PSCY9901 Admission And Discharge Process Of Involuntary Patient Assessment 2 Answer

Introduction

Good health is defined as physical and mental well being. Mental illness like dementia, schizophrenia, depression are progressive diseases which have a high toll on the patient's life. The treatment, admission, and discharge process of such patients are regulated by a set of rules which are in accordance with government standards. Mental health Act is a vital law for regulating the procedure of admission and discharge of the mentally ill patients. In this report admission and discharge process of an involuntary patient, Mr Smith is discussed in compliance with the Mental Health Act.

Scenario 1

Criteria for admission of the mentally ill patient under The Mental Health Act, 2007: 

Under the Mental Health Act, 2007, a civil procedure patient can be admitted for evaluation under the amended Act (section 2) Mr Smith should have the following characteristics (Mental Health Act 2007 No 8.,2020):

• Mental illness of the patient demands patient custody in the hospital for the purpose of assessment or medical treatment for a certain period.
• Availability of proper medical care for the patient which includes interventions related to psychological health, rehabilitation, nursing, habilitation, and care of the goal of prevention or alleviation of a disease condition or for the treatment of clinical manifestation.
• Found to be so detained in taking care of own health or can be harmful to the other persons. So need to be treated but cannot be provided unless a person should be apprehended under sections (section 2 &3) Simon Lawton-Smith - The King's Fund. (2008) (Mental Health Act 2007 No 8.,2020).

Criteria for admission of Mr Smith: 

According to the mental health act 2007(MHA) sections, 2 and 3 Mr Smith fulfils the admission criteria (Mental Health Act 2007 No 8.,2020). As per medical history given by his parent's statement that he hides all the knives under his bed and made windows covered by cardboard and paranoid that they are not his parents, looking more aggressive and hostile towards them. Moreover, for this mental illness, he was on medication Olanzapine which is neglected by him, and not interested in visiting the community health team for follow-up or treatment. Mostly he was found to be self muttering at night rather than sleeping. During admission in the psychiatric hospital assessment done in which he was uncooperative and required guards help, at the time he observed responding to unseen stimuli, the refusal for medication, and also paranoid towards his parents that they want to harm him. Therefore, all the mentioned assessment and history indicate that Mr Smith is not mentally fit and may harm his health and life and others as well. So, immediate hospitalization and treatment are required.

 Other Options in Management of Mr Smith: 

Apart from drug therapy, there are also other measures by which Mr Smith condition can be improved, such as: 

Psychosocial intervention: under this Mr. smith mental health condition should be supported by providing cognitive remediation such as behavioural improvement intervention, social skills training, family treatment, group therapy, individual supportive therapy, vocational rehabilitation so that his right to freedom to live, to be treated to socialize can be preserved, and way of living and thought can be improved. Moreover, involving him in a community program, yoga, and social interaction is also effective in making him continued engaged and adherence towards treatment (Treatment Outcomes, 2001; Ansari et al., 2020). There should be a provision of a crisis resolution team and community mental-health team who take care of his follow-up so that early detection and management of abnormal behaviour can be managed (Thara et al.,2008).

Individual supportive therapy: we can establish an empathetic relationship with him by listening to his complaints so that we can suggest and support him with a lasting therapeutic alliance (Nakajima et al., 2015).

Rehabilitation: as per him and his family members rehabilitation program should be culturally moulded so that family can also be supported and treated (Frankenburg, 2020).

Lifestyle and dietary modification: for preventing the morbidity and mortality of cardiac and metabolic side effects it is an important plan for lifestyle modification such as intervening in exercises, abstinence from bad habits if any, healthy dietary practices, etc. (Grover et al., 2017).

Family intervention: there should be involvement of the family in care of Mr Smith by offering emotional and practical support, fining their needs, and providing information about the purpose and benefits of psycho-educational treatment like group-based treatment, integrated psychosocial intervention so that acceptability and participation in interventions can be obtained (Grover et al., 2017; Ahmed et al.,2015). 

The Obligation of Treating Team:

 Upon admission to a psychiatric unit under the MHA, are there any additional obligations on the treating team to notify other parties? If so, what are the obligations? 

Under MHA, there are many other obligations which have widely performed by professionals (Mental Health Act 2007 No 8.,2020):

Registered medical officer (RMO): under the act 1983, the charge of treating mentally ill Smith has to behold by a registered medical practitioner. RMO can only decide about the discharge and leave of him.

Responsible Clinician (RC):  RC is an approved clinician who can perform most of the functions of RMO. Under section 20, for the renewal of the patient (Smith), detention RC is responsible for checking all the conditions and has to be met before furnishing the renewal report. Section 5(2) and (3), approved clinician (AC) consider an application for admission, must hold an inpatient for at least three days from the time report is prepared to the manager of the hospital (Smith, 2008). In this case, Mr Smith can be harmful to himself or others so he remanded for the hospitalization which can be reported by RC or RMO under section 35 (Smith, 2008; Mental Health Act 2007 No 8.,2020).

