QuestionSBA
QuestionChoice
When a patient is detained under section 3 of the mental health act, they can be detained for up to 6 months with option of further renewal. This patient has only had a short assessment so far and so would need a longer period of detention. Usually the least restrictive method, and therefore the shortest time required, would be used and so detention under section 2 would be used initially to detain the patient for 28 days
33174
b
Section 3
QuestionChoice
A patient can be detained under section 5(4) of the mental health act by a nurse who has been qualified and trained to work with mental health problems or learning disabilities. It is a short term emergency section to detain a patient for up to 6 hours until they can be seen by a doctor. This patient has already been detained under section 5(2) and so detention under section with a longer time period would be required to provide further assessments and/or treatment. The most appropriate answer would therefore be section 2 to detain the patient for up to 28 days
33175
c
Section 5(4)
QuestionChoice
Section 136 is slightly different to section 135. Both are carried out by police officers if they believe the patient has a mental disorder and in need of immediate care of control where they can detain a patient against their will to be taken to a place of safety until examined by a doctor. Section 135 is used when police require entry to a persons home, if need be by force, when they believe a person is at serious risk of harming themselves or others. Section 136 is used when police find the person in a public place and feel they need to bring the patient to a place of safety. A patient can be detained under section 135 and 136 for up to 24 hours
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Section 136
QuestionChoice
This patient has presented with an acute psychotic episode and is currently not safe to leave due to strong concerns that he is at risk of ending his life if he were to leave. He should therefore be detained under section 2 of the mental health act which allows detention for a period of 28 days. If the patient continues to require psychiatric treatment after the 28 days, then he could be considered to be detained under section 3 which would allow him to be detained for up to 6 months with option of further renewals. Section 2 can't normally be extended or renewed once expired
33173
a
Section 2
QuestionChoice
When a patient is detained under section 3 of the mental health act, they can be detained for up to 6 months with option of further renewal. This patient has only had a short assessment so far and so would need a longer period of detention. Usually the least restrictive method, and therefore the shortest time required, would be used and so detention under section 2 would be used initially to detain the patient for 28 days
33176
d
Section 17
QuestionComment
Can i just point out for clarification, you can't use a 5(2) in A+E.
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Relapse CT
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As a med student not studying in England where the law is different, these questions make me so stressed
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Hypertension Migraine
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also police can only enter patient's property under section 136 (NOT 135 as stated in the stem)
27877
QuestionComment
136 is used in public to a place of safety
135 is used to enter a house 
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Tazocin Suture
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Kinase Sclerosis
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# Summary

The Mental Capacity Act (MCA) is a crucial legal framework that provides guidance on decision-making for individuals who may lack the capacity to make specific choices. Enacted in 2005, the MCA establishes the principles and procedures for assessing mental capacity and ensures that decisions made on behalf of individuals without capacity are made in their best interests. Capacity, as defined by the MCA, involves the ability to understand, retain, weigh, and communicate information relevant to a specific decision. It is time- and decision-specific. The Act empowers individuals to make choices whenever possible, respecting their autonomy, while also safeguarding those who lack capacity through a structured and person-centered decision-making process.

# 5 Key Principles

The Mental Capacity Act (MCA) is used when a patient lacks capacity. It allows doctors (or less commonly, those with Lasting Power of Attorney) to make decisions in the best interests of their patient. There are 5 key principles:

- A person is assumed to have capacity unless proven otherwise
- Steps must be taken to help a person have capacity
- An unwise decision does not mean a person lacks capacity
- Any decisions made under the MCA must be in the person's best interests
- Any decisions made should be the least restrictive to a person's rights and freedoms

# Assessing capacity

Assessing capacity is a two step process: 

1) Is there an impairment of, or disturbance in, the functioning of the mind or brain? 

If yes, then step 2) For a person to lack capacity they must show an 'impairment of, or disturbance in, the functioning of the mind or brain' AND they are unable to undertake any of the following:

- Understand relevant information
- Retain the relevant information
- Weigh up the relevant information
- Communicate a decision

**If they are unable to do one of these things then they do not have capacity.**

### Next steps

- If they do not have capacity, can  we wait until they do before making a decision? Consider the (clinical) urgency of the decision that needs to be made
- Do they have a Lasting Power of Attorney (LPA), Advanced Directive, or Advanced Statement?
- Does a best interests meeting need to be had, including the MDT, and relatives/friends who know the patient well. If there is nobody who can advocate for the patient, an Independent Mental Capacity Advocate (IMCA) can represent them when making a best interests decision.

# Deprivation of Liberty Safeguards (DOLS)

The Deprivation of Liberty Safeguards is the procedure in law used where it is necessary to deprive a patient or resident of their liberty as they lack capacity to consent to treatment or care to keep them safe from harm. It safeguards for those who lack capacity and do not want to be somewhere and are not free to leave. There are a series of checks to make sure that any care someone receives that restricts their freedom is appropriate and in their best interests. 

If a patient lacks capacity to make decisions about ongoing care and are not free to leave, then an application for a DOLS may be made (proportionate and not excessively restrictive actions). This can be common in acute medical/geriatrics wards.

The following conditions must be met to allow a person to be deprived of their liberty under the safeguards:

* The person must be 18 or over.
* The person must be suffering from a mental disorder.
* The person must be a patient in hospital or a resident in a care home.
* The person lacks capacity to decide for themselves about the restrictions which are proposed so they can receive the necessary care and treatment.
* The proposed restrictions would deprive the person of their liberty.
* The proposed restrictions would be in the person's best interests.
* Whether the person should instead be considered for detention under the Mental Health Act.
* There is no valid advance decision to refuse treatment or support that would be overridden by any DoLS process.

# References

[Click here to see information on Legislation UK on the MHA](https://www.legislation.gov.uk/ukpga/1983/20/contents)

[Click here to see information on Legislation UK on the MCA](https://www.legislation.gov.uk/ukpga/2005/9/contents)
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Psychiatry
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The Mental Health Act and Mental Capacity Act
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Section 2
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Section 2 of the Mental Health Act (MHA) allows for the detention and assessment of an individual in a hospital for up to 28 days without their consent if they are deemed to have a mental disorder that requires immediate treatment and poses a risk to their safety or the safety of others.
A 28-year-old man was admitted under psychiatry for an acute psychotic episode after his colleague found plans to end his life and called the police. The police brought him to hospital under section 135. In A&E, he exhibited persecutory delusions and suicidal ideation, stating he has made several plans to end his life and would do so if discharged.


He has been held under section 5(2) while awaiting a full assessment and it has been decided that he is not safe to leave as he is a high risk to himself with serious concern that he would end his life if he were to leave.


Under which section of the mental health act (1983) should he be detained?
a