Transcript Mental Health Act, 2001: Implications for Mental Health

Mental Health Act, 2001:
Implications for Mental Health
Service Delivery
Dr. Philip Dodd
Dr. Janette Tyrrell,
St. Michael’s House, Dublin
October 2006.
Overview of Talk
• Mental Health Act, 2001:Provisions for
I.D.
• Reference Guide/Case Law
• Clinical Presentations
• Required Service Responses
• Future
Before we start…..
• This Presentation should not be relied on as
a legal interpretation of the Mental Health Act
2001. It is not intended to be a complete or
authoritative statement of the law and is not
intended as legal advice or advice of any
type. It is a personal interpretation only and
must be read in conjunction with the
provisions of the Mental Health Act 2001, any
regulations made thereunder and any other
relevant legislation.
Mental Health Act 2001
Legally Binding Principles (S.4)
• Best interest of the person is the principal
consideration in making a decision
• Due regard to be paid to the interests of others who
may be at risk of serious harm
• Right to information and participation so far as is
reasonably practicable
• Due regard, respect for dignity, bodily integrity,
privacy and autonomy
• Rights are not diminished because of mental disorder
• Clinical judgement and professional discretion are
key
Mental Disorder
S3(1), (a) or (b)
• S3(1)(a) because of the
illness, disability or
dementia
• There is a serious likelihood
of the person
• Causing immediate and
serious harm to
• himself or herself or to other
persons
•
S3(1)(b) because of the severity
of the illness, disability or
dementia
–
–
–
The judgement of the person is so
impaired
That failure to admit the person to
an approved centre would (EITHER)
• Be likely to lead to a serious
deterioration in their condition
OR
• Would prevent the
administration of appropriate
treatment that can be given
only by such admission AND
(IN EITHER CASE)
Their reception, detention and
treatment in an approved centre
would be likely to benefit or alleviate
their condition to a material extent.
Mental Disorder
• Mental illness, severe dementia and significant intellectual
disability are necessary but not sufficient.
• There must in addition be EITHER
– A serious likelihood of the person causing immediate and
serious harm OR
– Failure to admit would lead to
• a serious deterioration OR
• prevent the administration of treatment that can be given
only by admission AND
• admission would be likely to benefit or alleviate their
condition to a material extent.
Definition of Significant
Intellectual Disability
“…a state of arrested or incomplete
development of the mind of a person
which includes significant impairment
of intelligence and social functioning
and abnormally aggressive or
seriously irresponsible conduct on the
part of the person.”
(Section 3 (2))
Establishing a Mental Disorder
through a finding of Significant
Intellectual Disability
A state of arrest or incomplete development of the mind
includes:
Significant impairment of intelligence
AND
Significant impairment of social functioning
AND
Abnormally aggressive or irresponsible conduct
All of the above criteria must be established separately
Significant Impairment of
Intelligence
• IQ<69 – indication of significant impairment of intelligence
• Psychometric assessment: standardised test
–
–
–
–
reliable
valid
assessor competance
appropriate for age, culture, language and social background
• Developmental and educational history important
• Measured within the last five years
Significant Impairment of
Social Functioning
•
Observed behaviour in coping on a day-to-day basis with the demands
of his/her environment
•
From occasional to pervasive, in areas such as self-care,
communication, home living, self-direction, occupational, social and
interpersonal skills
•
Direct observation and interview with informant who knows the person
well (parent, carer, friend)
•
No one standardised assessment recommended (BPS, 2001)
• NW Belfast Health & Social Services Trust 28/5/03: Mental
Health (NI) Order 1986
Abnormally Aggressive
Conduct
Criteria
Must be associated with:
‘a state of arrested or incomplete development of the mind….
On Assessment:
Based on observation of behaviours
Judgement/Conclusions:
Actions are outside the usual range of behaviours
(Based on Unpredictability or Unreasonableness)
Seriously Irresponsible
Conduct
Lack of responsibility
and/or
Disregard for the consequences
-whether capable of judging consequences or not
-can include failure to act as evidence of irresponsibility
Assessment of Abnormally Aggressive
or Seriously Irresponsible Conduct
Observation (actual behaviour)
Judgement (abnormality and/or seriousness)
The conduct should result in
–
–
–
–
actual damage and/or distress to self or others
recently or
persistently or
excessive severity
Establishing a Mental Disorder
through a finding of Significant
Intellectual Disability
A state of arrest or incomplete development of the mind
includes:
Significant impairment of intelligence
AND
Significant impairment of social functioning
AND
Abnormally aggressive or irresponsible conduct
All of the above criteria must be established separately
Other Points….
Seclusion and Restraint (69 (1))
“ A person shall not place a patient in seclusion or apply
mechanical means of bodily restraint to the patient unless such
seclusion or restraint is determined….to be necessary”
Restriction on Admission of patients (67 (1))
“a person suffering from a mental disorder shall not be detained in
any place other than an approved centre”
Inspector’s Report, 2005
“This Act will protect the rights of persons receiving care and will also protect those
professionals providing care. It will ensure that standards of mental health care
delivery, set by the Mental Health Commission, will apply equally to those with
an intellectual disability and those without”.
“Professionals working in the intellectual disability service must understand that
persons who fulfil the criteria for having a mental disorder under the Act, and
who are incapable of giving informed consent to treatment, must receive that
treatment under the protection of the Mental Health Act 2001 and in a unit
approved under that Act. To provide such treatment in the absence of informed
consent, will be illegal.”
Vignette 1
• 22 year old woman, severe ID
• Long history of SIB
• Now Targeting staff – hair pulling and
pinching & assault
• No formal psychiatric illness
• Problem behaviours (DC-LD)
• Not obviously autistic
How do we manage/support this women?
Where?
Service Response:
R e s o u r c e De p e n d e n t
• Limited resources: Detention more likely
• Limited Guidance: Detention more likely
• ‘Expertise’ of Approved Centre
• M.H.I.D. Team (Vision for Change)
Vignette 2
• 67 year old man, moderate ID
• Chronic schizophrenia
• Acutely psychotic on withdrawal of Melleril
(after 26 years)
• Lives with very elderly parents
• Refuses to leave family home (TV)
• No food x24hrs – drinking normally
How do we manage/support this man?
Where?
Service Response:
R e s o u r c e De p e n d e n t
• No M.H.I.D. team: Detention likely
• “Expertise”of Approved Centre
• Home Care Option: Assertive Outreach
•
Hassiotis, A. Advances in Psychiatric Treatment (2003) 9: 368-373
Vignette 3
• 24y.o. man, moderate, I.D., Down’s
Syndrome
• Autistic Spectrum Disorder
• No previous history
• Parent deceased 3 weeks ago
• In respite
• Sporadic severe problem
behaviours;depressed, withdrawn, sleep
disturbed.
Service Response:
R e s o u r c e De p e n d e n t
• Manage/Support in Respite House?
• With M.H.I.D.Team
• Welfare of the Individual:
“Best interest of the person is the principal
consideration in making a decision” (S.4 (1))
Implications for I.D. Services
Positives
• Individual’s rights monitored
• External assessment of
restrictive practices
• Policy and legislative
framework for the
development of services
• Improved access to mental
health services and
improved treatment
• It is the Law!
Negatives
• Not Capacity Legislation
• ? Move away from social
care to treatment model
• Little I.D. experience in Irish
Mental Health Law
• Anxiety of interpretation!