Understanding Mental Health Disorder

welcome to Part two off the Understanding mental disorder course. This course is going to be looking at the question of treatments in relation to mental disorder on the legal provision. For that, we'll start by looking at how treatment for mental disorder in itself has evolved and will then consider the current legal definition off. What is treatments in relation to mental disorder? Well, then look at the treat ability tests on how that has evolved to consider the current appropriate treatment test. We'll have a brief overview off some of the types of treatments that is available and currently used for mental disorder. Andi also briefly consider the consent that may be required about treatments to be provided and finally will take a look at the nice. Guidelines are in relation to the treatment of mental disorder, the Department of Health advises us, but one in four adults experience mental illness at some point during their lifetime, and one in six experience symptoms at any one time. So having considered the impact of mental illness and disorder in society, let's have a brief look at the evolution of treatment for mental disorder research studies have shown us unfortunately primarily based on the lack of understanding and fear of mental illness and mental disorder. In history, medical treatments tended to be harsh, punitive and downright appalling. More often than not, people were incarcerated, chained and treated in the most appalling conditions. It's sadly was not until the middle off the 19th century, following initial steps that were taken in Europe, that the medical profession started to realize that kindness on better conditions. We're going to produce far better results in relation to the treatments and management of mental illness and disorder, and so steps were actually taken in this regard. However, it must be remembered that for the main part, those who attended on day to day basis, particularly to those who suffered from mental disorder, received little or nothing in the way of education and training. By the beginning of the 20th century, those who attended person suffering from a mental disorder, we're starting to be known as nurses rather than attendance on there. Waas More consideration being given to education training off those nurses. The early part off century saw recognition off things such as shell shock, with the soldiers returning from the battlefields off the first World War and some steps were made in improving treatments. However, during the beginning of the 20th century, the emphasis was still on benevolent constraints, so primarily that involved actual physical restraint with locked wards on secure wards on Duthie padded room or appallingly known cell as they were called. There was also emphasis on psychological constraints so that patients effectively became apathetic and so sound. There was a use of rules under teens and a lack of privacy. Onda a prohibition off personal possessions coupled with a lack of any type off engaging activity which could only produce such results. However, even though they controls on constraints continued on understanding of the fact that you could relieve and even cure those who suffered from mental illness. Wasat, last developing the Mental Health Act of 1930 introduced the concept off voluntary patients with the understanding that at least some of the patients would be well enough to eventually become discharged. This was a relatively new phenomenon. Also introduced mental hospitals and the idea was specialised hospitals for those suffering from mental illness on disorder. But unfortunately this was still accompanied by staff who had woefully insufficient training by this point benevolent constraint become benevolent coercion for those who did not comply. And so we saw compulsory detention and transfer to a secure ward. Unfortunately, by the middle of the 20th century, the attitude persisted. Had books such as the Mind Publication Ball Number, which was written by for a patient at Rampton. And then Harding offers a very interesting in sight to the medical health practitioner in 1959 then was taken to Bronson, which he refers to as being run in a military way on entering. Bronson then was forced to bathe in front of five officers I'm provided with Ah hospital Nightshirt, then says, I never saw my clothes again. During his introduction to Rampton, he was advised, This is Ranson on all persons you see here in uniform or in gray or green overalls you call, serve. You don't answer back at any time, and you don't question anything you see. Don't make any close friends amongst your fellow patients. If you want to have a nisi ride on, get out some time. The book office. Some very interesting use of ranson Andi Such appalling issues as the blatant misuse off patient fashions went for example, then describes how a staff member took home 12 patients salads to use at his personal party that he was holding at his own home. Unfortunately, as the 20th century progressed, patients tended to remain in isolation within the hospital, separated from the outside world, and new treatments such as E. C. T. On the bottom ease were being tried. By the 19 eighties nineties, new techniques such a Z magnetic resonance imaging or M R I were being developed, and we had for the first time disease definitions and classifications such as the Diagnostic and Statistical Manual GSM, which related to mental disorder. We also saw the start off specially targeted drugs such as selective serotonin reuptake inhibitors, or assess our eyes, which were the first antidepressants to control the activity off a specific neurotransmitter in this case, serotonin and so reduced solid effects. The first and