voluntary psychiatric admissions

zenfinite

what is the law in Ireland regarding voluntary psychiatric admissions? ie under what circumstances could a person leave the hospital

Our man in Havana

They can leave at any time.

zenfinite

so would it be illegal to stop a voluntary patient from leaving even if the doctor thinks it would be best for them to stay?

civis_liberalis

zenfinite wrote: »

so would it be illegal to stop a voluntary patient from leaving even if the doctor thinks it would be best for them to stay?

I wondered about that. Something I saw in a TV show had me thinking about it.

Logically, I can only assume that a doctor has absolutely no authority in that regard, unless the person was placed in their care by the courts or whoever in the first place.

Improbable

Voluntary admission to a psychiatric hospital or unit occurs in much the same way as admission to a general hospital. Referral may be made by your GP or consultant. Unlike patients in general hospitals, you are not always completely free to leave psychiatric care when you wish.

If you are a voluntary patient who wants to leave a psychiatric centre and the consultant psychiatrist or a doctor or nurse on the staff considers that you are suffering from a mental disorder, the professional may detain you for a maximum of 24 hours. If the voluntary patient is a child and the parents or guardian want to remove them, the professional may have the child detained and placed in HSE custody (if the professional considers that the child is suffering from a mental disorder).

The consultant psychiatrist must either discharge you or arrange for an examination by another consultant psychiatrist. The second consultant must issue a certificate stating that you should be detained because of a mental disorder or must discharge you. If you are detained, then you are an involuntary patient and all the procedures relating to information, review and appeal apply in the usual way


Source:
http://www.citizensinformation.ie/categories/health/mental-health/admission_to_a_psychiatric_hospital

drkpower

zenfinite wrote: »

so would it be illegal to stop a voluntary patient from leaving even if the doctor thinks it would be best for them to stay?

Remember, the provisions that Improbable refers to (section 23/24 of the MHA 2001) which allows the detention of a voluntary pateient who expresses an intention to leave, cant simply be used where a doc/nurse 'thinks its best' - it requires quite a bit more than that - specifically that they are suffering from a mental disorder. That is seperately defined, but , at the very least, it requires that the patients condition will deteriorate significantly if they do not remain in Hospital.

In other words, detention is not justified just because the doc thinks you would do better in Hospital than at home.

Our man in Havana

A voluntary patient can simply walk out the door. It is up to the hospital staff to stop him but they must have legal grounds to detain him.

zenfinite

maybe if a family member agreed that the person wasn't fit to leave, the person wouldn't have a choice. the thing about it is the hospital could dispute the person's mental state and say they were not fit to make decisions and afterwards cite this as cause to ensure the person remained in the hospital. This doesn't seem entirely fair.

drkpower

zenfinite wrote: »

maybe if a family member agreed that the person wasn't fit to leave, the person wouldn't have a choice. the thing about it is the hospital could dispute the person's mental state and say they were not fit to make decisions and afterwards cite this as cause to ensure the person remained in the hospital. This doesn't seem entirely fair.

As regards detaining a voluntary patient under section 23/24, the family's view is essentially irrelevent.

It is not a matter of whether the person is 'fit to make decisions'; the person must be suffering from a 'mental disorder'*. That is pretty much exclusively a medical call.

* - “mental disorder” means mental illness, severe dementia or significant intellectual disability where—
(a) because of the illness, disability or dementia, there is a serious likelihood of the person concerned causing immediate and serious harm to himself or herself or to other persons, or
(b) (i) because of the severity of the illness, disability or dementia, the judgment of the person concerned is so impaired that failure to admit the person to an approved centre would be likely to lead to a serious deterioration in his or her condition or would prevent the administration of appropriate treatment that could be given only by such admission, and
(ii) the reception, detention and treatment of the person concerned in an approved centre would be likely to benefit or alleviate the condition of that person to a material extent.

Improbable

As I posted above, the whole nonsense of a voluntary patient being able to walk out at any time isn't as straightforward as you might think. You do not have the right to leave if your doctor and a separate consultant can confirm that you do have a mental illness. At that point, you are considered an involuntary patient and therefore constrained by the rules applied to involuntary patients.

drkpower

Improbable wrote: »

As I posted above, the whole nonsense of a voluntary patient being able to walk out at any time isn't as straightforward as you might think. You do not have the right to leave if your doctor and a separate consultant can confirm that you do have a mental illness. At that point, you are considered an involuntary patient and therefore constrained by the rules applied to involuntary patients.

Remember, you need to have more than just a 'mental illness'; the vast vast majority of those who have a mental illness are not detainable.

Improbable

drkpower wrote: »

Remember, you need to have more than just a 'mental illness'; the vast vast majority of those who have a mental illness are not detainable.

The Act defines mental disorder as mental illness, severe dementia or significant intellectual disability where:
• Because of the illness, disability or dementia, there is a serious likelihood that you may cause immediate and serious harm to yourself or to other people or
• Because of the severity of the illness, disability or dementia, your judgement is so impaired that failure to admit you to an approved centre would be likely to lead to a serious deterioration of your condition or would prevent the administration of appropriate treatment that could only be given by such an admission and your reception, detention and treatment in an approved centre would be likely to materially benefit or alleviate your condition.

Mental illness means a state of mind which affects your thinking, perceiving, emotion or judgment and which seriously impairs your mental function to the extent that you require care or medical treatment in your own interest or in the interest of other people.

Severe dementia means a deterioration of the brain which significantly impairs your intellectual function and affects 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 the mind which includes significant impairment of intelligence and social functioning and abnormally aggressive or seriously irresponsible conduct.

drkpower

Precisely; as you can see, there is a fundamental distinction between a mental illness and a mental disorder.

Improbable

yeah, i was just generalizing in an incorrect manner.

zenfinite

I guess what is supposed to happen and what does are 2 different things.

drkpower

zenfinite wrote: »

I guess what is supposed to happen and what does are 2 different things.

You guess wrong; in the vast vast majority of cases what is supposed to happen actually does happen. And if it doesnt there are numerous checks and balances and legal avenues of redress.

zenfinite

really that's good. must look into that so