Ability to perform common functions of the Mental Health Act NSW (2007)
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.
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.
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”.
Candidates should be allowed no more than 3 minutes per question so as to ensure they can attempt each question. If 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
What are the legal requirements for detaining a person admitted as Mentally Disordered under the Mental Health Act NSW (2007)?
What is your role in reviewing & assessing the patient?
Supplementary: How would you go about this?
What would you do after assessing the patient?
What is the difference between a Mentally Disordered and Mentally Ill patient under the Mental Health Act NSW (2007?)
What rights do patients have as involuntary patients in hospital in NSW?
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
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
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
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