Approved mental health professional ( AMHP): 1983 act: under part 2, ASW is appointed who can perform various functions such as admissions, assessment, treatment, and detention in hospital can be done based on their applications. Under section 21, AMHP (Smith, 2008; Mental Health Act 2007 No 8.,2020) will evaluate all the factors for Smith admission after the appealed by his family members.

Clinician Report of Mr Smith for the Mental Health Review Tribunal (MHRT)

A short treating clinician’s report (Mental Health Act 2007 No 8.,2020) at the first hearing for the Mental Health Review Tribunal (MHRT) justifying the ongoing detention of Mr Smith in an inpatient psychiatric unit.

Identification data: patient Mr Smith is 35 years old male, unemployed, living with his family member.

Chief complaints: he is agitated and aggressive towards his parents, self muttering, and having paranoid behaviour. 

History of present illness: the patient has a lack of insight brought into the emergency department by his parents. During the assessment, he was observed increased hostile, agitated, and guarded, and he accused his parents that they are not what they say, and his parents were planning and plotting against them. His parents informed about his paranoid and bizarre behaviour and informed about poor compliance with his treatment as he has not been taking his medicine oral olanzapine. Parents also reported that Smith hid knives under the bed and kept his all windows covered which may harm himself or them. At the time of the assessment, he was found to be uncooperative, preoccupied, disorganized, and was responding towards unseen stimuli too. 

Current medication: none as he discontinued olanzapine.

Allergies: drug allergies not known

Social and development history: Mr Smith lives with his parents and unemployed, so for his expenditure, he depends upon his parents.

Mental status examination: 

Attitude: he demonstrated uncooperative behaviour with an interview and assessment session. Impression was hostile and agitated.

Psychomotor: psychomotor agitation is present

Affect: his effect is detached.

Mood: his mood is “violent”.

Thought process: thoughts are paranoid.

Thought content: he is preoccupied and doing self muttering, having a hallucination. Paranoid delusions are elicited. 

Insight: his judgment is poor as evidence by discontinuing medication and lack of engagement with mental health treatment.

Plan: for increasing the database I will try, and with the parents' consent, I will start the treatment for his betterment and for effect during his admission process, I anticipate titrating. 

Scenario 2

Discharge Process of Mr Smith and Options for his Management in Community 

As per evaluation of the treating team, they evaluated that Mr Smith responded well and his symptoms also ameliorated and can be managed in a less restrictive area under the medical treatment so he can get discharge cf 1990Act, section 132, by an authorized medical officer only after preparing a community treatment order and any order which can be authorized the patient’s detention closes to affect (Mental Health Act 2007 No 8., 2020). Furthermore, the Medical health officer has to notify the tribunal about the discharge of a detained patient (Smith) as soon as possible as he is a forensic patient. For the ongoing management of Mr Smith in the community, under section 56, a compulsory community treatment order will be prepared by the Tribunal (Mental Health Act 2007 No 8. (, 2020). Along with pharmacological management, the psychosocial treatment approach will be effective, which can be done by the following:

• By educating Mr Smith about new skills and helping him in controlling his lives
• Modifying his living environment more therapeutic and conducive so that he can achieve his personal goals.
• Provision of support on an ongoing basis.
• Provision of Illness self-management skills and skills training.
• Family intervention, in which they should be educated about the treatment plan and follow up. 
• Self-help group and other consumer-oriented services can also be involved
• Employment can also help him in a productive outcome.

Obligations on Treating Team with regard to the Principal Care Provider 

As per MHA 2007, here in the given case of Mr Smith principal care providers are his parents who can make a close relationship with him and provide welfare and primary care without any commercial interest (72A). Obligations of the treating team towards principal care providers (Gluck, 2020) are as follows:

• Encourage and support them in accepting the reality of Smith’s illness and related challenges; however, he responded well towards treatment but still, he lacks justice or insight about his mental illness.
• Educate the family members about disease condition, the importance of treatment plans; follow up, relapsing features, a community support group that provides schizophrenia help.
• The importance of medication should be explained clearly that his paranoid delusions, distorted thought process, hallucination, insomnia, and other treatment require potent medication therapy. Therefore, parents have to ensure that Smith takes his medicine as per advice and on time.
• Information should be provided about the existence of schizophrenia support groups and also about the online support forum.
• Encourage parents to have a healthy, honest, and trustworthy relationship with the treating team so that better health care interventions can be planned.
• The treating team should educate parents about stress and triggers, which can worsen the symptoms.

Community Treatment Order 

Under subsection 5(c), a medical officer can apply for the community treatment order (Mental Health Act 2007 No 8., 2020). Here in the case of Mr Smith when writing to the MHRT medical officer has to mention that Smith is on injectable antipsychotic medication, and he has shown improvement. His symptoms of hallucination, paranoid attitudes are ameliorated. However, still, he is not accepting that he has any mental disability and requires treatment which shows a lack of insight or justice and demands to live without medication. He recognized his parents as his loved ones who do not harm him. Apart from this medical history, he has a forensic record that was informed by a social worker. 

The medical officer has to provide treatment plans of Mr Smith which must include an outline of propose treatment, detail about the provision of counselling, rehabilitation, and other community services which has to be based on patient’s (Smith) health goals. Furthermore, methods should be mentioned clearly about the health care services, its place, and the frequency of Smith's visit.

