Search

Purpose -- The purpose of this paper is to describe the characteristics of individuals with intellectual disability in psychiatric hospitals in England who have been referred from the courts following charge or conviction for imprisonable offences. Design/methodology/approach -- Further analysis of data from the national census of psychiatric inpatients with intellectual disability or autism. Findings -- In total, 31 per cent of psychiatric inpatients with intellectual disability or autism were detained on a court order . In comparison to others they were older but fewer appeared to have severe disabilities. Fewer were hospitalised for mental illness or challenging behaviour, more for personality disorder . Rates in relation to numbers with intellectual disability in the population varied widely between regions of the country. Research limitations/implications -- The census was weak on exploring the nature of the risk posed by patients. As with all censuses it is always possible that the day chosen was unusual. Groups of patients characterised by longer stays inevitably appear more prominent. Practical implications -- Staff with expertise in the forensic mental health skills of risk assessment and management in the context of intellectual disability will be needed to resettle these patients satisfactorily. Originality/value -- The study draws attention to wide variations around the country in rates of use of hospital beds. This applies as much to detention under court orders, including restriction orders, as to informal admission, raising questions about the consistency of court judgements around the country. [ABSTRACT FROM AUTHOR]

The UK Supreme Court’s judgment in Cheshire West and Chester Council v P [2014] has had a huge impact on the promotion of human rights of vulnerable patients. The ruling emphasises the positive duty on the state and its organisations, such as the NHS, to have in place procedures that independently confirm that the human rights of those vulnerable patients are being applied in the same way as any other human being. This article discusses the background and basis for the Supreme Court’s decision in Cheshire West and its impact on vulnerable patients. [ABSTRACT FROM AUTHOR]

Accessible summary With the increase in numbers of people suffering from dementia there is a need for staff at all levels of nursing to be trained in, and to be knowledgeable of, the basics of the MHA 2007, MCA 2005 and DoLS., Decision-making processes concerning observation levels on inpatient wards must be a team-based., All individuals must be assumed to have mental capacity unless it has been proved otherwise., There is a need to develop clear and unambiguous observation policies for use on inpatient units., Abstract In England and Wales the interface between the Mental Capacity Act 2005 (MCA) and Mental Health Act 2007 (MHA) is frequently encountered in mental health practice. In services involving older adults many service users will have cognitive impairment and dementias in some instances with behavioural and psychological symptoms of dementia and assessments regarding their mental capacity to make decisions are frequently required. Service users with these illnesses are admitted to psychiatric wards and occasionally nursed under 'close observations' in order to maintain their safety and that of others. The concepts of 'complete and effective control' which may be exercised by ward staff in these circumstances, and the resulting 'loss of autonomy under supervision and control' must be understood in consideration of whether a 'deprivation of liberty' should ensue, particularly when they do not have mental capacity to make decisions about the observations. The observation policy must clearly delineate the different forms of nursing observations possible e.g. close, constant, intermediate, general etc. to avoid confusion among staff members implementing the observation plan. Various dilemmas and management of such dilemmas concerning the use of MCA 2005, MHA 2007 and observation policies has been discussed in this paper. Nursing staff working in both psychiatric and acute hospitals need training in concepts of MCA 2005, MHA 2007 and Deprivation of Liberty Safeguards. [ABSTRACT FROM AUTHOR]

