The Mental Health Act

The mental health act is an act design to protect people with mental illness. It was originally written in 1983 and reformed in 2007. It sets out clear guidance for a health professional when a person may need to be taken into compulsorily detained in a hospital. This is known as sectioning. This helps carers who are unable to cope without help. People can be sectioned if the health care profession thinks they are a danger to themselves, they are a danger to another person or in danger of abuse from another person.

The health professionals have a duty of care to the patient who is mentally ill. They must provide get the right treatment and to give them and their families the right information. The act gives rights to relatives, social workers, doctors and other health professionals to detain a person for their own safety. The act is used by mental health specialist and GP to treat the mentally ill. The mental health act has over 100 sections.

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However some sections are more relevant to people with dementia. The sections that appeal to people with Dementia are: section 2, section 3 and section 117. Section 2

This section set out clear guide leads sectioning. A person can be taken into care if the health profession thinks they are at risk. This is so they can be accessed; a section can last 28 days. A section can be from a health professional or a person’s next of kin. Compulsorily detainment normally done by health care professions. To ensure that people are sectioned when needed safely the local authority has a duty to provide training to the health professional to perform this role.

In order to get a person sectioned, two doctors must agree that there is a clear risk to person and that sectioning is the best option. They most sign a medical recommendations stating why someone can only be treated in a psychiatric hospital. One of the doctors most have special experience in working with people with a mental disorder.

The second is normally someone who knows the person, such as their GP or local nurse. The health professional must interview the person and be satisfied that detention in hospital is, given all the circumstances, the most appropriate way of providing the care and medical treatment they need. The health professionals must admit the person to the hospital within 14 days of when the medical recommendations were signed. Once admitted, the person will have to stay in the hospital and be closely supervised for their and other people's safety. Under section two a person can be detain if they are suffering from a “a mental disorder of a nature or degree that warrants detention in hospital for assessment” and if being detained is in the interest of your own health or safety or the health and safety of others. Section 3 -detention for treatment

This section allows for people to be detained in a hospital for treatment; they can be kept against their will for 6 months. After this the section can be renewed for another six month, then for a year at a time. The treatment can start as soon as someone is detained under section 2 or if it is clear from the start that the person is not willing to accept treatment voluntarily. Either a mental health care professional or the person's next of kin can apply for the person to be taken into care. To be detained under section 3 the person must be suffering from a “mental disorder of a nature or degree” that makes hospital treatment the most suitable treatment and for the right medical treatment is available. It must be necessary to detain someone for their own health or safety, or for the protection of others, that you receive such treatment and it cannot be provided unless you are detained under this section. Treatment for dementia may include therapies such as problem-solving therapy and cognitive behavioural therapy, specialist mental health nursing, and care. However the care professional cannot admit someone to hospital under section three without the next of kin agreement. Section 117 – After-care services

The duty of after-care is shared between the NHS and the local authorises. They have a joint duty to ensure that care services are ready for when a person comes out of compulsorily detainment. This helps to create a smooth transition between care services for the patient. The support is offered to all people are is not means tested. The care is free for all patients and includes care in the person's own home and paying for care home fees. However the local authority may decide that a person is no longer eligible for after-care support under section 117 and will have to start paying for their own care. Challenging sections

Sections can be challenged, there are four main ways to challenge a section. This first way is to ask a Responsible Clinician to discharge them. The responsible clinician must discharge the patient if the medical conditions not bad enough to justify the admission. The next step is to to request a meeting with hospital managers and ask them to discharge them. The third step is to ask your next of kin to discharged you by giving the hospital 72 hours notice in writing. After this, if the responsible clinician allows it the next of kin can discharged the person from the detainment. However the Responsible Clinician may if they think you would act in a manner dangerous to yourself or others. The finial option is to apply to the Mental Health Tribunal (MHT). The patient will be able to use a legal aid to get a solicitor free of charge to help you with your appeal to the tribunal and during the hearing. The legal aid is not means tested and offered to all people applying to the mental health tribunal. The section will run out if not renewed or replaced by another section. After this the person can choose to discharge themselves from hospital. The hospital always has a duty to make sure patients' needs will be met in the community after they are discharged. Independent monitoring bodies

