{"id":4668,"date":"2019-01-09T18:07:02","date_gmt":"2019-01-09T23:07:02","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4668"},"modified":"2019-01-09T19:56:29","modified_gmt":"2019-01-10T00:56:29","slug":"mental-health-service","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/mental-health-nursing\/mental-health-service\/","title":{"rendered":"Mental Health Service"},"content":{"rendered":"<p><strong>Contemporary perspectives- <\/strong><\/p>\n<p>Least restrictive treatment \u00e0 community focused care\u00a0 Influences in practice:<\/p>\n<ul>\n<li>Increased effectiveness\/availability of psychotropic medications<\/li>\n<li>Classification of mental illness<\/li>\n<li>Beacon Project (National Mental Health Seclusions &amp; restraint)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>established procedures:<\/p>\n<ul>\n<li>Independent review by the Mental Health Tribunal (MHT)- compulsory treatments\/rlectroconvulsive Therapy (rCT)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h2>Definitions-<\/h2>\n<p><strong>Patient- <\/strong>Person being treated under VMHA (2014)<\/p>\n<p><strong>Designated Mental Health Service- <\/strong>Approved MH service<\/p>\n<p><strong>Authorised person- <\/strong>Ambulance paramedic, police officer, medical practitioner &amp; mental health practitioner\u00a0 <strong>Mental health practitioner- <\/strong>registered nurse, registered psychologist, register occupational therapist or social worker<\/p>\n<p><strong>Authorised witness- <\/strong>Registered medical practitioner, mental health practitioner, anyone who can sign a stat declaration<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Supported decision making- <\/strong><\/p>\n<ul>\n<li>Central to the promotion of recovery-oriented practice<\/li>\n<li>rnables and supports compulsory patients to make decisions about their treatment and to determine their recovery<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><u>Advance Statement<\/u>&#8211; a formal statement of treatment that must be regarded in Tx decision making<\/li>\n<\/ul>\n<p>\u2212 Allows consumers have the opportunity to have their Tx wishes respected\u00a0 \u2212 Can be made at any time<\/p>\n<p>\u2212 Must be in writing (signed &amp; dated)<\/p>\n<p>\u2212 Witnessed by an authorised witness<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Nominated person (s. 23-27)-\u00a0 <\/strong><\/p>\n<p>A person who is nominated by the consumer to:<\/p>\n<ul>\n<li>Receive information and support the treatment preferences of the consumer<\/li>\n<li>Helps the person to exercise their rights and views<\/li>\n<li>Must be willing to be available to support the individual<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Second opinion (s.78)- <\/strong><\/p>\n<ul>\n<li>Provides another opinion to assess treatment and review of treatment<\/li>\n<li>Provides recommended changes if required<\/li>\n<li>Supports and provides written information for the individual &amp; nominated person<\/li>\n<li>Free service \u00e0 rligibility only for consumers on a treatment order or temporary treatment order (inpatient mental health service)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Capacity-\u00a0 <\/strong><\/p>\n<ul>\n<li>Individuals are presumed to have capacity<\/li>\n<li>The person has been given adequate information to make an informed decision<\/li>\n<li>Capacity: (s.68) is the ability of a person to make a particular treatment decision at a particular time<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>The person has capacity to make a decision if he or she:<\/p>\n<p>\u2212 <strong><em>Understands<\/em><\/strong> the information given<\/p>\n<p>\u2212 Is able to r<strong><em>emember<\/em><\/strong> the information<\/p>\n<p>\u2212 Is able to use or <strong><em>weigh up the <\/em><\/strong>information<\/p>\n<p>\u2212 Is able to <strong><em>communicate<\/em><\/strong> the decision<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Consent to treatment-\u00a0 <\/strong><\/p>\n<ul>\n<li>Some consumers may not have capacity to given consent to treatment\/refuse consent<\/li>\n<li>In these circumstances:<\/li>\n<\/ul>\n<p>\u2212 Authorised Psychiatrist may make treatment decision<\/p>\n<p>\u2212 Some decisions will require Mental Heath tribunal (MHT) eg. rCT<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h2>Assessment Orders (s. 28)- AO<\/h2>\n<p>\u2212 The person <u>appears<\/u> to have a mental illness<\/p>\n<p>\u2212 Requirement for the consideration of compulsory mental health treatment<\/p>\n<p>\u2212 Made by a registered medical practitioner or mental health practitioner<\/p>\n<ul>\n<li>Person must have been assessed within the last 24 hours<\/li>\n<li>Community or Inpatient Assessment Order<\/li>\n<\/ul>\n<p>\u2212 Valid for 24 hours; can be extended by up to 72 hours<\/p>\n<p>\u2212 Inpatient AO allows 72 hours for transport; 24 hour clock starts when received at DMHS<\/p>\n<p>&nbsp;<\/p>\n<h2>Temporary Treatment Orders (s.45) (TTO)<\/h2>\n<p>\u2212 TTO is an order for the provision of compulsory treatment\u00a0 \u2212 The person <u>has<\/u> a mental illness<\/p>\n<p>\u2212 Because the person has mental illness the person needs immediate treatment\u00a0 \u2212 Duration of 28 days (max)<\/p>\n<p>&nbsp;<\/p>\n<h2>Treatment Orders (s.52) (TO)<\/h2>\n<p>\u2212 The tribunal must be satisfied that all of the treatment criteria apply<\/p>\n<p>\u2212 Within 28 days, the tribunal will form and decide whether treatment criteria apply and if the patient needs to stay on an order\/treatment<\/p>\n<p>&nbsp;<\/p>\n<p>\u2212 If TTO is made &gt;18yrs<\/p>\n<ul>\n<li>Community TO (max 12 months)<\/li>\n<li>Inpatient TO (max 6 months)<\/li>\n<\/ul>\n<p>\u2212 If TTO is made &lt;18yrs<\/p>\n<ul>\n<li>Community TO &amp; inpatient TO (max 3 months)<\/li>\n<\/ul>\n<p><strong>Role of the Mental Health Tribunal- \u00a0<\/strong>\u2212 Independent of the treating team<\/p>\n<p>\u2212 Support process for consumers involvement in making and reviewing: tx orders and temp tx orders\u00a0 \u2212 Solution focused<\/p>\n<p>\u2212 Determine transfer of compulsory patients to other facilities<\/p>\n<p>\u2212 Review applications for rCT where consent is unable to be obtained<\/p>\n<p>\u2212 Are the only decision body for all rCT for people &lt;18<\/p>\n<p>\u2212 Review applications for neurosurgery and court secure treatment<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Electro-Convulsive Therapy (s.90-99)\u00a0 <\/strong><\/p>\n<p>\u2212 Is a safe &amp; effective treatment for some mental illness, particularly severe depression\/mood disorders<\/p>\n<p>\u2212 The application of electrical current to specific areas of the brain to produce generalised seizure<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Neurosurgery (s.100)\u00a0 <\/strong><\/p>\n<p>\u2212 A surgical technique\/procedure performed on the person\u2019s brain<\/p>\n<p>\u2212 Used to treat severe\/incapacitating mental illness where other treatments were ineffective<\/p>\n<p>\u2212 Requires informed consent and MHT has to approve the application<\/p>\n<p>&nbsp;<\/p>\n<h2>Reducing restrictive practices (Part 6 MHA)<\/h2>\n<p>\u2212 Can ONLY be used within a designated mental health service<\/p>\n<p>\u2212 All reasonable and less restrictive options must have been tried before using restrictive practices\u00a0 \u2212 The persons dignity is protected<\/p>\n<p>\u2212 Restrictive practices include: <u>seclusion &amp; restraint<\/u><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Seclusion- <\/strong><\/p>\n<ul>\n<li>A room where doors and windows are locked from the outside, no sharp edges, adequate windows to look into, no furniture<\/li>\n<li>Considered as <u>LAST RrSORT<\/u><\/li>\n<li>Aims to prevent serious harm to self or others<\/li>\n<li>Requires clinical observation by RN\/MO at 15 min intervals<\/li>\n<\/ul>\n<p>\u2212 Monitor breathing <strong>\u00a0<\/strong><\/p>\n<p>\u2212 Levels of aggression\/agitation <strong>\u00a0<\/strong><\/p>\n<ul>\n<li>Review by AP must be checked every 4 hours<\/li>\n<li>Report back to chief psychiatrist<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Bodily restraint (s.113) <\/strong><\/p>\n<ul>\n<li>Considered as <u>LAST RrSORT<\/u><\/li>\n<li>Includes physical or mechanical restraint that prevents a person having free moment or their limbs<\/li>\n<li>Aim to prevent serious harm to self or others<\/li>\n<li>Must be under continuous observation- every 15 mins with documentation<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Chemical restraint- <\/strong><\/p>\n<ul>\n<li>Medication provided to reduce symptoms and treat illness \u00a0 Used to treat high levels of agitation and aggression\u00a0 <strong>Consider risks: prone restraint\u00a0 <\/strong><\/li>\n<\/ul>\n<p><u>Positional Asphyxia- <\/u>occurs when breathing is compromised\/lack of O<sub>2 <\/sub><\/p>\n<table width=\"0\">\n<tbody>\n<tr>\n<td width=\"366\">rxacerbated by:<\/p>\n<p>\u2212 Obesity<\/p>\n<p>\u2212 Pre-existing medical conditions<\/p>\n<p>\u2212 Pressure on abdomen<\/td>\n<td width=\"54\">Signs:<\/p>\n<p>\u2212<\/p>\n<p>\u2212<\/p>\n<p>\u2212<\/td>\n<td width=\"223\">Person telling you they cant breathe<\/p>\n<p>Gurgling\/gasping sounds<\/p>\n<p>Sudden tranquillity<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Police involvement (s.351) <\/strong><\/p>\n<ul>\n<li>Police may apprehend a person if they person appears to have a MH illness<\/li>\n<li>Aim to transport to a designated MH service for assessment<\/li>\n<li>Police don\u2019t provide any clinical judgement<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Compulsory Notification Persons (CNP) <\/strong><\/p>\n<p>An authorised psychiatrist must ensure that reasonable steps are taken to inform the following persons<\/p>\n<ul>\n<li>The nominated person<\/li>\n<li>A guardian<\/li>\n<li>A carer<\/li>\n<li>A patient if the patient is under 16 years<\/li>\n<li>The secretary to DHS<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>When:<\/p>\n<ul>\n<li>As soon as possible!<\/li>\n<li>Deciding whether to make a TTO or TO including setting and duration<\/li>\n<li>The right to communicate is restricted<\/li>\n<li>Deciding whether to grant a leave of absence from inpatient unit<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h2>Principles<\/h2>\n<ul>\n<li><strong>Autonomy <\/strong><\/li>\n<\/ul>\n<p>\u2212 Right to make own decisions, provided it doesn\u2019t violate another\u2019s autonomy<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Beneficence <\/strong><\/li>\n<\/ul>\n<p>\u2212 Care provided is for the benefit of the individual; positive action or intervention<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Non-maleficence <\/strong><\/li>\n<\/ul>\n<p>\u2212 To do no harm; avoid actual harm, risk of potential<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>Justice <\/strong><\/li>\n<\/ul>\n<p>\u2212 Society\u2019s expectation of what is fair &amp; right<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Contemporary perspectives- Least restrictive treatment \u00e0 community focused care\u00a0 Influences in practice: Increased effectiveness\/availability of psychotropic medications Classification of mental illness Beacon Project (National Mental Health Seclusions &amp; restraint)&hellip; <a class=\"continue\" href=\"https:\/\/www.amyork.ca\/academic\/zz\/mental-health-nursing\/mental-health-service\/\">Continue Reading<span> Mental Health Service<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[121],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4668"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4668"}],"version-history":[{"count":0,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4668\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4668"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4668"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4668"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}