will usually be under sections 2 and 3 of the Mental Health Act.
The change means that they can be held for an initial period of up to 36 hours. This can be extended for a maximum of another 12 hours.
The change means that they can be held for an initial period of up to 36 hours. This can be extended for a maximum of another 12 hours.
References
References
ReThink link:
ReThink link:
Eaton, G. (2019) ‘Law and Ethics for Paramedics’. Class Publishing, Bridgewater.
Eaton, G. (2019) ‘Law and Ethics for Paramedics’. Class Publishing, Bridgewater.
Mental Health Act 1983/2007
Mental Health Act 1983/2007
Mental Capacity Act 2005
Mental Capacity Act 2005
The Mental Capacity Act (MCA) is a legal framework for assessing whether a person has the capacity to make specific decisions (Bartlett, 2019). It should be assumed that persons have the capacity to make decisions until it can be proved they lack capacity. The Act is applicable to persons aged over 16 years old.
The Mental Capacity Act (MCA) is a legal framework for assessing whether a person has the capacity to make specific decisions (Bartlett, 2019). It should be assumed that persons have the capacity to make decisions until it can be proved they lack capacity. The Act is applicable to persons aged over 16 years old.
As the saying goes ‘Do not judge a book by its cover’ the same goes for assessing capacity, you cannot judge capacity purely on a person’s look, age or behaviour.
As the saying goes ‘Do not judge a book by its cover’ the same goes for assessing capacity, you cannot judge capacity purely on a person’s look, age or behaviour.
A person cannot be deemed to lack capacity just because they make an unwise decision, providing it is legal and does not cause possible harm to others. If the decision they make such as attempting suicide, then the person should be assessed under the Mental Health Act 1983/2003, to ascertain whether they have an underlining or undiagnosed Mental Health Condition and may need to be sectioned for assessment (section 2) or treatment (section 4).
A person cannot be deemed to lack capacity just because they make an unwise decision, providing it is legal and does not cause possible harm to others. If the decision they make such as attempting suicide, then the person should be assessed under the Mental Health Act 1983/2003, to ascertain whether they have an underlining or undiagnosed Mental Health Condition and may need to be sectioned for assessment (section 2) or treatment (section 4).
The assessment
The assessment
This is a two-stage test to assess if a service user has capacity. Both of these must be carried out before a conclusion can be made.
This is a two-stage test to assess if a service user has capacity. Both of these must be carried out before a conclusion can be made.
Stage 1 – The diagnostic test (Section 2(1) of MCA 2005)
Stage 1 – The diagnostic test (Section 2(1) of MCA 2005)
For the purpose of this Act, a person lacks capacity in relation to a matter if at the material time they are unable to make decision for themselves in relation to the matter because of an impairment of, or disturbance in the functioning of the mind or brain, this can be temporary or permanent.
For the purpose of this Act, a person lacks capacity in relation to a matter if at the material time they are unable to make decision for themselves in relation to the matter because of an impairment of, or disturbance in the functioning of the mind or brain, this can be temporary or permanent.
Stage 2 – The function Test (Section 3(1) of the MCA 2005)
Stage 2 – The function Test (Section 3(1) of the MCA 2005)
Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?
Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?
The MCA says that a person is unable to make their own decision if they cannot do one or more of the following four things:
The MCA says that a person is unable to make their own decision if they cannot do one or more of the following four things:
- Understand information given to them
- Retain that information long enough to be able to make the decision
- Weigh up the information available to make the decision
- Communicate their decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand.
If they are unable to complete one or more of the above questions, then they are deemed to lack capacity at the time a decision needs to be made.
If they are unable to complete one or more of the above questions, then they are deemed to lack capacity at the time a decision needs to be made.
The HCPC standards of Proficiency state ‘You should understand the need to act in the best interests of service users at all times’ (HCPC, 2014 page 7 & MCA 2005). Therefore, the decision to assess capacity and any treatment must be done in the service user’s best interests.
The HCPC standards of Proficiency state ‘You should understand the need to act in the best interests of service users at all times’ (HCPC, 2014 page 7 & MCA 2005). Therefore, the decision to assess capacity and any treatment must be done in the service user’s best interests.
The MCA also states ‘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 freedoms of action’ (Section 1(6) if the MCA, 2005). This means if a service user is deemed to lack capacity the decision to treat, manage or discharge, must be done in their best interests and must be the least restrictive and the decision must be required at the time.
The MCA also states ‘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 freedoms of action’ (Section 1(6) if the MCA, 2005). This means if a service user is deemed to lack capacity the decision to treat, manage or discharge, must be done in their best interests and must be the least restrictive and the decision must be required at the time.
All decisions to test capacity must be documented, where they failed and why.
All decisions to test capacity must be documented, where they failed and why.
References
References
Mental Capacity Act 2005
Mental Capacity Act 2005
Bartlett, E. (2019) ‘Law and Ethics for Paramedics’. Editor Eaton, G. Chapter 10, Class Publishing, Bridgewater.
Bartlett, E. (2019) ‘Law and Ethics for Paramedics’. Editor Eaton, G. Chapter 10, Class Publishing, Bridgewater.
Samantha McCabe-Hogan - Senior Lecturer in Paramedic Science, Sheffield Hallam University
Samantha McCabe-Hogan - Senior Lecturer in Paramedic Science, Sheffield Hallam University
@samhog
@samhog
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