mhca – 10 chapters (76 sections)10 chapters (76...

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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


� 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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� 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


� 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


� 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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� 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


� 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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� 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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� 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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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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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)

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Some tipsSome tips

� Know the HE’s internal guidelines on movement of forms / transport / referral routes

� Know where and who is responsible for keeping copies of the forms at the HE

� SAPS’s assistance may be requested to apprehend a possible MHCU and cause him to be examined – Sect 40

mhca – 10 chapters (76 sections)10 chapters (76...

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