the most famous SS are I was introduced in 1987 under the brunt name Prozac. So how is medical treatment for mental disorder actually defined? Well, let's start with reminding ourselves off the changes to the definition of mental disorder made to the 1983 milk mental health Act by the Mental Health Act of 2007. In 1983 mental order was defined as mental illness, arrested or incomplete development off the mind, psychopathic disorder and any other disorder or disability of minds be 2000 and seven. Mental Health Act and sea currents. Definition off Mental Lord is simply any disorder or disability off the mind in terms of medical treatment. In its definition, the 2000 and seven act made amendments to the 1983 act so giving a seat current definition as to what legislation refers to as medical treatments and the Section one for 54 We are advised that any reference in this act of medical treatment in relation to mental disorder shall be construed as a reference to medical treatment, the purpose of which is to alleviate or prevent ah, worse thing off the disorder all one or more off its symptoms or manifestations. So we're looking at alleviating or preventing a worsening um dissection one for five. The definition of treatments is fully expanded to include nursing, psychological intervention and specialised mental help ability, ation rehabilitation on care, in addition to what one would consider as being treatments in any events. And interestingly, the explanatory note also lists cognitive therapy, behavior therapy and counseling as examples off mentioned health medical treatments. As the Mental Health Commission pointed out in issue 17 of its policy briefing for commissioners, the idea behind this seems to be specifying that medical troop treatments includes psychological intervention on they deemed was probably there to reinforce the fact. But personality just so does fall within the reach off powers within legislation. So what is for the treat ability test on what is appropriate treatment? Well, retreats ability test relates to the 1983 that, and under section three off the act, for example, as originally enacted, a person could be admitted to hospital on detained there for treatment on the grounds that a he's suffering from what was then the old definition of mental disorders. We've just seen Andi. In the case of psychopathic disorder or mental impairments. Such treatment is likely to alleviate or prevent the do deterioration off his condition on, and it is necessary for the health or safety off the patient, or for the protection of persons that he should receive such treatments and it cannot be provided unless he is detained under this section. In that particular section, Section three, also required to registered medical practitioners to cover, made a written recommendation in the prescribed form that would include prescribed particulars of the grounds for the opinion insofar as it related to paragraphs A and B but also a statement of the reasons for that opinion relating to the conditions set out in subsection C specifying whether other methods of dealing with the patient are available and, if so, why they were not appropriate. So the emphasis really was on treatment that was likely to alleviate, prevents a deterioration of condition, or what became known as the Treat Ability test. The 2007 act made changes to sections like Section three, which became amended to determine that admission and detention was on the grounds that he is suffering from mental disorder off a nature or degree, which makes it appropriate for him to receive medical treatment in a hospital. Andi, in the case of Section three, it's necessary that helpful safety patient or for the protection of persons that he should receive such treatment and it cannot be provided unless he's detains onto the section on and appropriate medical treatment is available for him. So essentially, for appropriate treatments. We've got the three elements, so the test is in effect. But it's not sufficient. That appropriate treatment actually exists in theory, the patient's condition. But this test now requires that the appropriate treatment is actually available for this patience. So we know that the ANC tells us that appropriate medical treatment needs to be available. Good. What is defined as appropriate medical treatments? Well, Section 34 has been inserted into the 1983 act by the 2000 and seven act, and this tells us that appropriate medical treatment in relation to a person suffering from a mental disorder a references to medical treatment, which is appropriate in his case, taking into account the nature and degree off the mental disorder. Andi Aly other circumstances off this case well, we know that in terms of the 1983 act and case law, nature refers to the particular mental disorder for which the patient is suffering. Looking at its quickness ity, it's prognosis on the patient's previous response to receiving treatment for disorder. Andi degree refers to the current manifestation off the patient's disorder as was disgustedly crowd against the Mental Health Review Tribunal for the South Tens region Ex Party Smith in 1999. So we've got Beat 1983 definition, which tells us that treatment had to be likely to levy eight. That is to be effective on by 2007. The treatment has to be available now. So in practice, there have been a suggestion that the new test maybe actually fairly similar when it's broke down on considered in practical terms. So in what circumstances do we have to think about appropriate medical treatments and when it might supply well? The test will primarily apply to detentions and the following sections of the act and, of course, the criteria for renewal. Andi Discharge off compulsion under