Mental Health Decisions
A mental disorder means mental illness, severe dementia or significant intellectual disability, where there is a likelihood of the person concerned causing immediate and serious harm to himself or others or because of its severity the judgment of the person concerned is so impaired that failure to admit him to an approved centre would be likely to lead to a serious deterioration in his condition or prevent the administration of appropriate treatment that could only be given by such admission, and the reception, detention and treatment would be likely to benefit or alleviate the condition of that person to a material extent.
Treatment covers the administration of physical, psychological and other remedies including care and rehabilitation of a patient under medical supervision intended for the purpose of ameliorating a mental disorder.
Mental illness is defined as a state of mind of a person which affects his thinking, perception, emotional judgment and which seriously impairs the mental function of the person to the extent that he or she requires care or medical treatment in his own interests or the interests of others.
Severe dementia is a deterioration of the brain of a person which significantly impairs intellectual functions, thereby affecting thought, comprehension and memory and which includes severe psychiatric or behavioural symptoms such as physical aggression.
Significant intellectual disability means a state of arrested or incomplete development of mind of a person, which includes significant impairment of intelligence and social functioning and abnormally aggressive or seriously irresponsible conduct on the part of the person.
The legislation provides that a person may not be involuntarily admitted to an approved centre only by reason of the fact that he suffers from a personality disorder, is socially deviant or addicted to drugs or intoxicants. In effect, the grounds for admission relate to the danger of harm or the need for treatment.
The assessment of the criteria for admission is undertaken by clinical experts. The Mental Health Commission has published reference guides in relation to the purposes and objectives of the legislation. They have given some guidance in relation to the meanings of severe dementia and significant intellectual disabilities.
Generally, the persons concerned must have severe psychiatric and behavioural symptoms. This may include aggressive behaviour but need not necessarily do so. Significant intellectual disability is intended to cover significant impairment of intelligence, social functioning and abnormally aggressive or socially seriously, irresponsible behaviour. The person’s IQ need not necessarily be below a certain level under these criteria.
Decisions
The key criteria in making decisions under the Mental Health Act is that the decision should be made in the best interest of the person concerned. Due regard is to be given to the interests of other persons who may be at risk of serious harm if the decision is not made.
Where a proposal or recommendation on admission note is proposed to be made in respect of a person or treatment is proposed, the person shall insofar as reasonably be practical be notified of the proposal and be entitled to make representations in relation to it. Before deciding the matter, due consideration should be given to representations made. Due regard is to be given to the right of the person to dignity, integrity to provide privacy and autonomy.
Rights Issues
Several aspects of mental health law raise significant issues under constitutional and human rights law. There are constitutional rights to liberty, autonomy, and bodily integrity. There are broadly dissimilar human rights under the European Convention on Human Rights.
It is the basic principle of law, set at Article 40 of the Constitution that no person shall be deprived of his personal liberty save in accordance with the law. The courts interpret “law” in this context as not simply meaning laws as enacted. Those laws must comply with basic due process and constitutional principles. Compulsory detention in mental health institutions raises significant issues in this context.
The Mental Treatment Act 1945 was intended to be replaced by The Mental Health Act in 1981. The latter legislation was never initiated. Certain aspects of the 1945 legislation were considered outdated and were later found to be unconstitutional. Ultimately, the Mental Health Act 2001 attempted to modernise the legislation and provide for a mechanism compatible with constitutionally complaint procedures.