What is the Definition of Mental Disorder?

Hello and welcome to this Data Lord training session. My name's stuff Barber on I'm from Law Hound Limited. I'm a retired solicitor and previously I was on the Law Society's Mental Health Review Tribunal panel. This session is going to examine what is the definition off mental disorder as defined by the Mental Health Act 1983. As now amended, I'd like to start by way of background looking at the original definition of mental disorder at Section 12 off the Mental Health Act 1983 as it WAAS enacted and effectively that definition created sub categories of mental disorder. We had severe mental impairment, which was defined as state of arrested or incomplete development of the mind, which included severe impairments of intelligence on social functioning. Andi was associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned. We had mental impairment which was defined as a state off arrested or incomplete developments of the mind not amounting to severe mental impairments, which included significant impairment of intelligence and social functioning on, was associated with abnormally aggressive or seriously a responsible conduct on the part of the person concerned. So In effect, we had mention impairment, which implied a lack of intelligence that didn't amount to severe mental impairment but nevertheless required or would respond to mental treatment On. Then we had severe mental impairments, which implied a lack of intelligence on social functioning associated with aggressive or seriously irresponsible conduct. So ultimately, we had severe mental impairment and mental impairment which related to people with learning disabilities, but only where that was associated with abnormally aggressive or seriously irresponsible conduct. We then had psychopathic disorder, which was defined as a persistent disorder or disability, whether all not including significant impairment of intelligence which resulted in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned. And finally we had mental illness. And rather surprisingly, the act didn't actually define mental illness because it is still one of the most common forms of mental disorder which people are dealt with under the act. So there was no actual legal definition. So following the enactment of the 1983 act, there was a focus more on what was not a mental disorder and eventually became a parent that having quite a complex definition off mental disorder meant that some disorders just didn't fit easily into any of the four categories of mental disorder on it led to exclusion from treatments because of the confusion. So that, in effect led us to the mental health 2007 which made various changes to the 1983 Mental Health Act, including to the definition of mental disorder on what the act did was effectively removed the separate definitions or sub categories in relation to mental disorder. So what we're left with on the current definition of mental disorder the purposes of the Mental Health Act is any disorder or disability off the mind. It's much broader, a much more all encompassing. So let's have a look about determining if someone has a mental disorder on that process. Of course, if someone is determined is suffering from mental disorder than they will fall within the Mental Health Act on may be liable if they meet the additional criteria, for example, for detention. I don't intend to go into that in this session, but I think it's important to bear it in mind. So how is the determination carried out now? Of course, there are various sections off the act But basically determining whether a person is suffering is, of course, carried out by a medical professional. And that's usually a registered medical practitioner, although there are certain sections off the act referred to its emergency sections whereby, for example, that initial determination might be carried out by a nurse. But that is only for a very short period of time, and at this point I'd like to introduce the Department of Health Code of Practice. So the Mental Health Act 1983 Let's have a just quick look at the purpose and legal status of the code of practice. The code itself confirms that it was devised to provide guidance to registered medical practitioners, doctors, if you like approved clinicians, managers and staff of hospitals and approved mental health professionals on how they should proceed when undertaking their duties under the act. In terms of legal status, it doesn't actually have a legal status. But the NHS guidelines make it very clear that if there are any departures from the code, then that must be clearly recorded on reasons given for any departure. And in fact, the code itself goes on to say that departures from the code could give rise to a legal challenge. Andi, called in reviewing any departure from the code, will scrutinize the reasons for the departure to ensure there is sufficiently convincing justification in circumstances. So going back to determining if a person has a mental disorder. There is guidance within the Department of Health Code, which indicates that relevant professionals should determine whether a patient has a disorder based on good clinical practice on accepted standards off. What constitutes a disorder or disability on what the guidance does do is to provide a non exhaustive list by way of example, of the types of disorders that could on That's not will. It's could for within the definition. And some of the examples given off mental disorder are effective disorders such as depression and bipolar disorder. Schizophrenia on delusional Disorders Neurotic stress related Andi so much perform disorders such as anxiety phobic disorders, obsessive compulsive disorders, post traumatic stress disorders on hyper con drill disorders, organic mental disorders such as dementia and delirium. However, there caused personality and behavioral changes caused by brain image or damage. However, that might be acquired. Various types of personality disorders, mental and behavioural disorders caused by psychoactive substance use subject to further clarification, which we'll discuss later on in this session eating disorders, non organic sleep disorders and nonorganic sexual disorders. Learning disabilities subject again to further clarification, which I'll discuss in a moment. Autistic spectrum disorders including Asperger s syndrome, again subject to further clarification on behavioral and emotional disorders of both Children and adolescence on the code goes on to give further guidance to those who are determining whether a person has a mental disorder or not providing very specific guidance about the need to take the individuals whole circumstances into account. And the code actually says that diagnosticians must always take into accounts the individual to avoid diagnosing or failing to diagnose mental disorder on the basis of preconceptions about people or failure to appreciate cultural on social differences. It goes on to say that what may be indicative of mental disorder in one person, given their backgrounds and individual circumstances maybe nothing of the sort in another person, and it goes on to determine that difference should not be confused with disorder, meaning that the code both recognizes and reinforces individuals may be simply that holding a wide variety of individual