Report for Local Court:

Under section 4(1),14, 15 mental health act 2007, s32(6) a person's behaviour is irrational for the time being and justifying an outcome on rationale grounds that temporary treatment, care, or control of the behaviour is needed for the purpose of personal protection and also for others (Mental Health (Forensic Provisions) Act 1990 No 10., 2019). Here in this Mr Smith case 6 months ago he was not mentally balanced, paranoid towards his parents that they were planning to harm him. Because of a lack of insight, the paranoid attitude he threatened his father and also pushed his mother against the wall. Though he also committed an assault and apprehended violence order has been initiated. But under section 32, Mr Smith was mentally unstable and was having a problem of cognitive impairment, suffering from a mental disorder: Schizophrenia, and was detained in mental health hospital for treatment (Simon, 2008). 

Therefore, it is important to consider Smith’s mental status at the time when he committed the offence. In support of the violence act here, a document is attached, which involves all the medical data relevant to the Smith condition.

Mr Smith was admitted to the mental hospital Cricos Unit at St Veracity’s Hospital because of his mental disorder schizophrenia. He was commenced on injectable antipsychotic medication, and he has shown improved response and his symptoms ameliorated. In the current status, he trusted his parents, and no more believed that his parents are against him. Now Smith wants to live his medication-free life and wants discharge from the hospital. However, his mental status is not allowed to stops medication because still his judgment is impaired not at all; he believes that he has any mental disability. In response to his application for discharge, the provision of the community health team, psychosocial therapies, and other supportive groups’ information is being shared and informed about the follow-up and relapsing features. Moreover, he is being charged with the assault just two days prior to his admission, and AVO also occurred, however, the crime which he committed is under the influence of his mental disability and was committed unintentionally. So it's a requesting appeal to consider Mr Smith's mental status during the commitment of crime and grant him so that he can live a healthy life under the supervision of the mental health team.

Relevant Principles and Ethical Issues that Arise in Relation to the Involuntary Treatment of Persons with Mental Illness and/or Disorders:

Principle of Autonomy: freedom and ability to act in a manner of self-determination is referred to as Autonomy and to make a personal decision without any interference is the right of a rational person. All individual has unconditional worth should be recognized under the principle of Autonomy without regards towards the individual goal of treating the individual in accordance with the other goal is the violence of Autonomy (Appelbaum,2016).

Principle of Justice: Mr. Smith is refusing his medication treatment which shows that he needs hospital admission and leaving him without treatment will be injustice towards him 

Principle of Non-Maleficence: this principle ensures the safety of the patient under the provision of care. In this principle planning for good to promote patient health is considered. So respective to his ethical principle, involuntary detention provides an opportunity to evaluate the mental capacity and mental state of an individual (Appelbaum, 2016). 

After coercive treatment possibility of discontinuing antipsychotic treatment is there and also a side-effect of drugs may also impair other body functions so it is important to consider this principle so that harm to the individual can be prevented (Steinert, 2016). 

Principle of Beneficence: any action which is for the purpose of helping others is beneficence. In real meaning, those actions are meant for treating or eliminating harm so that people's conditions can be improved. In clinical mental health counselling, beneficence holds the role to ensure beneficial treatment has to be delivered to the individuals. For the implementation of the correct treatment of the condition, which has a negative impact on the health of the mentally ill patient and for the prevention of the harm, clinical counsellors are accountable. For the assessment and balancing of the probable benefits antagonist to the increased risk towards action, the clinical counsellor is holding the obligation (Newton-Howes & Gordon, 2020).

Justice: one of the complex principles is justice. It concerns fairness, impartiality, and equality. Two categories of justice are considered in clinical mental health counselling and in general health care with respect to the justice concept. First is about distributive justice under whom all individuals are treated equally without any discrimination in terms of their gender, nationality, and race in relation to other social divides. The second is about social justice. As per this equitable distribution of resources among individuals is recommended when it concerns health care (Steinert et al., 2016).

Fidelity: this concept is based on the principle of confidentiality under which one has to be loyal to the patient. In this principle, the individual is expecting to do not disclose their matters with others related to their medical issues (Appelbaum, 2016). 

Aspirational Ethics: it means about the needs of the individual to provide their duties as per high standards. This principle encourages counsellors to perform their duties at the highest level of performance (Steinert et al., 2016).

Principle of Veracity: it means that an individual has to be truthful every time. In the concept of this principle, veracity is all about being truthful towards those individuals who are in a position to understand their health condition. Health personnel is expected to be truthful irrespective of the impact, whether it has a negative or positive impact upon the person. Professionals are obliged to express truth only (Steinert et al., 2016). 

Conclusion 

The mentally ill patients require quality care with complete precautions. The health care organizations must abide by the government standards to deliver services with a patient-centric approach. Mentally ill patients need special care for their holistic well-being. Thus, these laws provide certain rules for the health care provider so that such patients are served with respect and care. Moreover, it is also worth mentioning that these patients may sometimes become involuntary and turn harmful for themselves, their families, and society. Henceforth, it becomes immensely significant to handle such cases by complying with the law and also considering the rights of mentally ill patients.