SUMITTED BY

MISBAH ARIF SIDDIQUI (L)

HIRA MEHMOOD
HIRA FAROOQ
SUMITTED TO
DR. ZEENAT ISMAIL
COURSE NAME & NO.
ETHICS & PROFESSIONAL ISSUES IN MENTAL HEALTH (542)
YEAR AND SEMESTER
BS 3RD YEAR (6TH SEMESTER)
DATED
26TH AUGUST’2019
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 GUARDIANSHIP

Disability, physical or mental illness or drug abuse can limit a person’s ability to live an independent
life. In such cases a guardian may be appointed to take care of everyday tasks such as housing,
education, medical care, and house and clothing. Guardianship is the appointment of a guardian to
help and supervise patients in the community for their own welfare and to protect other people. A
guardian may be a local authority or someone else approved by a local authority (a ‘private
guardian’).

Purpose of Guardianship

 The purpose of guardianship is to enable patients to receive care outside hospital where it
cannot be provided without the use of compulsory powers. Such care may, or may not, include
specialist medical treatment for mental disorder.
 Guardianship provides an authoritative framework for working with a patient, with a
minimum of constraint, to achieve an independent life as possible within the community.
Where it is used it should be part of the persons overall care plan.
 The decision to use guardianship should be taken having considered the guiding principles.
Guardianship does not give anyone the right to treat the patient without their permission or to
consent to treatment on their behalf.

Power of a Guardian

Guardians have three specific powers as follows:

 They have the exclusive right to decide where a patient should live, taking precedence even
over an attorney or deputy appointed under the Mental Capacity Act 2005 (MCA). The Court
of Protection also lacks jurisdiction to determine a place of residence of a patient whilst that
patient is subject to guardianship and there is a residence requirement in effect1
 They can require the patient to attend for treatment, work, training or education at specific
times and places (but they cannot use force to take the patient there), and
 They can demand that a doctor, approved mental health professional (AMHP) or another
relevant person has access to the patient at the place where the patient lives.

Routes of Guardianship

A person may become subject to guardianship:

 On the basis of an application for guardianship under Part 2 of the Mental Health
Capacity Act, i.e. If the a 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 of an
impairment of, or a disturbance in the functioning of, the mind or brain.
 By being given a guardianship order by a court under Part 3 of the Mental Health
Capacity Act, i.e. if a person is unable to make a decision for himself. The court must
first be satisfied that the local authority or named person is willing to act as guardian.
 or because they are treated as if they were subject to one of the above on being transferred
from detention in hospital (see paragraph 19.137 onwards of the Mental Health Act 1985
amended 2007)

The powers of Guardians are the same in all cases.

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Assessment of Guardianship

An application for guardianship may be made, in relation to a person who is aged 16 or over and
who is not a ward of court, on the grounds that:
 the patient is suffering from mental disorder of a nature or degree which warrants their
reception into guardianship, and
 It is necessary, in the interests of the welfare of the patient or for the protection of other
persons, that the patient should be so received.
Guardianship is most likely to be appropriate where:

 The patient is thought to be likely to respond well to the authority and attention of a
Guardian and so be more willing to comply with necessary treatment and care for their
mental disorder

 There is a particular need for someone to have the authority to decide where the patient
should live or to insist that doctors, AMHPs or other people be given access to the patient.

As with applications for detention in hospital (see chapter 14), AMHPs and doctors making
recommendations should consider whether the objectives of the proposed application could be
achieved in another, less restrictive, way, without the use of guardianship.

Guardianship and Hospital Care

Guardianship does not restrict patients’ access to hospital services on an informal basis. Patients
who require treatment but do not need to be detained may be admitted informally in the same way
as any other patient. This applies both to physical and mental healthcare. Nor does guardianship
prevent the deprivation of a person’s liberty being authorized under the MCA, if the person needs
to be detained in a hospital in their best interests in order to receive care and treatment. A Doll
authorization or Court of Protection order can be sought so long as:
 it would not be inconsistent with the guardian’s decision about where the patient should live,
and
 The person does not object to being kept in hospital for treatment for mental disorder or to
receiving that treatment.

Otherwise, guardianship should not be used to require a patient to reside in a hospital except where
it is necessary for a very short time in order to provide shelter while accommodation in the
community is being arranged.

Patients who resist the authority of the guardian

If a patient consistently resists exercise by the guardian of any of their powers, it can normally be
concluded that guardianship is not the most appropriate form of care for that person, and the
guardianship should be discharged. The local authority should first consider whether a change of
guardian – or change in the person who, in practice, exercises the local authority’s powers as
guardian – might be appropriate instead

Guardianship orders - Section 37

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Guardianship may be used by courts as an alternative to hospital orders for offenders with mental
disorders where the criteria set out in the Act are met. The court must first be satisfied that the local
authority or named person is willing to act as guardian. In considering the appropriateness of the
patient being received into their guardianship, local authorities should be guided by the same
considerations as apply to applications for guardianship under part 2 of the Act.