these provisions, First of all, relate to Section three detention for treatments on the Relevance Criminal Justice provision such as Section 36 remand for treatment when we know that a person must be suffering from the mental disorder of the nature of degree, which makes it appropriate for him to be detained in hospital for medical treatment, Onda appropriate treatment is available for him till supplies to section 48th e transfer up and sentenced prisoners when the person must be again suffering from mental sword of a natural degree. Which leg should appropriate for him to be detained in hospital for medical shipments on and he's in urgent need of six treatments on today's The appropriate medical treatments is the appropriate treatment would also apply to Section 51 6 a hospital order where it's impractical or inappropriate to bring the detainee before court, where the courts satisfied on the written or oral evidence of least to register medical practitioners that the detainee is suffering from mental, the sword of the nature of degree, which makes it appropriate from patiently detained in hospital for medical treatments. Andi appropriate medical treatment is available for him Out under that section was also an additional criteria that the court should be of the opinion after considering depositions or other documents that it's proper to make such an order appropriate treatment all supplies to Section 57 58 which relates to the second opinion, pointed doctor or sewed. Now we look at this briefly Traum in calls, but these are provide safeguards for patients in relation to particular types of treatments and the appropriate treatment test also replaces the treat ability test, where a sewed certificates is required and the section requires now that Britain certification be provided that it's appropriate for the treatment to be given. In both of those sections, 57 on day 58 one of goods help look briefly some of the types of medical treatments that are available for mental disorder. That this is intended to be just a very brief overview and by no means a substitute for one's own in depth research. As a general guideline, it's been determines that the aim of treatments in circumstances where a cure particularly may not be possible, is to lessen on where possible, relieve distressing symptoms and to help person to cope with those distressing symptoms and see. First of all, obviously, most severe type of treatments is newest surgery. It remains regarded as a last resort when all other types of treatments have failed. In the UK, For example, in 2000 and nine, your surgery was performed on only two patients. Newest surgery is not a cure on it is irreversible. It's most commonly used to treat severe depression on and obsessive compulsive disorder It's generally a frontal lobe siege where the aim is to disrupt nerve connections in the limbic system, which deals with emotional responses such as rage, fear, enjoy Andi unconscious physical responses such as changes in heart traits and blood pressure. There are three main types of procedure within the UK and allow carried out under a general anaesthetic and involves making a burr hole that is a small hole in the skull emerging, such as an R. I. Unsophisticated computer equipment with lasers is used to pass electrical currents to generate heat on destroy small, tiny areas within the brain with a very actually going debilitation from this type of surgery. Andi, as you dimension many adverse side effects, potentially including damage to the blood vessels, which can result in stroke, epilepsy, confusion, headaches, apathy. Andi weight gain is associating with some of the procedures. Andi more rarely personality changes. How is it I accuse? Schools can be raised as results of newer surgery. Research has determined that this probably because previously patients suffered from poor concentration. Andi US will examine it. That's really good consent in relation to treatment. There are safe guards in relation to the use of newer surgery, with Section 58 in the treatment that requires consent or a second opinion. The next treatment is E. C T, which became Paul Puma in use during the last century. It involves passing an electrical current through the Anethe Ties patient's brain on juicing, a type of sea jer. It was stated to be beneficial in certain types of depression, although it has been used quite widely for other forms of mental illness as well. It's very controversial treatments which was very widely used. However, the ability now to avoid E. C. T. Has changed as a result of Section 27 off the mental health that which inserts a new section, Section 58 A. Into the act, Andi will look a Section 58 a one week look at the question off consent later on in the course next time treatment is psychotherapy, and that's often referred to as talking treatments, which allow the patients who literally talk through that. Concerns and problems on the Royal College of Psychiatrists advised that it's used for stress, emotional problems, relationship problems, troublesome habits and problems such as hearing voices. WC therapy can take place on a one to normal individual pieces. But there's also a group therapy aimed to help patients deal with problems and hey have in relating and communicating with people with a view to developing self awareness. It's also therapeutic communities where living in a therapeutic community is deemed to encourage the patient to think about the effects of the own behavior on other people, and some of the types cycle there. People talking treatments include cognitive behavior therapy, or CBT, and that focuses on on addresses. Challenges specific aspects of thoughts, feelings, behavior or attitude to help overcome problems