The use of supportive observations within an inpatient mental health unit for older people and dilemma of using the Mental Health Act (2007) or the Mental Capacity Act (2005) in England and Wales

Authors

  • F. A. KHAN MBBS MD MRCPsych,

    Corresponding author
    1. Consultant Psychiatrist Birmingham and Solihull Mental Health NHS Foundation Trust
    2. Hon Lecturer in Ageing and Mental Health
      F. A. Khan, Centre for Ageing and Mental Health, Staffordshire University, Blackheath Lane, Stafford ST18 0AD, UK, E-mail: farooqkhan@nhs.net
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  • D. RICE MRCPsych,

    1. Consultant Old Age Psychiatrist, Shelton Hospital, Shrewsbury
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  • G. TADROS MD MRCPsych

    1. Professor in Ageing and Mental Health, Centre for Ageing and Mental Health, Staffordshire University, Stafford
    2. Consultant Old age Psychiatrist, City Hospital, Birmingham, UK
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  • Declaration: No conflict of interests.

F. A. Khan, Centre for Ageing and Mental Health, Staffordshire University, Blackheath Lane, Stafford ST18 0AD, UK, E-mail: farooqkhan@nhs.net

Abstract

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.

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