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It is important for nurses to recognise when patients are anxious and/or distressed and try to calm the patient to the best of their ability. It is also a requirement of the NMC for nurses to act compassionately and politely towards patients when they are feeling vulnerable to ensure that the patient feels as comfortable as possible.

Under the NMC Code of Conduct nurses are required to “accurately assess signs of normal or worsening physical and mental health in the person receiving care.” This means that it is the nurse’s responsibility to ensure that Jonathan is assessed appropriately before his operation, so the appropriate members of staff can decide whether or not he has the capability to consent to the operation.

It is also the responsibility to “make a timely and appropriate referral to another practitioner when it is in the best interests of the individual needing any action, care or treatment.” It is important for Jonathan's mental and physical health that he is assessed as soon as possible to prevent his physical condition from worsening and to prevent him from becoming more distressed and causing himself any harm.

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Jonathan is in hospital and is mentally unstable and unable to make decisions for himself, which means he has been put under section 3 of the Mental Health Act 1983. The nurse in this situation would have to respect the decision of the Jonathan, however as there is a legal side to this scenario the nurse must also respect that. As Jonathan is mentally unstable, the nurse needs to try and explain to him what is going on so he has the level of understand that the nurses around him do. The most important role of the nurse in this situation would be to talk to him and make sure he understand what is happening and why it is happening. He needs to be calmed down, and the nurse needs to try and get the level of trust so he can know what they are doing it for the best interest of him and not for the hospital.

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The values of a Mental health Nurse are mainly, treating people equally, it is about being honest with your patient and not judging them on there ethnicity or religion. in order to get on with your patient there must be that level of trust and that can come through being honest with one another and understanding that everyone isn't the same.
Professional Values
It is important to understand the difference between professional values and normal everyday values. Professional values in nursing are different as they all need to take into account the NMC Code of Conduct (2015), they need to know the different relationships they can have with patients and colleagues and the borderlines.
Values as a Mental Health Nurse
Values of a Mental Health Nurse as again different as you are looking at a whole new perspective of nursing.  It is about looking and understand the recovery that your patients will be going through, its a life long learning role, and it is about learning to work in partnership with a range of different companies.
http://www.wales.nhs.uk/sites3/documents/816/Mental%20Health%20Act%201983%20Code%20of%20Practice%20for%20Wales.pdf

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The Act has three main effects:

1. You can seek justice in a British court

It incorporates the rights set out in the European Convention on Human Rights (ECHR) into domestic British law. This means that if your human rights have been breached, you can take your case to a British court rather than having to seek justice from the European Court of Human Rights in Strasbourg, France.

2. Public bodies must respect your rights

It requires all public bodies (like courts, police, local authorities, hospitals and publicly funded schools) and other bodies carrying out public functions to respect and protect your human rights.

3. New laws are compatible with Convention rights

In practice it means that Parliament will nearly always make sure that new laws are compatible with the rights set out in the European Convention on Human Rights (although ultimately Parliament is sovereign and can pass laws which are incompatible). The courts will also, where possible, interpret laws in a way which is compatible with Convention rights.

Find out more about human rights and how they play a part in our everyday lives: what are human rights?

Download a full copy of the Human Rights Act.

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The Human Rights Act allows you to defend your rights in UK courts and ensures that public organisations respect and protect your human rights.

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Safeguarding adults provides additional actions for patients who are less able to protect themselves from harm or abuse. Safeguarding covers the prevention of harm but also covers the multi-agency responses when harm and abuse has already happened. Safeguarding adults is an integral part of patient care and is required by professional regulators, service regulators and is supported in law. Duties to empower people to make decisions and be in control of their care and treatment is underpinned by the Human Rights Act 1998, the Equality Act 2010 and the Mental Capacity Act 2005 (Manson, 2011).

Safeguarding adults are shaped by six principles:

1.    Empowerment – the presumption of person led decisions and consent

2.    Protection – the support and representation for those in greatest need

3.    Prevention – the primary objective is the prevention of harm and abuse

4.    Proportionality – the least intrusive response appropriate to the risk presented

5.    Partnerships – local solutions through services in the community

6.    Accountability – transparency in delivering safeguarding
(Manson, 2011)

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Safeguarding Adults: The role of health practitioners

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Books:
Britain, G. and Constituti, D.F. (2007) Mental capacity act 2005 code of practice: 2007. London: Stationery Office Books.
Websites:
Choices, N. (2016) What is the mental capacity act? Available at: http://www.nhs.uk/conditions/social-care-and-support-guide/pages/mental-capacity.aspx (Accessed: 4 November 2016).
Quotes:
Britain, G. and Constituti, D.F. (2007) Mental capacity act 2005 code of practice: 2007. London: Stationery Office Books.