such as fears and phobias. By actually changing behavior. And cognitive behavioral therapy combines behavioral, psychotherapy and cognitive therapy. Behavioral psychotherapy is designed to come problems by actually changing behavior. The Royal College of Psychiatrists, the honest Pay say that the therapist won't help you very gradually to spend more and more time in the situation you fear on will help you feel comfortable and relax in that situation. Cognitive therapy so the RST advises, focuses more on the way that what you believe you think can keep problems going. It helps you to test any unhelpful beliefs by talking about them and then developing ideas that are more helpful for you. You then shy, thes out in between sessions and so develop more helpful ways of thinking and fighting. It can take account of what happens in the past, but mainly looks at presence on the future. Next type of therapy is Kabul Analytical Therapy or C T, and it's similar to see the tea, the Royal College, it off. Some characterise says that the therapist didn't see a tea will help describe how your problems have developed from the events of your life and your personal experiences. It will cut the ways camping you have developed to deal with these problems and think of ways of changing your ways of coping so that you feel better and can cope more easily. They go on to say that the therapist puts this all into writing after your first few sessions. At the end of the treatment, the therapist gives you a final letter, which summarises your difficulties on the ways you have worked out have to cope better into personal therapy, or I. P T. Is a treatment for depression but has also been news with other problems, and this aims to help with an understanding as to how problems can be connected with the way the patient's relationships work with a view to firstly finding better coping mechanisms and, secondly, strengthening those relationships. Psycho Dynamic Treatments is also known as psycho analytic psychotherapy, Mr Pride and Insight for people allowing them to understand their feelings on to find better coping mechanisms generally. And the Royal College Off Psychiatrists describes this as regular time to think and talk about the feelings that the patient has about themselves on other people, especially family. And there was, the patient is close to, they say. You discuss what's happening in your life at the moment, how you do things on the part you play in things going right or wrong for you. You discuss what's happened in the past and how the past can affect how you're feeling thinking on behaving right now Had they point out with therapists in this type of treatment? Facilitates making connections between the past and present, and comments on what happens in the sessions to show the link with unconscious feelings from the past. Another type of therapy is art seven p, and this is a particularly useful type of psychotherapy for people who find it difficult to actually talk about their feelings and problems, as the name suggests, that uses the arts since his music painting, dance, voice of drama, ex cetera till our person to express and understand themselves in a therapeutic environments with course. A trained therapist, Andi the Royal College of Psychiatrists describes it, is using the creation of art or craft to help release on. Explore the precise and personal images metaphors which lie at the foundation off the personality so that they could be explored on discussed within a therapeutic relationship. What type of therapy is relationship or family? 70 which aims to work with patients, partner or family to understand and deal with problems that the patient faces The Royal College Off Psychiatrists describes this type of psychic therapy is working with family strengths to help family members think about and try different ways of behaving with each other and then finally cancelling, which is an opportunity to discuss what a person feels with the aim off as the RSP states to help you to be clear about your problems on by being clearer. To come up with your own answers, Counseling is very often used to cope with recent events such as bereavement and is not intended to actually change the patients as an individual are some herbal therapies do? And these various types of therapies approaches are often used together. So a patient may stop, for example, with individual therapy and then go on to have group therapy psychiatrists working to find a therapy or a combination that will suit that particular patient's needs. Another type of treatments that's becoming more available and more widely used is complementary Andi alternative types of therapy, for example, Occupation Therapy. The Bridges Association of Occupational Therapist describes occupational therapy as having a unique philosophy that acknowledges the link between what people do on their health and well being and to their profession. Occupation means all the activities of person and takes enjoys values, and, more importantly, they say everything we do our daily occupations helped define our identity and roll. So if an individual is unable to do what's important to them and fulfill their role, the health well being consult for so occupational therapists work to address this by enabling individuals to find ways to do those activities that are important to them. I know that altered to therapy is Hydra 30. It's the use of water to assist on and alleviate symptoms. It was previously used in an extremely barbaric way, but in a modern day setting with the right controls and mechanisms has been reported to offer quite substantial relief to some patients. Very often, this is connected with massage each. Andi acupuncture. Increasingly, we're