Purpose – Psychiatrists are among the front-line professionals involved in the implementation of Deprivation of Liberty Safeguards (DOLS). This paper aims to explore how the safeguards are perceived and practised amongst psychiatrists. Design/methodology/approach – The authors carried out a postal survey among 519 psychiatrists on their views and experiences on DOLS. Findings – A total of 171 psychiatrists (36 per cent) responded to the survey. Nearly three-quarters of the participants had received DOLS training and 81 per cent of individuals who had training believed that DOLS would protect the rights of vulnerable people. Almost half of both groups agreed that DOLS make a valuable contribution to the provision of necessary care in the least restrictive way possible. The most common concern raised was possible increase in bureaucratic process. Interface between the existing legislations continues to be a grey area for many practitioners with difficulties in interpreting the relevant Code of Practice. In total, 50 per cent of the participants felt DOLS should extend to community placement provisions. Originality/value – The views and concerns expressed by psychiatrists in this paper are relevant to all professionals working with adults who lack capacity to consent to their care or treatment in any setting. As the process continues to widen, it is important to recognise the issues, encourage use of DOLS process to protect human rights, and to address key gaps in training. [ABSTRACT FROM AUTHOR]

The Mental Capacity Act 2005 was fully implemented in England and Wales in 2007. The Deprivation of Liberty Safeguards were introduced into the MCA and fully implemented in England and Wales in April 2009. A range of anomalies and paradoxes in the use of DOLS are described in detail in this paper. [ABSTRACT FROM AUTHOR]

The roots of mental incapacity and mental health legislation in England and Wales are deeply intertwined. Changes in healthcare policy, human rights principles, demographics and social attitudes have highlighted deficiencies in the law to protect the interests and rights of people considered to lack decision-making capacity. This led to calls for legal reform from social workers amongst other groups. The Mental Capacity Act 2005 took shape alongside the more controversial Mental Health Act 2007. Whilst mental capacity and mental health legislation are separate once again, both are concerned with the care and treatment of adults who are perceived as lacking capacity to make specific decisions. The Deprivation of Liberty Safeguards enacted as part of the Mental Health Act 2007 to amend the Mental Capacity Act 2005 will change practice for many social workers as they will give rise to new assessments and roles. Social workers will need to be aware of the potential interaction of the two Acts to ensure compliance with the laws and to promote positive practice. This article explores the interface between the Mental Capacity Act 2005 and Mental Health Act 2007 in England and Wales and examines and speculates on some of the possible implications for social work practitioners. [ABSTRACT FROM AUTHOR]

The Mental Health Act (1983) and the Mental Capacity Act (2005) (both amended by the Mental Health Act (2007)) together provide a comprehensive framework for the care and treatment of people with a mental disorder in England and Wales. The Mental Health Act relates solely to the treatment of mental disorders whilst the Mental Capacity Act has much wider applicability to decisions surrounding treatment and care where a person lacks capacity. Psychiatrists require a good working knowledge of relevant mental health and mental capacity legislation whatever jurisdiction they work in: here, key legal issues for England and Wales are briefly reviewed. [Copyright &y& Elsevier]

Established as an amendment to the Mental Capacity Act 2005, the deprivation of liberty safeguards were introduced to ensure that anyone who lacks capacity to consent to their care, and was being deprived of their liberty, has rights equivalent to those held under the Mental Health Act 1983. These rights include someone to oversee any deprivation of liberty, the right of appeal and the guarantee of review of appeal in a timely manner. This article outlines how deprivation of liberty safeguards work, how a deprivation of liberty safeguards is applied for and obtained, what to discuss with the next of kin, and some special circumstances to consider. It also provides information about the criteria by which deprivation of liberty safeguards applications are assessed and the process by which this is done. This provides an overview for junior doctors working in secondary care, to increase their knowledge and confidence when patients require a deprivation of liberty safeguards application.

The United Kingdom Supreme Court judgment in Cheshire West and Chester Council v P in 2014 introduced a more inclusive 'acid test' for determining the objective element of a deprivation of liberty in cases concerning people who lack decision-making capacity. The case made clear that adults and young people who lack capacity could be deprived of their liberty in care settings other than hospitals and care homes, including the person's own home. A deprivation of liberty that occurs in a setting other than a hospital or care home must be authorised by a Court. This article explains the revised process for applying for Court authorisation of a deprivation of liberty where it occurs in supported living, Shared Lives placements or the incapable person's own home.