Articles for category: Law

Beyond Cheshire West: A Triangular Framework for Decision Making

February 17, 2025February 17, 2025 by TheEditor

The intersection of mental health law and clinical practice creates complex decision-making challenges for practitioners. A conceptual framework, which we call the Decision-making Triangle, offers clarity in navigating these challenges. This triangle comprises three interconnected elements: the acid test for deprivation of liberty, the definition of treatment under Section 145 of the Mental Health Act, …

Cheshire West: What’s to be learned?

February 16, 2025February 14, 2025 by TheEditor

The Cheshire West case serves as a seminal authority on the interpretation of deprivation of liberty within the framework of the Mental Capacity Act and the European Convention on Human Rights. It has established a robust legal precedent, emphasising the universality of the right to liberty and the necessity of rigorous procedural safeguards to protect …

Section 136: A Framework in Crisis

February 15, 2025February 12, 2025 by TheEditor

From 2017 changes to the MHA 1983 reduced the period of detention under 136 from 72 hours to 24 hours, with a provision to extend to 36 hours. Mental Health Services had struggled to deliver when the timeframe was 72 hours. Now they struggle even more, leading to unquantified instances nationally where Trusts have had …

Section 62(1): the hard boundary between law and ethics

February 17, 2025February 1, 2025 by TheEditor

In a previous post I unpacked some of the key issues in Section 62(1). Appropriate study of this article will necessitate digestion of Fathoming Section 62 of the MHA 1983 – Investigative Psychiatry (April 2024). Understanding of this article depends on having a foundational understanding of Statute Law, what it means and the power of …

Mental Health Tribunals

February 5, 2025January 18, 2025 by TheEditor

This article provides a detailed explanation of Mental Health Tribunals (MHTs) within the context of the Mental Health Act (MHA) 1983 in England and Wales. The MHA 1983 (Amended 2007) provides the legal framework for the compulsory admission to hospital for treatment or assessment of individuals experiencing mental disorders that may pose a risk to …

We Need to do Something about Smoking and Mental Health

February 5, 2025November 9, 2024 by TheEditor

This article is brazenly one-sided because it is about an addictive killing substance sold legally. The author is unapologetically anti-smoking because tobacco is the only killing substance sold legally for consumer use. Smoking (of tobacco) is normally seen as a physical health problem. This article will show it is a serious mental health problem as …

Intersection of Mental Health Act and Capacity Legislation

February 5, 2025October 22, 2024 by TheEditor

The case of Tees Esk and Wear Valleys NHS Trust v KAG [2024] EWCOP 38 (T3) and others offers a compelling illustration of the complexities that can arise at the intersection of mental health law and capacity law in the context of medical treatment decisions. This case involved the proposed insertion of a percutaneous endoscopic …

Article 2 in Psychiatry – Savage and beyond

February 16, 2025October 14, 2024 by TheEditor

The Right to Life, enshrined in Article 2 of the European Convention on Human Rights (ECHR), holds profound implications for the care and treatment of individuals within mental health services. Article 2 declares that “Everyone’s right to life shall be protected by law.” This publication explores the evolution of legal understanding concerning the positive obligations …

Punishment in Psychiatry

February 5, 2025October 3, 2024 by TheEditor

Nobody in their right mind would consider ‘punishment’ as a means of treating patients in psychiatry of today – or so you might think. Punishment was a part of treatment in the history of behavioural modification. To be 100% clear no contributor at this website thinks that punishment should be brought back into psychiatry or …

What is forensic psychiatry?

