The Mental Health Act

Daytonite, BSN, RN · May 9, 2009

is this a state specific law you are talking about? i am in california and we have very specific state laws regarding detention of patients for mental health reasons. they made a movie about it recently, changeling. you should be able to find your state law by doing a search on your legislative website using the search words "unlawful detention" or "detention and treatment".

it is illegal to hold someone in involuntary detention (california). under california welfare & institutions code 5150 a person can be held for 72 hours for evaluation and treatment if they are a danger to themselves or others or are gravely disabled.

under a 5250 a person can be held for 14 days of intensive treatment. they can be held for 90 days if they are a danger to themselves or others (5300). people who are suicidal are committed indefinitely.

these laws are things that need to be left to each state to work out.

rachelgeorgina · May 10, 2009

I'm actually in Australia, which is why I didn't specify a specific piece of legislation, because I know each state/country differs in it's exact working and specifics. However, from my understand, most Mental Health Acts have the same general principle to them - someone can be detained under a mental health act if the clinician feels that the patient poses a significant risk to themselves or others.

I guess what I'm asking after is a) your experience of this in practice. Have you seen patient's detained for reasons other than those specifically stated in the legislation - like clinician connivence, for example? The practice of defensive medicine to prevent liability on the part of the clinician whilst striping the client of their autonomy? & b) do you think the mental health is discriminatory in allowing detention PRIOR to an act of violence (which is illegal under common law)?

Daytonite, BSN, RN · May 10, 2009

i have never seen anything like this. the biggest controversy for staff nurses has been the use of physical restraints, as in soft wrist restraints of confused patients to prevent them from pulling out their ivs and other tubes. restraining vests were done away with some time ago. there is federal legislation regarding the use of these restraints. i can give you the actual citations of these laws if you would like them for the acute hospitals and the nursing homes here in the u.s. many facilities will also have policies regarding the use of restraints that incorporate the federal laws.

we cannot hold any patient against their will (i'm talking about acute hospital) and a patient may leave at any time as long as they sign a document stating that they understand that the consequences of leaving have been explained to them. this is called leaving against medical advice (ama). psych patients are different and you would need to ask a psych nurse about this because i do not believe that all psych patients are able to leave their treatment ama.

today, in the u.s., we have too many third party payers of the patient's hospital bills and accounting people that scrutinize every page of the chart that a doctor could no more falsify a record or abuse the use of a facility without someone detecting it and reporting it. the coding system of medical records is so complex that i can't imagine how a doctor could possibly know all the nuances of it to fool all the bureaucrats in order to pull off dumping one of his patients somewhere for an illegal mental health hold.

you should, however, ask your question on the psychiatric nursing forum of allnurses (https://allnurses.com/psychiatric-nursing/) or the emergency nursing forum (https://allnurses.com/emergency-nursing/). i don't think this happens today. as i mentioned, the movie, changeling. with angelina jolie not only told of the corruption of the los angeles police department of the 1920s, but it also told of how the mental health system was abused and uncooperative persons were tossed into county psychiatric facilities under mental health holds for indefinite periods of time and subjected to all kinds of physical and medical abuse. you just don't hear of that happening anymore.

rubystar · May 10, 2009

Even each state of Australia has its own Mental Health Act. I'm only familiar with the WA one and I did just did my mental health rotation in an authorised hospital.

I'm not sure where you are going with these questions in regard to the act because in the act itself that WA works under there are provisions for all the different things that you mentioned. It's not just about having a mental illness that can make patients involuntary, they also have to have the other requirements which also includes the assessment of whether treatment can be given in a less restrictive way and they have to have the impairment of mood/volition/perception etc that affects judgement or behaviour to a significant extent. So the criteria is pretty rigorous.

I guess it depends what states act you are working under but I've done mental health, law and ethics and my mental health rotation at an authorised hospital that has involuntary patients in WA and yes, I do think the law was followed because ethically if somebody is under the act they pose a pretty big risk of some sort to themselves. Are those the actual questions that you have to answer?

rachelgeorgina · May 10, 2009

^^ We were given a paper (Wand, T & Chiarella, M 2006) that suggested that mental health legislation was discriminatory and fundamentally non-democratic because it provided different provisions for those who are mentally ill to the rest of the population based on a set of assumed characteristics (e.g. prone to violence, are dangerous etc), which is the basis for involuntary admission (i.e. threat to self/others, in so many words). If one is not mentally ill, then this doesn't apply - right? Therefore everyone is NOT equal in the eyes of the law.

At least, that's the argument of the paper, anyway. I'm really curious as to people's thoughts on this suggestion (because that's what I'm trying to write my paper on!)

rubystar · May 11, 2009

I have a few issues with the paper because it's mostly opinion and not entirely credible in terms of references that are out of date.

I think it mostly centres around the principles of autonomy and duty of care. I also think there are enough safeguards in the law itself because its a rather rigourous set of creiteria. The only thing I saw in the mental heath area which was kind of dodgy was the issue of absconding, ie people that wanted to leave hospital while either a voluntary or involuntary patient that wanted to leave hospital but they were deemed at risk and made to stay in hospital.

That sounds like a pretty awful assignment and I wish you luck with it. I know theres a lot more that I could say about it but being really tired doesn't really make for good argument skills.

madnurse2b · May 17, 2009

I just finished psych clinicals and had a patient that was in long term because being pregnant and refusing meds she was placing herself and fetus at risk - there were other issues involved, and I don't want to get too specific here. So there are times when they go to self harm/other harm vs. least restrictive environment, and harm always wins.