looking at alternatives to medication such as plants and herbs as ST John's Word, which is a perennial flowering herb. And these are very often ingested in place off pharmaceuticals. Andi are often used in combination with another alternative therapy, and that is diet on. That was being quite a lots of research into Domnitz and self help. For example, it's been shown that eating foods high in omega three fatty acids can reduce the symptoms off. Depression. On the final type of treatments we're going to look at is medication, which is the most common type of treatment is given by GPS hundreds psychologists. There are four main types drugs, darkness, crimes. There are unti psychotics used to control disturbing faults. I don t depressants to lift depression, mood stabilizers to control extremes of moods and tranquilizers or sleeping pills were chained to calm down or assist in sleeping. And, of course, it's fine lines determine medication and getting the strengths and doses and leave Brown's right in take some time. While strokes, of course, consists someone to function working. Maintaining a family life, etcetera they can be with types of drugs, particularly the prescribed for mental disorder, have quite devastating side effects. They can be addictive and difficult to withdraw from, and they can cause physical damage particularly obviously, the higher the dose and therefore this now a more prevailing school of thought that all medication has to be used with some caution. I'm looking at the lowest possible dose for the shortest possible time. Now. More done is have a look at some of the most common types of medication. Looking at what that provided its treatment full, What drugs are actually available? The brunch majors what they do and some of the most common side effects. And by most common, I'm thinking of the most prevalent side Effects are not those which would be deemed to be read, so having a look. Firstly, four more major problems mood stabilizers are prescribed some times referred to as anti Mannix and mood normalizes. Some of the most common include 50 of Combinator. It's and Let Him Sigh Trait, Help rates. Andi. I've listed the ground names for you to consider. And of course, what these medications intend to do is to normalize or even out mood swings. And some of the most common side effects for this type of medication include tremor, stomach thanks, passing a lot of you having a constant metallic taste in the mouth, a constant first on extremely dry now for depression. The drugs referred to US anti depressants on Do we have the drug group be traced sick? I'm teaching presence. And again, I listed the drugs available on the Runge names for you to consider Andi. What the strikes are intended to do is to improve mood in people were feeling low or depressed. Some of the most common side effects include drowsiness, constipation, dry mouth, blurred vision and weight gain for anxiety. Most commonly used RV beater blockers. Andi again, I listed the available drugs times the brand names, lower doses used to help treat symptoms off anxiety such as palpitations, sweating and shakiness. Because the more common use for these is heart conditions such as hypertension, high blood pressure and the most common side effects are fatigue on very extreme fatigue at cold extremities. Another treatment for anxiety is a group of drugs no, as the benzo dies, a Peens and often wrongly referred to so medical opinion would say as the minor, Trump says. And again, I listed someone drugs available and brand names. Of course, they have been subject of litigation drugs available, including Dies a pound of us Uh, branding such as that Librium on what they do is help calm down, cause sleepiness. They treat but not cure the symptoms of exam ity. The tension feeling shape, he sweating and difficulties and thinking straight. The most common side effects, of course. Drowsiness, dizziness, But of course, they are extremely addicted. Andi have until most recently be described quite high doses for very long periods of time, leading to very severe addiction for schizophrenia. There are the antipsychotic drugs on again, incorrectly referred to as major trunk cornices, and these book the dopamine, the chemical messenger in the brain, mainly involved with thinking, emotions, behavior ons, perception, those receptors to reduce the effects of too much of these and, if you like, correcting the imbalance in the most common side, effects include drowsiness movements, disorder on and other side effects, like shaking a pounds, feeling shaky on the eyes and tongue moving on the only general feeling and symptoms off restlessness. Another drug to treat schizophrenia is Khloe's API on the streets. Symptoms of schizophrenia. You have not done well on at least two other similar drugs, so have not responded or had bad side effects. A side effect. This can actually know a resistance to infection. So reducing the number of white blood cells there are now safeguards, such as the monitoring will be white blood cell counts every week for the 1st 18 weeks and then every fortnight, at least for us, long as cause the pain is taken on. Doctors who want to prescribe the drug have to register themselves. Their patients and dispensing pharmacists with a special monitoring service on scientifics include also drowsiness, constipation, hyper salivation. I'm type O attention, a low blood pressure and weight skin treatment for psychosis, a drugs known as anti psychotics and again, often incorrectly purchase. Major tranquilize is, and again I listed the drugs available and the bullet brand names, so the most common there include large back to on What they do is block some dopamine, the chemical messengers in the brain again