February 5, 2025September 28, 2024 by TheEditor

Forensic psychiatry in the UK is a specialised branch of psychiatry that interfaces with the legal system. It focuses on the assessment and treatment of individuals with mental health disorders who have come into contact with the criminal justice system. Forensic psychiatrists work in various settings, including secure hospitals, prisons, and community services. Their scope …

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Stage	Cost/Price (£)	Tax/Duty (£)	Tax/Duty Type	Calculation	Calculation
1. Manufacturer’s Cost	2	0	N/A	This is a hypothetical cost of production.
2. Specific Duty Added	2	5.89	Specific Duty	£294.72 per 1000 cigarettes / 1000 * 20	Fixed amount per pack.
3. Manufacturer’s Profit	7.89	0	N/A	(Assumed to bring the total to £7.89)	This is a hypothetical profit margin.
4. Ad Valorem Duty Included	9	1.11	Ad Valorem Duty	16.5% of £9.00 (approx. retail price before VAT)	Included within the retail price, not added separately.
5. Retailer’s Profit	10.11	0	N/A	(Assumed to bring the total to £10.11)	This is a hypothetical profit margin.
6. Final Retail Price (excl VAT)	13	0	N/A	(Includes specific duty and ad valorem duty)	This is the price displayed on the shelf, excluding VAT.
7. VAT Added	13	2.6	Value Added Tax (VAT)	20% of £13.00	Applied at the point of sale.
Total	15.6	9.6	Approximately 61.5% of the final price (£15.60) is tax – due to the simplified conservative assumptions about manufacturer and retailer costs and profit margins.

Documentation Issue	Critique
Vague Descriptors	Terms like “distressed state,” “emptiness,” and “intense anger” lack specific behavioural anchors. The descriptions are mere observations without any real substance. How was the intensity of the anger manifested? What did the patient say? How did she appear? Was she grimacing? Without concrete examples, these descriptors are open to interpretation and do not provide a clear picture of the patient’s presentation.
Generalised Interventions	Phrases like “explored coping mechanisms” and “discussed strategies” are so general that they amount to padding. No one will know what specific coping mechanisms were explored. How did this worker actually attempt to help the patient? What exact strategies were discussed? How were these tailored to the patient’s individual needs and the nature of their emotional instability?
Lack of Measurable Outcomes	The record mentions the patient feeling “slightly calmer” but lacks objective measures to assess the effectiveness of the interventions. How was this improvement gauged? Is it just ‘your’ word for saying so? Many services will accept such records as ‘standard’ because of cultural norms.
Ambiguous Plan	The plan to “continue to work on developing skills” and “encourage the patient to practice techniques” is vague and lacks specific, measurable goals. What specific skills will be targeted? What techniques were discussed ‘between sessions’? How will progress be monitored? What constitutes “practice” in this context, and how will adherence be assessed?
Omission of Risk Assessment	Given the nature of EUPD and the potential for self-harm, the record should include a formal risk assessment. What specific risk factors were considered? How was the risk of self-harm evaluated and managed?
Limited Patient-Specific Insight	While the record mentions EUPD, it does not provide specific insights into how this diagnosis informs the interventions or the plan. How were the chosen strategies tailored to the patient’s unique challenges related to their personality disorder?

Cognitive Activity	Description
1. Information synthesis	Gathering and integrating diverse information; evaluating reliability and relevance of each piece
2. Evidence evaluation	Critically assessing quality and strength of available evidence; identifying gaps
3. Principle balancing	Weighing competing ethical principles; reconciling guidelines with case-specific considerations
4. Stakeholder consideration	Analysing individual patient needs/rights; considering regulatory and societal requirements
5. Consequence projection	Anticipating potential outcomes; assessing short-term and long-term consequences
6. Risk-benefit analysis	Systematically evaluating risks; weighing risks against potential benefits
7. Legal framework integration	Incorporating relevant legal standards; ensuring compliance with statutory obligations
8. Ethical reasoning	Applying ethical frameworks; resolving ethical dilemmas in forensic psychiatric practice
9. Interdisciplinary integration	Synthesising perspectives from various disciplines; reconciling conflicting viewpoints
10. Decision refinement	Iteratively reviewing and adjusting decisions; fine-tuning to address all relevant factors
11. Uncertainty management	Acknowledging areas of uncertainty; developing mitigation strategies
12. Prioritisation	Determining relative importance of factors; focusing on critical elements
13. Cognitive bias recognition	Identifying potential biases; implementing strategies to minimise their impact
14. Justification formulation	Developing clear, logical rationale; ensuring transparent and defensible reasoning
15. Contextual adaptation	Tailoring approach to specific case factors; recognising unique case influences

Articles for category: Law

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