mhca – 10 chapters (76 sections)10 chapters (76...
TRANSCRIPT
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MENTAL HEALTH CARE ACTMENTAL HEALTH CARE ACTAct No 17 of 2002Act No 17 of 2002
MHCAMHCA –– 10 Chapters (76 sections)10 Chapters (76 sections)
I Definitions
II Fundamental provisions
III Rights & duties
IV MH review boards
V Voluntary, assisted,
involuntary MH care
VI State patients
VII Mentally ill prisoners
VIII Administration property
IX Regulations
X General provisions
Regulations
12 Chapters / 48 Regulations
Annexure
1-48
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CaseCase
You are the casualty officer at a large secondary care hospital. The SAPS presents a young man who was found roaming around half dressed, shouting at people passing by, kicking at cars and shop doors.
The man refuses to say who he is, resists being properly examined and becomes threatening ...
QuestionsQuestions
1. Is he mentally ill? Is something medically wrong with him? Is he intoxicated? Is he a bad character?
2. What is your duty towards him?3. Do you have a duty towards others?4. Do you need to / have the right to treat or
admit him?5. Does he have rights to refuse admission /
management / treatment?6. What legislation / regulations do you follow? 7. Can the HE manage such a case?
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PreamblePreamble
� RECOGNISING that health is a state of physical, mental and social well-being and that mental health services should be provided as part of PRIMARY, SECONDARY AND TERTIARY HEALTH SERVICES;
� RECOGNISING that the Constitution of the Republic of South Africa, 1996 (Act No.108 of 1996), prohibits against unfair discrimination of people with mental or other disabilities;
PreamblePreamble
� RECOGNISING that the person and property of a person with mental disorders or mental disabilities, may at times require protection and that members of the public and their properties may similarly require protection from people with mental disorders or mental disabilities; and
� RECOGNISING further that there is a need to promote the provision of mental health care services in a manner which promotes the maximum mental well-being of users of mental health care services and communities in which they reside;
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Chapter I: DefinitionsChapter I: Definitions
� Head of a Health Establishment (HHE)� Person who manages the establishment concerned
� Mental Health Care Practitioner (MHCP) � A psychiatrist, registered medical practitioner, nurse, occupational therapist, psychologist / social worker trained to provide MH-CTR
Chapter I: DefinitionsChapter I: Definitions
� Mental Health Care User (MHCU)� A person receiving CTR, a state patient / mentally ill prisoner
� The person concerned is below the age of 18 years / incapable of taking decisions
� May include - prospective user / the person’s next of kin / a person authorised by any other law or court order to act on that persons behalf / a curator ad litem or an administrator appointed in terms of this Act / and an executor of that deceased person’s estate
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Chapter I: DefinitionsChapter I: Definitions
� Health Establishment (HE) � Institutions, facilities, buildings or places where persons receive CTR, diagnostic or therapeutic interventions or other health services and includes facilities such as community health and rehabilitation centres, clinics, hospitals and psychiatric hospitals
� Psychiatric Hospital
� Health establishment that provides CTR for users with mental illness
Chapter I: DefinitionsChapter I: Definitions
� Mental Health Status� Level of mental well-being of an individual as affected by physical, social and psychological factors and which may result in apsychiatric diagnosis
� Mental Illness� A positive diagnosis of a mental health related illness in terms of accepted diagnostic criteria made by a MHCP authorised to make such diagnosis
� Severe or Profound Intellectual Disability� A range of intellectual functioning extending from partial self-maintenance under close supervision, together with limited self-protection skills in a controlled environment through limited self care and requiring constant aid and supervision, to severely restricted sensory and motor functioning and requiring nursing care
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Chapter II: Fundamental provisionsChapter II: Fundamental provisions
�� Objects of ActObjects of Act
�� Implementation of policies and measures Implementation of policies and measures by stateby state
�� Designation of HE as psychiatric hospitals Designation of HE as psychiatric hospitals / CTR centres/ CTR centres
�� Provision of MHProvision of MH--CTR at HECTR at HE
Chapter II: Fundamental provisionsChapter II: Fundamental provisions
� Best interest of MHCU within the limits of the available resources
� At primary, secondary and tertiary levels
� Promote community-based care
� Designated HE which serve as psychiatric hospitals / CTR centres
� CTR at appropriate level
� Refer according to established referral / admission routes
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Chapter III: Rights & dutiesChapter III: Rights & duties
� 11 SECTIONS:
� 8 (3)
� 9
� 11
� 13
� 16
� 17
Chapter III: Rights & dutiesChapter III: Rights & duties
� 8. Respect, human dignity and privacy
� (3) CTR administered to MHCU must be proportionate to his / her MHS
