Mental Illness

Definition

A mental illness is a psychiatric disorder that results in a disruption in a person's thinking, feeling, moods, and ability to relate to others.

Types of Mental Illness

Psychosis:

Psychosis is a psychiatric classification for a mental state in which the perception of reality is distorted. Persons experiencing a psychotic episode may experience hallucinations (often auditory or visual hallucinations), hold paranoid or delusional beliefs, experience personality changes and exhibit disorganised thinking. This is sometimes accompanied by features such as a lack of insight into the unusual or bizarre nature of their behaviour, difficulties with social interaction and impairments in carrying out the activities of daily living. (From Wikipedia)

Neurosis:

A neurosis, in psychoanalytic theory, is an ineffectual coping strategy that Sigmund Freud suggested was caused by emotions from past experience overwhelming or interfering with present experience. For example, someone attacked by a dog as a toddler may have a phobia or overwhelming fear of dogs.

There are many different specific neuroses and many of them are named: pyromania, obsessive-compulsive disorder, anxiety neurosis, and an endless variety of phobias.

Mental Health act 1983

The Mental Health Act 1983 has a number of sections that provide powers for involuntary detention, hospitalisation or other medical treatment for people affected by mental illness. The use of these sections of the Act is known as sectioning.

Section 2: Admission for Assessment - This is the most common way of detaining people. It allows for a patient to be compulsorily detained in hospital for assessment or assessment followed by treatment for a period of up to 28 days. It cannot be renewed or extended either by a further section 2 or by use of nurses and doctors powers under Section 5: If a person needs further detention Section 3 should be used. 

The grounds for the Application, are that the patient is "suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and he ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons".

Applications can be made by an Approved Social worker or by your nearest relative. They must be based on two medical recommendations. Preferably at least one of the Doctors will have had previous knowledge to the patient.

Section 3: Admission for Treatment - This section allows a patient to be detained in hospital for treatment. It is used when if following a Section 2 the patient needs a further period of detention or when the patient is well known to the clinical team and it is felt that a treatment plan can start straight away.

Applications can be made by an Approved Social worker (ASW) or by the patient's nearest relative. They must be based on two medical recommendations. Preferably at least one of the Doctors will have had previous knowledge of the patient. (if neither of the doctors knew you why are they doing a section 3?).

The applicant must have seen the patient within the previous 14 days from the making of the application, as must the doctors. The 2 Doctors must have examined the patient within 5 days of each other. If an ASW is making the application he should consult with the patient's nearest relative unless it would cause unreasonable delay. If the nearest relative objects then the admission cannot proceed.

The initial duration is for up to 6 months. This can be renewed for a further 6 months and then further renewed for 12 month periods.

Section 4: Emergency Assessment - Section 4 allows for compulsory admission to a hospital for assessment in cases of emergency. It can be used in place of a Section 2 where there is extreme urgency and the delay that would be caused by implementing a Section 2 is not acceptable (the Act uses the term 'undesirable delay').

It requires an application by an Approved Social Worker or your nearest relative. This has to be based on a recommendation from 1 Doctor. The Doctor should be one who knows you or who has been approved under Section12 of the Act.

It can last for up to 72 hours. During that time, if a second Medical Recommendation is made, the Section 4 is converted into a Section 2.

Section 131: Informal Admission - There is nothing in this Act that should stop a patient entering hospital on an informal basis. It also says that a patient can remain as an informal patient once the section that they were under has come to an end. If they are an informal patient they can discharge themselves from hospital at any time unless they are placed on a section 5. 

Section 135: Place of Safety Order (Private) - This Section is divided into 2 parts.

Part A allows an approved social worker to apply to a magistrate for a warrant which will allow a police officer to enter premises where it is thought the patient is, (using force if needed - they can break in), in order to search for, and if thought fit, remove them, and take them to a Place of Safety.

The purpose of this is to allow the patient to be assessed to see if they need admission to hospital, or for other arrangements for their care to be made.

Part B allows a police officer to apply for a warrant to enter premises when seeking to re-take you if you are already Sectioned and liable to be detained, but you are absent without leave. If this happens an approved social worker and a doctor can accompany the police, but this is not compulsory.

This section lasts for up to 72 hours from the time that the patient arrive at the Place of Safety. This cannot be extended or renewed. During this time they should be assessed. The section 135 ceases to have effect as soon as they have been assessed and any arrangements made for their treatment or care.. 

Section 136: Place of Safety Order (Public) - If a patient is in a place to which the public have access and a police officer thinks that they may have a mental disorder, and are in need of immediate care and control, then he can take them to a place of safety for their own protection, or for the protection of others.

Just the fact they have a mental disorder isn't enough; they have to be causing 'bother' or appear to be at risk in some way.

The patient can be held there for up to 72 hours to allow them to be seen by a doctor and an approved social worker, and for any necessary arrangements for their care to be made. Once this has been done the section ceases to be in effect.

A place of safety can be:

  1. A police station.
  2. A hospital.
  3. A mental nursing home or residential home for people with a mental disorder.
  4. A residential home provided by the social services.
  5. Any suitable place of which the occupier is willing to have you.

Usually a hospital is the preferred place. If it is felt that there could be some risk to yourself or others if you went there, then a police station could be used.

Approved Social Worker: Under this section local authorities have a duty to appoint a sufficient number of approved social workers (ASW's) to carry out the functions described in the Mental Health Act.

An approved social worker must be appointed by a local authority - no one else can do this. So though other organisations can appoint social workers, they cannot be approved under this Act.

Though they are bound by the terms and conditions of their employment with the local authority, approved social workers act in a personal capacity when undertaking functions and duties under the Mental Health Act.

To be an approved social worker they have to be 'approved' as having appropriate competence in dealing with people suffering from mental disorder.

Thanks

Many thanks to Mark Walton for allowing me to copy extracts from his site on Mental Health issues

 
Further Reading
  1. Mental Illness 
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Question

  • Give a brief description of section 4 of the Mental Health act 1983