mainly involved in thinking, emotions, behavior and perception receptors, reducing the effect and again correcting that imbalance. And some of the most common summit effects include drowsiness, movement to soldiers in the shaking of hands and feeling shaky. Constipation, driver waits, gain and blurred vision. Andi In this next section, we're going to have a look at very briefly at consents to treatments into faras it particularly related to treatment for mental disorder. Another two main situations we have to consider. The first situation is where the patient is not detained under mental health legislation. On the second situation is where the patient is properly detained under that legislation. So first of all, if the patient is not detained, the general rule is to seek consent where the patient has capacity, that is consent to all forms of treatments and where a person does not have the capacity, then we need to consider the Mental Capacity Act. That act explains that person lacks capacity in relation to a matter if, at the material time he is unable to make a decision for himself in relation to the matter because oven impairment off or disturbance in functioning off the mind or brain. And we have the basic tests that a person would be deemed unable to make a decision if they are unable to do one or more off the following things. Unable to understand the information relevant to the decision, unable to retain the information for long enough to be able to make a decision unable to use away at the information was part of the process of making a decision or unable to communicate decision by any possible method. And so looking at communication, which is obvious talking, perhaps for sign language but also taking into account all forms of physical communication, such as appropriately squeezing someone's hand. And, of course, the mental capacity axe allows planning in advance to refuse treatments, etcetera Andi. Everything is done in the person's best interests. In contrast, there are provisions within the Mental Health act was do what happens in relation to consent. When a patient is detained for these purposes, it's not looking so much at emergency sections which are excluded. So section 135 on 36 etcetera, or section five. Those exclusions are are covered under Section 56 and so full that detained patient Section 63 determines that certain treatments does not require consent. On that treatment is treatment, which is not covered by Section 57 or section 58 of the Act Andi. That treatment does not require patient's consent for any medical treatments given to him for the mental disorder from which is suffering. If the treatment is given by or under the direction off the approved finish in in charge off the treatments. So in practical terms, then a patient can be given medication, for example, for up to three months without that consent providing coursed, it falls within the provisos of Section 63. However, there are two sections which deal with consent to the question of obtaining a second opinion, and those are Section 57 treatment, which requires consent. Andi, a second opinion and Section 58 which requires consent or a second opinion on these sections, apply where the treatments required is not urgent or an emergency as defined under Section 62 which will look out in a moment, so Section 57 deals with treatment which requires both consent. ONDA. A second opinion on that treatment is surgical operations on your surgery effectively, but can't be other forms of treatment specified within the regulations. ANDI. Effectively under section 57 unless it's an emergency or urgent, we have to look at the fact that the patient needs to consent. Andi A. So that is a registered medical practitioner appointed within the criteria to meet the act, who is not. The responsible commission of the Rizwan or the person in charge of the treatment has certified that the patient is actually capable of understanding the nature, purpose and likely effects of the treatment that he's consented to and also that sold, certified in writing, that it's appropriate for the treatment to be given. So it's that appropriate treatment trust test we spoke about earlier and under section 57 3 the sold before reaching that opinion and making that certification needs to consult with two other persons who have been concerned with that patient's medical achievements of one of those needs to be a nurse. On the second was speak another person professionally concerned with the treatment. Who's neither a nurse nor a doctor on. Neither of those two people can be the Patients responsible commission if they have one or the approved mission in charge of patients treatment. So building in some safeguards for the patient and Section 58 deals with treatment, which requires consent or a second opinion. Andi, effectively the sort of treatment that would come within Section 58 would be medication given to a detained person where the medication being given for three months or more. Since first administration Andi, under Section 58 the patient has to either consents to the treatment Andi. This actually certification that ensures that the patient understands the nature purpose and likely effects off that treatments or alternatively, hey Sowed has confirmed that either the patient is incapable off consenting or that the patient is capable but doesn't consent. Andi that it is appropriate for the treatment to be given Andi Section 58 4 provides, as did section 57 3 that he sold must consult with two of the persons who have bean concerned with the patient's medical treatment at the first being a nurse. On the second, another person professionally concerned who is neither a nurse or doctor in again. Neither of those two