Mental act manager's hearing is an independent panel that are similar to a tribute but the people on the panel have no medical experience. The hearing are organised by the hospital MHA Administrator, were as Tribunals are organised by the Tribunal secretariat in the local area. There is no medical member on the panel so there is no medical examination before the hearing. They have the power to discharge unrestricted patients but not restricted patients. This is because the ministry of justice has to give permission to discharge restricted patients. Although they tend to adjourn for a further hearing. There is no period to apply and applications can be made at any time. The mental health review tribunal is an independent panel that has the power to discharge a person after they have been section under the mental health act. The tribunal hearings take place at a hospital. The tribunal decide if a person is correctly section under the mental health act.

Tribunals happen when a person appeals to a section. The care quality commission is a independent commission that work for the government checking the standards of care provided by services. They regulate the mental health act by reviewing it and checking it is being used properly. This is done by visiting all place where patients are detained under the mental health act. When it is requested the might also make checks on a community treatment order. They find that many services for the people with mental health disorders do not meet their needs. For example, they found that 14% were on a ward with no access to GP service. Strengths of the mental health act

One strength of the mha is that it protects people who lose the ability to make their own decisions through advocate and guardianship. This protest people from abuse. It allows the family to make choices on behalf of the people, allowing them to still get individualised care. It is easy to miss treat a person with dementia as they will not have memory of the event. This stops them from being able to tell a person about the event. So they need strict rules and procedures from the government to stop abuse from happening. This is known as safeguarding people. A second strength was it prevents people with mental illnesses from harming themselves or others. This is by sectioning people with mental illness who are at risk of harming to themselves or to others. This takes people out of situations which have high risk factors and allow them to start treatment without needing the person agreement. A third strength is it makes the service accountable to checks made by independent bodies. It is done by independent bodies to stop bias. Having services checked ensures they are following the rules and guidelines set by the act.

This ensures that all services provide quality care from a high standard. This makes sure all people are given quality care and well looked after. Therefore all people are given the right care for their condition regardless of their mental health. A third strength is it gives people a voice and right. This gives people choices and options. Even through people with dementia may not be mentally fit to make decision they can make decisions about their future in the early onset of dementia. The act allows the choices they made in advance to be followed and choices they can make about treatment to be respected. The act also gives them rights and ensures they are treated with respect and regard. It ensures the carers follow the people's basic human rights. As part of this, the people cannot be forced into treatment unless their illness is severe and a GP or specialist agrees with the discussion. This is one example of how they are given rights and not treated as a “number”.

Their emotion are taken into account as much as possible. A fifth strength is it provides a system of redress. This allows people to challenged a section or choice by a doctor. This allows people to complain about bad treatment. This should stop unfair treatment as care providers can get in trouble for poor care. It prevents A sixth is to raises awareness of rights of people with MHN. This helps people to have a understanding of mental illness. This helps mental ill people to be helped in public. It also stops negative stereotypes about the mentally ill. Finally it has lead to improved services for people with mental health issues as the raise in awareness has lead to more service givers thinking about their mentally ill patients. Also the act means by laws the services most provide suitable care for the mentally ill. Weakness of the mental health act

The first weakness is it has not been able to changed people’s attitudes towards mental illness. The act has do not enough to change people’s negative stigma towards the mental illness. The services still do not do enough to promote equal rights for people with mental health problems. One example of stigma towards is people still use words such as “mad” or “crazy” to describe the mentally ill, this is bad as it reinforces stigmas and makes out that people with mental disorder are less able to function than a person without a disorder. Another example is people do not see minor disorders as being unimportant. Many people think ADHD is caused by bad parenting or people who are depressed should just cheer up. However “time to change” and other charities are doing campaigns to how spread knowledge on mental health. For example time to change did a “time to talk” campaign in 2011. A second weakness is the service users may not be aware of their right. Like many act the people it protects are unaware of the rights the act providers them. For example many people do not know how to challenge sections.