Guardians no longer willing or able to act

Any change in the Guardian requires that the AMHP service is aware to ensure that an AMHP is
allocated to support the order. Private Guardians may resign the role by notifying the responsible
LSSA in writing. In this event, the local authority becomes the Guardian. The same applies if the
private Guardian dies. In either case, the local authority must take whatever steps are reasonably
practicable to inform the person it thinks is the patient’s nearest relative, unless the patient has
requested otherwise (or does not have a nearest relative). This must be done either before the transfer
or as soon as practicable afterwards. Information given to the Nearest Relative must be in writing,
but may be communicated by electronic means (e.g. e-mail) if the Nearest Relative agrees.

References:

 Mental Health Act 1983, section 26 – 30

 Mental Health Act Code of Practice 2015 Chapter 30 and 31
 Mental Health Act 1983: Code of Practice

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 INFORMED CONSENT

Informed consent ensures that a patient, client, and research participants are aware of all the
potential risks and costs involved in a treatment or procedure. Both the patient receiving treatment
and the client funding it needs to be aware of any possible harm that might occur.
For informed consent to be considered valid, the participant must be competent, and the consent
should be given voluntarily.
Elements of Informed Consent in Psychology Research

According to the American Psychological Association, researchers must do the following to obtain
informed consent from participants in psychology research:
 Inform the participants about the purpose of the research, the anticipated duration of the
study and the procedures that will be used.
 Participants must be told that they have the right to decline to participate in the study. They
also must know that they can withdraw from the experiment at any time.
 Participants must be made aware of any possible consequences of declining or withdrawing
from the study.
 Participants must be made aware of any potential consequences of participating in the study.
This includes any potential risks, adverse effects or discomfort that may occur.
 Participants must be made aware of the potential benefits of the research.
 Any limitations on confidentiality must be disclosed.
 Any incentives for participation should be clearly identified.
 Participants must be told who they can contact if they have questions about the research or
the rights of participants in the study.

Is Informed Consent Always Necessary?

There are a few instances where the APA suggests that psychologists may do without informed
consent. Such cases include when there is a reasonable
Assumption that the research would not cause any distress or harm. Another instance is when a
study takes place as part of the normal classroom curriculum or educational practices.
Studies that involve anonymous questionnaires, archival data or naturalistic observations do not
require informed consent as long as the research presents no risk to the participants. Even in cases
where informed consent is not needed, the participants can still withdraw at any time.
Inform consent process
As a researcher, it is your responsibility to educate the participants about the study purpose, the
procedures, the risks and benefits, and obtain their consent before involving them in your research,
and keep them informed. While a consent document that gives this information, and more, is a vital
part of the process, the opportunity to discuss any questions or concerns with a knowledgeable
research team member is also necessary. This is the "informed consent process".

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Background

The APA issued the first Ethical Standards of Psychologists text in 1953 (APA, 1953), shortly after
the publication of the Nuremberg Code, in an effort to provide an ethical standard governing each
professional service performed by Ph.D. level psychologists. The APA has revised this code 9
times as ethical dilemmas in the field have evolved. The Ethical Principles of Psychologists and
Code of Conduct document was published on December 1, 1992 and represented a more
comprehensive and inclusive set of guidelines than had previously existed (APA, 1992). This
document was amended in 2010 (APA, 2010). The APA has established a number of ethical
standards to guide the use of human participants in psychological research and stated in standard 8,
section 2.
The APA ethics code continues on to describe ethical issues as they relate to specific circumstances
of informed consent, including treatment research, working with subordinate or vulnerable
participants, the use of deception, offering incentives, and general circumstances that would allow
for researchers to forego informed consent (APA, 2010). More recently, the American Psychiatric
Association published a task force report detailing 12 recommendations for ethical research that
also recognized the importance of obtaining informed consent (American Psychiatric Association’s
Task Force on Research Ethics, 2006).
Reasons why it is necessary

Beyond the need to conform to organizational guidelines, researchers gather informed consent for a
wide variety of reasons. First, as history demonstrates, the protection of each participant’s human
rights and personal safety must be of primary importance. Similarly, each participant’s autonomy
must be respected. In the area of criminal diversion, an informed participant understands that
participation is not necessary to receive services or avoid additional punitive action. Second, the
public must feel that researchers can be trusted. Without public trust, it would not be possible to
recruit participants in any practical manner. Third, informed consent protects researchers and
institutions from legal consequences. Finally, participant miscomprehension has the potential to
introduce unanticipated variability and spurious effects into a study. For each of these reasons, the
development of methods to optimize a potential participant’s understanding of the procedures to
which they may consent would be of great benefit to both the field of social science research as
well as those responsible for conducting it.

References

 https://www.verywellmind.com/what-is-informed-consent-
2795276#targetText=Informed%20Consent%20in%20Psychology&targetText=Informed%
20consent%20ensures%20that%20a,possible%20harm%20that%20might%20occur.
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399711/
 https://research.uncc.edu/departments/office-research-compliance-orc/human-
subjects/informed-consent