&
� May intrude only as little as possible to give effect to appropriate CTR
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Chapter III: Rights & dutiesChapter III: Rights & duties
� 9. Consent to CTR & admission to HE
� 9(1) MHCP or HE may provide CTR to or admit a MHCU only if:
� (a) MHCU consented
� (b) Authorised by Court / MHRB
� (c) Due to mental illness, any delay in providing CTR may result in:
� Death / irreversible harm
� Inflicting serious harm to self / others
� Serious damage to / loss of property belonging to self / others
Chapter III: Rights & dutiesChapter III: Rights & duties
� 9(2) Any person or HE that provides CTR to or admit a MHCU in circumstances referred to subsection (1) (c):
� (a) Must report in writing to MHRB
(Annexure 01)
� (b) May not continue CTR for longer than 24h unless application is made in terms of chapter V
MHCA 1
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During 24h emergency admissionDuring 24h emergency admission
EXAMINE TREAT +/-ADMIT
EMERGENCYAPPROPRIATE REFERRAL
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Chapter III: Rights & dutiesChapter III: Rights & duties
� 10. Unfair discrimination on the grounds of his / her MHS
� 11. Exploitation and abuse must be reported
(Annexure 02)
� 15. Right to representation
� 16. Discharge report – Must give copy to patient
(Annexure 03)
� 17. Knowledge of rights
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Chapter III: Rights & dutiesChapter III: Rights & duties
� 13.Disclosure of information� May not disclose any information MHCU is entitled to keep
confidential in terms of any other law
� 13(2) HHE may disclose if failure to do so would seriously prejudice the health of MHCU or of other people
� 13(3) MHCP may temporalily deny MHCU access to information in their health records if likely to:
� Seriously prejudice the user
� Cause user to conduct him / herself in a manner that may seriously prejudice him / her or the health of others
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Chapter IV: Mental Health Review Chapter IV: Mental Health Review BoardBoard
Chapter V: CTRChapter V: CTR
VOLUNTARYVOLUNTARY
ASSISTEDASSISTED
INVOLUNTARYINVOLUNTARY
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Chapter V: CTRChapter V: CTR
VOLUNTARYSect 25
ASSISTEDSect 26-31
INVOLUNTARYSect 32-37
�Submits voluntary
�Appropriate CTR
�Appropriate HE
�Suffering Mental
Illness or Severe –
Profound Mental
Disability
�Incapable Informed
decision
�Requires CTR
�CTR must be provided
without consent
�MI such nature likely to
inflict harm to self /
others
�CTR is necessary for
protection of financial
interest / reputation
Sect 38 = Transfers to Maximum Security FacilitiesSect 38 = Transfers to Maximum Security Facilities
Section 40 = Intervention of South African Police Service Section 40 = Intervention of South African Police Service
Voluntary CTRVoluntary CTR
� Submits voluntary / Able to consent
� Appropriate CTR
� Appropriate HE
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Assisted CTRAssisted CTR
� Sect 26-31
� Suffering Mental Illness or Severe –Profound Mental Disability
� Incapable Informed Decision
� Requires CTR
� And who do not refuse the health interventions
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Assisted CTRAssisted CTR
Assisted CTRAssisted CTR
1. Application
2. 2 X Examination MHCP – 1 MHCP qualified to do a physical examination
3. Submit written findings to HHE
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APPLICATION EXAMINATIONAPPLICATION EXAMINATION
1. May only be made… (State relationship)
2. Unwilling / Incapable / Not available: MHCP (State reason)
3. MHCP ‘must’ not be the applicant
1. Physical health
2. Collateral information
3. Mental Health Status
4. Provisional Diagnosis
5. Homicidal / Suicidal / Dangerous
6. Recommend Assisted -CTR
7. I hereby declare……..
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Involuntary CTRInvoluntary CTR
� CTR must be provided without consent
� MI such nature likely to inflict harm to self / others
� CTR is necessary for protection of financial interest / reputation
� Refuse health intervention
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Involuntary CTRInvoluntary CTR
1. Application
2. 2 X Examination MHCP – 1 MHCP qualified to do a physical examination
3. Submit written findings to HHE – If involuntary care recommended …
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CONSIDER 72CONSIDER 72--HOUR ASSESSMENTHOUR ASSESSMENT
HHE:
1. If the findings concur
2. Cause MHCU to be admitted
48h Designated HE
where
72h-assessments
can take place
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AT THE DESIGNATED H.EAT THE DESIGNATED H.E. .
1. 2 X Examination by different MHCP ( – 1 MHCP qualified to do a physical examination
2. Submit written findings to HHE
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WITHIN 24H AFTER FINDINGSWITHIN 24H AFTER FINDINGS
1.
Does not warrant
Involuntary CTR
2.
Warrants further
Involuntary CTR as
OUTPATIENT
3.
Warrants further
Involuntary CTR as
INPATIENT
Discharge Prescribed conditions
Transfer to OPD
Within 7 days
Psychiatric Hospital
HHE opinion:
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Three more obligationsThree more obligations
� Appeal (MCHA 15)�MHCU against decision�MHRB consider
� Periodic Review (MHCA 13A & B)�6 Months after CTR�And then every 12 months
�Discharge / Transfer (MCHA 3)