Many people have not researched the act and therefore do not know their rights. A third weakness is that sometimes it takes a long time for treatment to begin. Services will often wait to see if the person will ask for help themselves rather than sectioning. Often people have to be in a emergency situation before care will be often to them. This leads to many cares and dementia suffers having to suffer alone for a long time before being given help. Also there is not enough funding to dementia so offer services will try to save money by giving the family of the dementia patient to care for the person for as long as possible. Services being under funded meant George had to struggle to get the right care for Audrey. For other families they may need to give up their jobs or leisure activities to care for a relative with mental illness. The lack of funding can led to people being discharged too early to save money. As a section only last for 28 days so sometimes they run out without being renewed.

That can led to people being released before they are ready. A third weakness is that it puts too much focus on controlling people than treatment of them. This leads to negative stigma attached to mental health being reinforced. People who are a danger to themselves or others are locked up and do not treat them. This leads to people thinking mental hospitals are still like “mad houses” from the past. Focus needs to be put onto the treatment of patients and making them better. This will improve there quality of life for the mentally ill and to remove the negative stigma. As well as shifting the focus onto treatment over controlling people they should also allow for community care to become an option. Reform of the Mental health 2007

After time the mental health act became outdated. The aim of the reformed act was to improve people's own safety through safeguarding; to improve treatment of people to help people gain freedom and independence as much as possible. A finial aim was to move away from institutionalisation. One of the main changes to the act was the definition of mental disorder. In the 1983 act it defines a mental disorder as “mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind". From this it was broken down into 4 sub categories. The first was a mental illness; this was defined as a “was undefined, but includes, for example, schizophrenia and bipolar affective disorder”. The second was a psychopathic disorder; this is a disorder or disability "of mind which results in abnormally aggressive or seriously irresponsible”. The next type is a mental impairment; this is a disorder or disability that cause “significant impairment of intelligence and social functioning” often “associated with abnormally aggressive or seriously irresponsible”The last type was a severe mental impairment; this is a conditions that creates “severe impairment of intelligence and social functioning” these are normally “associated with abnormally aggressive or seriously irresponsible”.

However, the 2007 reform act simplify the definition to be a “disorder or disability of the mind”. This was better as by categorising different types of because it allows the treatment to be given base on need instead of what category they are under. The next way the act has been updated is changes to the role of the nearest relative. The first change is it allows the patient to make a application to count to ask to have their next of kin changed and for the count to allow this if they agree the person is unsuitable for the role. It has also change so that civil partners can be the next of kin. This was necessary because of gay rights laws changing since the 1980's. This ensure the patient has choice over their next of kin. The next change was the age-appropriate services for patients under 18. they should be accommodated in a suitable environment for their age group. This is important as young people might find it scary to be treated in a mental health hospital made for adults. This could make treatment harder and a longer process. According to young minds around 850,000 children have a mental health problem. This allows suitable early intervention. Thus making treatment easier, quicker and less stressful for children. The third change will be new criteria for detention.

It has created new appropriate medical treatment test which applies to all the longer-term powers of detention. As a result some will not be given compulsorily detainment or their compulsorily detainment will end. This new criteria has abolished the “treat-ability” test. The forth change is to the professional who can section a person. More professionals are now allowed to section a person and treat a person with a mental disorder. Provided they have the right training. The firth change was the introduction of supervised community treatment for patients following a period of detention in hospital. This allows for patients with a mental disorder to be discharged from a compulsorily detention and to be cared for within the community. They may leave a hospital so long as they are not a risk to themselves or other and continue the treatment outside of the hospital. For some people they are happier and more relax being treated in a finial environment, this means they are better treated within the community.

The sixth change was that hospital managers must refer case that need to go to the tribunal if they do not apply themselves in a shorter amount of time. This reduces waiting time for people waiting for a tribunal who can not apply for themselves. The finial change is to allow independent mental health advocacy: It places a duty on the local authority to make arrangements for help to be given to people with mental health problems by independent mental health advocates. The mental capacity Act

Mental capacity means to be able to make choices and decisions for yourself. A person unable to do this are said to “lack capacity” this might be due to illness, injury, a learning disability, or mental health disorders. In order to make a decision a person must be able to understand the information and remember it long enough to make a fully informed decision. They most also be able to communicate their decisions. For a person with dementia their mental capacity may fluctuate. This means they may be better at understanding at certain points at the day. For example they may be better at making decision in the morning rather than the evening when they are tired. They may also make better decision when in a familiar place such as their home. The carers should pick a appropriate time to ask the person important questions so they are more able to understand and answer the questions. The mental capacity act 2005 is a law that protects and supports people who are lack mental capacity, The act covers all people over 16 in England and Wales. It also provides guidance for help people who need to make decisions for someone else.

