CME 22/10/15 – Emergency Medicine, Psychiatry and the Law

Here is Salam’s very informative talk on psychiatry in the emergency department, including the recent changes to the Western Australian Mental Health Act.

 

General Psychiatry Resources:

  • Note: printed copies of the mental health act forms are available on the flight deck from the “Psych Shelf” below the PACS viewer near the ED Ward Clerk (see below):

 

Psych Shelf Picture

 

Assessment of Capacity:

  • Capacity Definition:
    • Mental capacity can be defined as having ‘sufficient understanding and memory to comprehend in a general way the situation in which one finds oneself and the nature, purpose, and consequence of any act or transaction into which one proposes to enter’ (www.dictionary.com) – in other words, as the ability to make a decision.
  • Capacity assessment principles:
    • A person has decision making capacity to make a specific decision if (at the relevant time) they have the capacity to do ALL :
      • Understand any information about the decision
      • Understand the matters involved in the decision
      • Understand the effect of the decision
      • Weigh up the above factors for the purpose of making the decision
      • Communicate the decision in some way.
      • No Coercion
    • Assess the person’s decision-making ability – not the decision they make

 

Referral for Psychiatric Examination:

  • Form 1 (MHA 1996), Form 1A (MHA 2014)
  • A practitioner can only refer a person for examination by a psychiatrist where they reasonably suspect that:
    • the person is in need of an involuntary treatment order (see below), or
    • if the person is currently on a community treatment order, the person is in need of an inpatient treatment order.
    • The assessing practitioner must have regard to the criteria for an involuntary treatment order
  • The term ‘reasonably suspects’ is to ensure that even if there is some doubt as to whether the patient should be referred, the practitioner may still refer them for an examination by a psychiatrist
  • The following criteria must ALL be met before the making of an Involuntary Treatment Order (ITO):
    • the person has a mental illness requiring treatment
    • the mental illness presents a significant risk to the health or safety of the person or another person, or a significant risk of serious harm to the person or another person
    • the person does not demonstrate the capacity to make a decision about the provision of treatment to themselves
    • treatment in the community cannot reasonably be provided to the person,
    • there is no alternative that would be less restrictive to the person’s freedom of choice and movement.

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