persons could be the Patients responsible commission if they have one or the approved commission in charge. The patient's treatment Now the 2000 and seven act introduced a new section, section 58 a into the 1983 mental health on that's in relation to E. C. T. That controversial treatment that we've discussed earlier. Andi. Therefore, this section confirms that unless it's an emergency, E C T. And incidentally, any other specified types of treatment that that may be added cannot be given to a patient who has the capacity to consent unless that patient has actually consented. If the person does not have the capacity to consent, then the treatment can only be given if it is appropriate. Andi, if it would not conflict with an advance decision which the registered medical practitioner is satisfied is valid or decision made by an attorney, a deputy or the course protection Andi. Yet again, they're safe. Kant's for the sewed to consult with the two of the person's, just as we've seen in section at 57 58. Now we've mentioned the urgent or emergency treatment which I've referred to as being dealt with under Section 62 off the IT and Section 62 tells us that Section 57 58 don't apply to treatment, which is immediately necessary to save the patient's life, which not being irreversible is immediately necessary to prevent a serious deterioration of his condition or again not being irreversible off. This time, hazardous is immediately necessary to alleviate serious suffering by the patient, or finally which not being irreversible or hazardous is immediately necessary on represents the minimum interference necessary to prevent the patient from behaving violently or being a danger to himself or others On Section 62 3 clarifies that treatment is irreversible if it has unfavorable, irreversible physical or psychological consequences, and it's hazardous if it entails significant physical hazards. And it goes without saying that the whole question off consent to treatment on what may be provide to detained patients in the absence of treatment is complex and so circumstances relating to individual patients stroke clients needs to be considered carefully, and then this final section will look at nice guidelines. Nice are the National Institute for Health and clinical excellence who advise they were set up to reduce variation in the availability and quality of NHS treatments and care. So cold postcode lottery. They say their evidence based guidance and other products help resolve uncertainty about which medicines, treatments, procedures on devices represent the best quality care on which offer the best value for money for the NHS. Onda Nice perform a wide variety of functions, and just part of that role is clinical guidance, which has been described as systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. Andi in effects. The guidelines contain guidance dealing with the clarification of the appropriate standards of care and evidence based medicines. A nice say that their clinical guidelines are recommendations on the appropriate treatment and care off people with specific diseases and conditions within the NHS in England and Wales. Clinical guidelines are based on the best available evidence on guidelines help healthcare professionals in their work, but they do not replace their knowledge and skills so effectively. The guidelines contained clinical guidance with a view to improving the quality of health care and changing its process. Developing standards on helping patients make informed decisions. Andi. For each clinical guideline, there's a process which involves expertise from royal medical colleges and professional bodies and patient carer organizations in the drafting and development off the guidelines on this ample opportunity for full consultation with a view to reaching the best recommendations on the appropriate treatments and care, and each guideline is relation to a specific disease or condition on the idea is to help health professionals but not replace the knowledge and skills. Therefore, versions of guidelines published ASI full guideline, which contains all of the recommendations and all of the details. We then have the nice guideline, which presents the recommendations from the full version in a former suited to implementation by health professionals and NHS bodies. The Nice Pathway, which is an online tool for health and social care professionals, bringing together all the related guidance, quality standards in implementation tools on a topic in a set of interactive flow charts. And finally, there's Theo Understanding Nice Guidance, which is written in what has turned suitable language for people without specialist medical knowledge and the roll off. The nice confidence is summed up by the Medical Defence Union, which concludes that nice guidance. Six. Alongside the knowledge and skills have experienced health professionals. It is not the intention of nice guidance to replace the clinicians knowledge and skill, but rather to support it. There are a number of guidelines available in relation to mental illness and disorder, and these include eating disorders, self harm, violence, post traumatic stress disorder, depression O, C, D and B D. D and dementia. Bipolar schizophrenia, etcetera. On There are further governance on things like transcranial magnetic stimulation, fort severe depression and computerized cognitive behavior therapy in depression, Andi anxiety and finally, by way off example, off what's is contained in a nice gardens and what it may look like. I've extracted a section from one of the guidances in relation to bipolar disorder and in relation to the use off E C. T. Which we've discussed in this course. And this now concludes the course. Thank you.