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This is an act that applies to service users over the age of 16, who suffer from a lack of mental capacity affecting their decision making.(Choices 2016). Section 2(1) of the mental capacity act describes lack of capacity as "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.". (Britain and Constituti, 2007).
This can mean that individuals with dementia, a learning disability, suffered from a stroke, suffered from brain damage etc. (Britain and Constituti, 2007). It also can mean that the individual in question could have capacity to make certain decisions such as what house to live in whereas they might not have the capacity to say whether the house is sheltered accommodation.

The issue raised with this act and this scenario is that as a nurse do we over ride person centered care for the health benefits for service user.

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Professional standards of practice and behaviour for nurses, midwives and nursing associates. All standards apply within your professional scope of practice.

Contents:

About us

The Nursing and Midwifery Council exists to protect the public. We do this by making sure that only those who meet our requirements are allowed to practise as a nurse or midwife in the UK, or a nursing associate in England. We take action if concerns are raised about whether a nurse, midwife or nursing associate is fit to practise.

It is against the law to claim to be, or to practise as, a nurse or midwife in the UK, or as a nursing associate in England, if you are not on the relevant part of our register.

It is also a criminal offence for anyone who, with intent to deceive, causes or permits someone else to falsely represent them as being on the register, or makes a false representation about them being on the NMC register.

Publication date: 29 January 2015
Effective from: 31 March 2015
Updated to reflect the regulation of nursing associates: 10 October 2018

A note on this version of the Code

All regulators review their Codes from time to time to make sure they continue to reflect public expectations. This new version of the Code is substantially similar to the 2015 version, but it has been updated to reflect our new responsibilities for the regulation of nursing associates. In joining the register, nursing associates will uphold the Code.

The current versions of our Code, standards and guidance can always be found on our website. Those on our register should make sure they are using the most up to date version of the Code.

For more information about the Code, please visit: www.nmc.org.uk/code.

Introduction

The Code contains the professional standards that registered nurses, midwives and nursing associates ¹ must uphold. Nurses, midwives and nursing associates must act in line with the Code, whether they are providing direct care to individuals, groups or communities or bringing their professional knowledge to bear on nursing ² and midwifery practice in other roles, such as leadership, education, or research. The values and principles set out in the Code can be applied in a range of different practice settings, but they are not negotiable or discretionary.

Our role is to set the standards in the Code, but these are not just our standards. They are the standards that patients and members of the public tell us they expect from health professionals. They are the standards shown every day by those on our register.

When joining our register, and then renewing their registration, nurses, midwives and nursing associates commit to upholding these standards. This commitment to professional standards is fundamental to being part of a profession. We can take action if those on our register fail to uphold the Code. In serious cases, this can include removing them from the register.

The Code sets out common standards of conduct and behaviour for those on our register. This provides a clear, consistent and positive message to patients, service users and colleagues about what they can expect of those who provide nursing or midwifery care.

The professions we regulate have different knowledge and skills, set out in three distinct standards of proficiency. They can work in diverse contexts and have different levels of autonomy and responsibility. However, all of the professions we regulate exercise professional judgement and are accountable for their work.

Nurses, midwives and nursing associates uphold the Code within the limits of their competence. This means, for example, that while a nurse and nursing associate will play different roles in an aspect of care, they will both uphold the standards in the Code within the contribution they make to overall care. The professional commitment to work within one's competence is a key underpinning principle of the Code (see section 13) which, given the significance of its impact on public protection, should be upheld at all times.

In addition, nurses, midwives and nursing associates are expected to work within the limits of their competence, which may extend beyond the standards they demonstrated in order to join the register.

The Code should be useful for everyone who cares about good nursing and midwifery.

Patients and service users, and those who care for them, can use it to provide feedback to nurses, midwives and nursing associates about the care they receive.

Those on our register can use it to promote safe and effective practice in their place of work.

Employer organisations should support their staff in upholding the standards in their professional Code as part of providing the quality and safety expected by service users and regulators.

Educators can use the Code to help students understand what it means to be a registered professional and how keeping to the Code helps to achieve that.

For the many committed and expert practitioners on our register, this Code should be seen as a way of reinforcing professionalism. Through revalidation, nurses, midwives and nursing associates provide evidence of their continued ability to practise safely and effectively. The Code is central to the revalidation process as a focus for professional reflection. This gives the Code significance in the professional life of those on our register, and raises its status and importance for employers.