beliefs, values opinions on displaying on being involved with behaviors, which might seem unusual or even cause people alarm, distress or at danger. It clarifies, if you like that, just because an individual might be different, it doesn't mean to say that they're suffering from a mental disorder solely because of those beliefs or types of behavior. So that is, unless there are proper clinical grounds to believe that their symptoms or manifestations of a disability or disorder of the mind. Examples particularly given relate to an individual's political, religious or cultural beliefs, funnies and opinions or involvement or likely involvement in illegal, antisocial or immoral behavior on. Indeed, the code actually confirms that sexual orientation, as you may expect towards people off the same gender, is not a mental disorder for any purpose. So it's really core if i ng and drilling down and spelling out in black and white the kind of things that a diagnostician should not be confused about and, of course, very much reinforcing the question off equality. You may recall that when I was discussing the Department of Health Code of Practice on that non exhaustive list of examples of the types of disorder, which could fall within the definition off mental disorder. I mentioned at dependency on drugs in particular and said there were certain exceptions. I'd like to just go into that in a little bit. More details on drugs for these purposes could be taken to include solvents on similar substances with a psycho active effect and section one subsection three off. The act makes it clear that dependence on alcohol and or drugs is not considered to be a disorder or disability of the mind. The purpose is off the definition of mental disorder in the act itself. So this means, for example, there are no grounds under the act for detaining a person in hospital or using any other of the compulsory measures within the act on the basis off alcohol or drug dependence alone. However, we do need to clarify that, of course, alcohol and your drug dependence may be accompanied by or associated with a mental disorder which does fall within the definition off the Mental Health Act. So if someone meets the criteria of mental disorder within the act, it won't be a prohibition because they're also dependent on alcohol and or drugs and equally disorders or disabilities of the mind, which are related to the use and or dependence of alcohol, and our drugs are not excluded in themselves. So, for example, the withdrawal state with delirium or associate ID psychotic disorder, acute intoxication on organic mental disorders associated with prolonged use of drugs and or alcohol would be a mental disorder within the definition off the act. And so medical treatment for mental disorders under the act can include measures to address alcohol and your drug dependence if that's an appropriate part of treating the mental disorder, which is the primary focus off the treatments. And I'd like to look at learning disabilities again. When I discussed the Department of Health's code on that non exhaustive list of examples of the types of disorder that could fall within the definition of mental disorder, I mentioned both learning disabilities Andi autistic spectrum disorders and I said they were subject to further clarification. So let's start by looking at the definition of learning disability under Section one, subsection four off the act, which is a state of arrested or incomplete development off the mind, which includes significant impairment of intelligence on social functioning. So that means, in effect, learning disabilities and or autistic spectrum disorders, for example, are forms of mental disorder as defined within the act. However, effectively person with a learning disability whose disability is not associated with abnormally aggressive or seriously irresponsible conduct on their part won't be considered by reason. Is that disability to be suffering from a mental disorder for the purposes of certain provision within the act, Normally be deemed to require treatment in hospital for mental disorder for certain provisions and sections within that act. So just because you've got a learning disability and, in effect, a mental disorder under the act, it doesn't mean to say that that in itself is going to mean that you could be, for example, Compulsory admitted to hospital for treatment and Section three be subject to guardianship under Section seven on various other sections off the which are defined in Section two B on sections 17 e 50 and 53 I don't intend to go through those. But suffice to say it's those provisions which relate to mental disorders on compulsory measures such as detention. However, if you do have a learning disability, Andi is accompanied by abnormally aggressive or seriously irresponsible conduct on your part, then the person with the learning disability could be subject to those compulsory sections off. The acting could, for example, be detained Andi. It's also, of course, worth remembering that someone with a learning difficulty may well have a separate mental disorder, which means that they might meet the criteria in relation to compulsory measures such as detention. But that would be quite separate from the learning disability in itself if it's not accompanied by the abnormally aggressive or seriously irresponsible conduct on their part. So in general, having a mental disorder doesn't automatically mean that the provisions of the Mental Health Act will apply to you, for example, in relation to compulsory measures such as detention. Just because a person is suffering from mental disorder that is never going to be sufficient grounds for any compulsory measure which could be taken under the act, compulsory measures under the Mental Health Act can only be taken when you also meet specified criteria. So just by way of example, under Section three off the act for a person to be detained for treatment, they need to be suffering from a mental disorder off a nature or degree which makes it appropriate for that person to receive medical treatment in a hospital. Andi. It's necessary for the health or safety off the patient, all the protection of other persons that that individual should receive such treatment. Onda that the treatment can be provided unless they're detained. Under this section, three off the act and appropriate medical treatment is available for that person. So for a specific compulsory measures to be taken under the act, you have to have a mental disorder on Meet the other criteria as per my example of section three. And of course, it's really important to bear in mind that there are many forms of mental disorder which are unlikely to ever call for any compulsory measures in relation to the Mental Health Act. In the session, we've been discussing mental disorder as defined by the Mental Health Act. Of course, you also where it's equally important that you bear in mind mental disorder and, like qualities, mental incapacity on mental disability when you're delivering your services to clients and it's part of the S r. A requirements brings me neatly to the end of the definition off mental disorder. I'm Steph Barber, consultant at Law Hound. Thank you so much for working with me on this session on. I look forward to welcoming you on future mental health sessions.