Staff awareness of the application of Mental Health and Guardianship Legislation in the care of hospitalised older persons

Panesar, Narinder; Valachova, Iveta; Schmidtman, Robert; Chan, Daniel Kam Yin

doi:10.1177/1039856218758545

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…Research has highlighted poor awareness among clinicians of human rights frameworks, 71 , 72 and inadequate knowledge of capacity assessment 24 and relevant legislative frameworks to manage treatment refusal. 24 , 88 , 89 …”

Section: Discussionmentioning

confidence: 99%

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

O'Cionnaith¹,

Wand²,

Peisah³

2021

CIA

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The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice. Case Presentation: Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted. Conclusion:There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.

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Section: Discussionmentioning

confidence: 99%

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

O'Cionnaith¹,

Wand²,

Peisah³

2021

CIA

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“…If a patient refuses treatment in the ED, there are at least three possible pieces of legislation specific to New South Wales (NSW) that may need consideration: the Mental Health Act 1 (MHA), the Guardianship Act 2 (GA) and the Public Health Act 3 (PHA). Understanding of the intersection between the MHA and the GA among clinicians is suboptimal, [4][5][6] and the utilisation of legislation tends to be flawed. 7,8 Such challenges have already given rise to an algorithm for the use of the MHA and the GA in the general hospital.…”

Section: Introductionmentioning

confidence: 99%

Algorithm for the use of the Guardianship Act, the Mental Health Act and the Public Health Act in emergency departments in New South Wales

Huber

Aguirrebarrena

Ryan

2021

Emerg Medicine Australasia

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Objective: To address frequently asked questions regarding the use of the Guardianship Act, the Mental Health Act and the Public Health Act within New South Wales EDs and present an algorithm to guide the use of this legislation. Methods: An ED-specific algorithm was developed for the use of the three pieces of legislation. Then an emergency psychiatrist and an emergency physician reviewed the algorithm with ED staff to understand its usefulness and where further detail was required. Frequently asked questions were collated. Results: Frequently asked questions are addressed with reference to the algorithm. Conclusion: This paper offers an algorithm that can be easily followed for use in EDs across New South Wales.

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Staff awareness of the application of Mental Health and Guardianship Legislation in the care of hospitalised older persons

Cited by 2 publications

References 4 publications

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

Navigating the Minefield: Managing Refusal of Medical Care in Older Adults with Chronic Symptoms of Mental Illness

Algorithm for the use of the Guardianship Act, the Mental Health Act and the Public Health Act in emergency departments in New South Wales

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