The act also helps people to make plans for future when some one has a degenerate conditions such as dementia. They are able to make decisions for the future and the act ensures these choices are respected and followed as much as they can. The act covers important decisions the person will make, including what care will be given in the future, individual's property and financial affairs. It also apples to mundane decisions such as personal care, what they will wear and what they want to eat. For example a Muslim may ask to wear the headscarf even when they lose the ability to continue to make their own decisions. The act has five main principles for people when making decisions on behalf of someone who lacks mental capacity. The first is that “every adult has the right to make decisions for themselves”. People show be allowed to make choices for as long as they can and even after they lose the ability to make decision past decision most be respected. It should be assumed that they can make a decision unless proved otherwise. Just because a person has dementia they may still be able to make decision. The second is that “Every adult has the right to be supported to make their own decisions”. This means if a person can not make a important decision they should be given help and should to make it.

For example the carers could provide information on the choice in simpler terms so it is easier to understand. The question could be broken into more manageable questions for the person. This support can allow a person to make their own decisions. The third point is that “Every adult has the right to make decisions that may appear to be unwise or strange to others”. This means the choices they make should not be change if a carer thinks it is unusual or weird. The forth point is that “any decisions taken on their behalf must be the option least restrictive to the person's rights and freedoms”. This means that the person should be given as much choice as possible for them. The choice made for them most promote their freedom and rights. For example if a person with dementia often wandering off then the care home should true to give them safe in which they can safely wander rather than locking them in a room. The finial point is that “any decisions taken on their behalf must be in their best interests”. The act clearly sets out a check-list to ensure that choices are made in the person “best interests”.

The first point is that the person making the decision should not make decision based assumption on person's age, appearance, condition or behaviour. For example a person should not assume a older lady will enjoy bingo. The next point is to consider if the decision can be postponed until the person can make the decision. For example a person with dementia may have more mental capacity in the mornings when they are more awake, so decision may be delayed to the next morning. The next point is that the person should be involved in the decision as much as possible. Along with this the person views should be taken into account. For example in may case study, it was decision Audrey needed to go into a care home but Audrey was able to choose which care home to move into. The final point is that the views of considering the views of others such as the family of the person. For example George wanted to be a part of Audrey's care for as long as possible. To allow this the care providers arranged for George to come into the care home to give Audrey a meal everyday. Power of Attorney

The mental capacity act has made a new type of power of attorney; the new power of attorney is known as Lasting Power of Attorney (LPA). This will replaced the Enduring Power of Attorney (EPA). This allows people to choose who will make the decisions about their health and finances when they lose the ability to do so for themselves. The “attorney” is the person chosen to make the decisions for the person. The are two types of lasting power of attorney. The first is property and affairs. This gives the attorney the power to make decisions about the person's financial and property. The second type is the welfare lasting power of attorney. This give the attorney the power to make decisions the person's health. Deputies and the count of protection

A deputy is a person who make decisions for people who lack the capacity to do se themselves. This is used when people lose their mental capacity without setting up any formal arrangements have not been made. This could be because the person never through to set up a lasting power of attorney or if the person lost their mental capacity suddenly. For example is a person head a stroke, leading to brain damage. A deputy will normally be a friend or relative of the person but is sometimes a professional. In order to become a deputy the person must first apply to the count of protection. They make choices for the person in the best interests of the person. The decisions might be about property or financial affairs, such as selling a house or redeeming a insurance policy. The court of protection has authority to make orders about the person's healthcare, welfare or financial matters. Safety measures

To kept people with mental health problems from abuse or negate the act has established some safety measures. The first is the count of protection. This is a court that chooses whether a person lacks capacity, can make orders for someone care or to appoint deputies for a person who lacks capacity. The count gets finial say on most matters. The next safety measure public guardian. The next safety measure is having clear guidelines for research. This controls want research can be done on a person who lack capacity as they can not choice whether to join in the research. This ensures that the research is a safe and relates to the person's condition. The next safety measure is having a that it is a criminal offence to neglect of a person who lacks capacity. A person found guilty of this offence may go to prison for upto five years. The finial safety measure is Independent mental capacity advocates. The Independent mental capacity advocates checks for abuse and negate within the care for the mentality ill. They check all choices are done in the best interest of the person. If they stop any abuse or negate they can report it as a criminal offence.

