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Yes, so, hi, everyone. Thank you for coming. Um So today we have Doctor Christina with us to give us a talk on m and psychotic disorders. So I'll pass them over to her. Um, if you have any questions, pop them into the chat. Um Yeah, so ho awesome. Hi, everyone. Thank you so much, uh, for coming to the talk. Um Hope you're having a good Monday. Um, today we'll be talking about the Mental Health Act and Psychotic disorders. Um Yeah, and as as we said, if you've got any questions, just pop them in the chat. If after the lecture, you've got any questions, feel free to email me. I popped my email over there. Um, but yeah, we've got one hour. So I'd, I'll say let's, let's start right away. Right. So, uh my name is Justina. I am currently an F one doctor. Um, my first f one job was in Psychiatry, so I got a lot of exposure to the topics that we'll be discussing here today. Also can't recommend psychiatry enough as an F one job. If you've got any questions, let me know. Um, my next jobs for pediatric surgery and I'm on Acute General Medicine. Um And that's all at Oxford University NHS Trust. Perfect. So we'll be talking about the Mental Health Act first and then we'll be talking about psychotic disorders. I've got quite a few SBS and a few open questions in the powerpoint. So hopefully, um yeah, that will help with your learning and checking your understanding. Um and just generally, um if there's anything in the powerpoint that differs from anything that your lecturer said, uh please always um go by whatever your lectures said. Um I made these slides using resources like uh appear in psychiatry, um ICD 11 DSM five. and also some of the sites that I uh had from uh fifth at Imperial. So hopefully, um it should all be correct. But if there's anything that's different between what I'm telling you and what you've heard from one of your lectures, always stick with what your lectures said. Great. So we'll just jump straight into the Mental Health Act. Um We're gonna start with an SBA um There's a mentee code in the top right corner. Um So if you could join the mentee. Yeah, perfect. And thanks for putting that in the chart. Um I'll go to the correct question. Hopefully it should be active now. So a 35 year old female with paranoid schizophrenia was admitted to hospital following an asthma attack. Her schizophrenia is currently well controlled on QUEtiapine. She now wants to leave the hospital against medical advice to attend her sister's wedding. Under which section of the Mental Health Act, could this patient be detained? You've got five different options. Section 52, section 54135136 and none of these. So we've got a couple answers coming in. Right. Perfect. I think most of you have answered by now and most of you are absolutely correct. The correct answer here is e so why is it e um this patient does have a background of a mental health disorders. Um But this is currently well controlled. She's wanting to leave the hospital against medical advice to attend an event that's important to her. Um We don't have any evidence in here suggesting that um her mental health is deteriorating or um that you would need to question um her ability to make this decision based on any issues related to her mental health. In this um in this scenario, you would, what you would need to do is a mental capacity assessment to determine whether she has the capacity to make this decision. Um So what I wanted to make clear with this SBA is that we do have to um understand that there's a difference between the Mental Health Act and Mental Capacity Act. So, the Mental Health Act is a legal framework which enables the compulsory health care for people suffering from a mental disorder in England. And it's when involuntary treatment can be imposed by clinicians when people are at risk to themselves or others. Um And um so the situations in which you can um involuntarily treat people would be under the Mental Capacity Act or the Mental Health Act. If you're doing this under the Mental Health Act, it would have to be for specifically the treatment of a mental health disorder and not physical health problems. There are a few exceptions where the physical health disorder um and mental health disorder are directly linked to one another. But in general mental health disorder, uh Mental Health Act is only for mental health disorders. And um I know we always speak about different acts within the Mental Health Act. You have to think of it as basically a long document with different acts um describing what can be done in certain scenarios, right? So we'll move on to the next SBA we've got um you are an f two doctor working a night shift and covering the surgical wards, a 22 year old patient, one day post laparoscopic appendicectomy for gangrenous appendicitis is threatening to leave the ward. They report they don't think life is worth living anymore and say that they did not want to have the surgery anyways. They have a pulled out their cannula and are now trying to leave the hospital against medical advice. This patient has past medical history of depression and previous suicide attempts. Which section of the Mental Health Act could you use in this scenario. Would it be section two, section three, section 5254 or section 17? Amazing. Thank you all for participating. Um Yeah, all of you have answered. Absolutely correct. Um In this case, it would be section 552. let's look at why? So you're an FF two doctor. So for a section 52, you need to have at least one year of clinical experience. So I could not um, I could not fill out the paperwork. It would have to be someone F two or above. Um, and you're covering a surgical ward. So this patient is admitted to a ward. Um, you can see that they've, um, they've, uh, they've got suicidal ideation. They're quite at high risk because they have had previous suicide attempts and you there, you know, they have grounds to actually be concerned about this patient's safety if they were to leave the hospital. So, um, in this moment, it would be very right to consider, um, using section, um, 52 of the Mental Health Act, we'll do a couple more SBA S and then we'll move on to speak about the different sections, um, in detail if that's ok. All right. So our next ba a 19 year old male is seen behaving oddly on a busy road. He appears to be having a conversation with someone who is not there. He's also observed to run onto the street and stop cars, bystanders unconcerned and have called emergency services. The man is stating that he does not want to go to hospital because he needs to follow Linda's advice and search for the answers to all the questions in the universe. Which section of the Mental Health Act applies here. And again, we've got 5254 17, 135 and 136. Right? Fantastic. We've got a little bit of a mix um in answers here, but most of you have gone with the correct answer, which is section 136. so you can see that this, um, this person is behaving quite oddly and they are at risk to themselves because they could run in front of a car hurt themselves, but they could also cause an accident that could harm others. Um, he is, um, he seems like he's having, um, hallucinations, he's speaking to someone called Linda and, uh, uh, he seems to be thinking about quite, um, odd things. So there, you know, you, um, he does seem to be suffering from a mental health disorder and he is at risk himself or others in addition to that he is in a public place. So section um, section 52 and 54 would not apply here because he is not an inpatient on of the ward. Section 17 is more about leave. So that would not apply here either. And then we've got section 135 and 136. both of these are quite similar. In section 135, you could uh remove someone from a property to bring them to safety. And in section 136, it would be from a public place. So that's why answer E is correct here, right. Um Se uh S B5 um A.