Code of Practice
The code of practise for the mental capacity act gives guidance on how the act should be used on a daily basis. This gives case studies and explained in detail to ensure people do not misunderstand the key features of the law. The professionals working with a mental disorder, a person acting as a attorney under lasting power of attorney; a deputy appointed by the court of protection or another person working with a mentally ill person all have a duty to follow the code of practice. The family, friends and other unpaid carers should use the code of practise as guidance when caring for a mentally ill person. what is the impact of the mental health act, the reform act and the mental capacity act from the viewpoint of the service users. The mental health foundation say that “The Act is there for use as a last resort” This leads to people needing help having to cope alone for too long. This can lead to people being put into danger as people who need more care. This makes it a more stressful process of get the person care. It also puts friends and family of the person into danger as they have top look at the person.

They also think that services are “failing to prevent many people from becoming unwell”. This means people need more care and help than they would have done with early intervention. Through early interview they could save time and money. The lack of early intervention can cause compilations for people having treatment of mental illness. They say there is a need for “promoting good mental health” for people to avoid people developing mental disorders. Many services think that awareness of mental disorders need to be raised. This could help people spot the signs of mental illnesses in a person to get faster help, it would also improve people's understanding and opinions towards mental health problems. Finally it would allow people more understanding towards the mentally ill and know how to act around people with a mental disorder. They also say that it needs to provide better “crisis care in the community”. This would allow people to be care for within the community. This is better than in a hospital as it is more relaxing for them to be care for from or near home. It also allows people to stay within the community of people they know. This is less scary for some people as they feel safer. This is especially important in tight communities where everyone knows each other.

Their finial point is that the “high number of recalls to hospital suggest that for many people the act is not successful in keeping people safe and well in the community". The act needs to focus on the rules to community care so that people are safe when being cared for by the community. This would lower the numbers of people being recalled to hospital. Thus people would be happier. If the services within the hospital should keep people in. This stops the people having to go through the stress of being recalled to a hospitals. The dementia “opportunity for change” report found that the were long waiting times especially between referral to diagnosis. This cause “undue stress” at a difficult time. Long waiting times can be caused by the act only offering emergency care. This could be improve by making a new act which puts treatment and early intervention over restriction of people. Another point the “opportunity for change” makes is that the services should put the people first. Dementia is a “complex condition” so people suffering from it will have to see lots of different specialist.

This has created a system that is “often difficult to navigate”. This means people often find it hard to find the services suitable for their needs. For example there are few care homes suitable for younger suffers of dementia. Dementia in people from 50 is more rare meaning there are less specialist services for dementia patients of this age. If the act put more focus on ensuring people find the right services for them, then there would not be this problem. A third point is that the people do not get enough choices. People do not have the opportunity to make sure the services reflex there personal views and opinions. For example, some people are forced to move into a care home when they would be happier at home because they do not have support from their family or the money to live at home. The act is to focus on controlling and sectioning rather than offering the choices. A forth point is that communities need to become more dementia friendly. This can be achieve through raising awareness about dementia. This will leads to people without medical knowledge being able to help and support the person. This would allow the person to live in their community. This would make them happier.

References

http://www.mentalhealth.org.uk/our-news/news-archive/2011/11-10-11/ http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=117 http://www.mind.org.uk/information-support/legal-rights/mental-health-act-the-mind-guide/compulsory-admission-to-hospital/

http://webarchive.nationalarchives.gov.uk/+/ www.dh.gov.uk/en/Healthcare/Mentalhealth/DH_078743 http://www.youngminds.org.uk/about/what_we_do
http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=354 http://www.scie.org.uk/publications/guides/guide03/law/capacity.asp