The Code contains a series of statements that taken together signify what good practice by nurses, midwives and nursing associates looks like. It puts the interests of patients and service users first, is safe and effective, and promotes trust through professionalism.
1 Anyone practising as a registered nurse or midwife in the UK, or a nursing associate in England, has to be registered with us. The nursing associate role is being used only in England.
² We have used the phrase 'nursing' in this document to apply to the work of nurses and nursing associates. Nursing associates are a distinct profession with their own part of our register, but they are part of the nursing team.

Prioritise people

You put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.

1 Treat people as individuals and uphold their dignity

To achieve this, you must:

1.1 treat people with kindness, respect and compassion

1.2 make sure you deliver the fundamentals of care effectively

1.3 avoid making assumptions and recognise diversity and individual choice

1.4 make sure that any treatment, assistance or care for which you are responsible is delivered without undue delay

1.5 respect and uphold people's human rights
The fundamentals of care include, but are not limited to, nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions. It includes making sure that those receiving care have adequate access to nutrition and hydration, and making sure that you provide help to those who are not able to feed themselves or drink fluid unaided.
2 Listen to people and respond to their preferences and concerns

To achieve this, you must:

2.1 work in partnership with people to make sure you deliver care effectively

2.2 recognise and respect the contribution that people can make to their own health and wellbeing

2.3 encourage and empower people to share decisions about their treatment and care

2.4 respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care

2.5 respect, support and document a person's right to accept or refuse care and treatment

2.6 recognise when people are anxious or in distress and respond compassionately and politely

3 Make sure that people's physical, social and psychological needs are assessed and responded to

To achieve this, you must:

3.1 pay special attention to promoting wellbeing, preventing ill health and meeting the changing health and care needs of people during all life stages

3.2 recognise and respond compassionately to the needs of those who are in the last few days and hours of life

3.3 act in partnership with those receiving care, helping them to access relevant health and social care, information and support when they need it

3.4 act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care

4 Act in the best interests of people at all times

To achieve this, you must:

4.1 balance the need to act in the best interests of people at all times with the requirement to respect a person's right to accept or refuse treatment

4.2 make sure that you get properly informed consent and document it before carrying out any action

4.3 keep to all relevant laws about mental capacity that apply in the country in which you are practising, and make sure that the rights and best interests of those who lack capacity are still at the centre of the decision-making process

4.4 tell colleagues, your manager and the person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person's care (see the note below)
You can only make a 'conscientious objection' in limited circumstances. For more information, please visit our website at www.nmc.org.uk/standards/code/conscientious-objection-by-nurses-and-midwives/
5 Respect people's right to privacy and confidentiality

As a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately.

To achieve this, you must:

5.1 respect a person's right to privacy in all aspects of their care

5.2 make sure that people are informed about how and why information is used and shared by those who will be providing care

5.3 respect that a person's right to privacy and confidentiality continues after they have died

5.4 share necessary information with other health and care professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality

5.5 share with people, their families and their carers, as far as the law allows, the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand

Practise effectively

You assess need and deliver or advise on treatment, or give help (including preventative or rehabilitative care) without too much delay and to the best of your abilities, on the basis of the best evidence available and best practice. You communicate effectively, keeping clear and accurate records and sharing skills, knowledge and experience where appropriate. You reflect and act on any feedback you receive to improve your practice.

6 Always practise in line with the best available evidence

To achieve this, you must:

6.1 make sure that any information or advice given is evidence-based, including information relating to using any health and care products or services

6.2 maintain the knowledge and skills you need for safe and effective practice

7 Communicate clearly

To achieve this, you must:

7.1 use terms that people in your care, colleagues and the public can understand

7.2 take reasonable steps to meet people's language and communication needs, providing, wherever possible, assistance to those who need help to communicate their own or other people's needs

7.3 use a range of verbal and non-verbal communication methods, and consider cultural sensitivities, to better understand and respond to people's personal and health needs

7.4 check people's understanding from time to time to keep misunderstanding or mistakes to a minimum

7.5 be able to communicate clearly and effectively in English

8 Work cooperatively

To achieve this, you must:

8.1 respect the skills, expertise and contributions of your colleagues, referring matters to them when appropriate

8.2 maintain effective communication with colleagues

8.3 keep colleagues informed when you are sharing the care of individuals with other health and care professionals and staff

8.4 work with colleagues to evaluate the quality of your work and that of the team

8.5 work with colleagues to preserve the safety of those receiving care

8.6 share information to identify and reduce risk

8.7 be supportive of colleagues who are encountering health or performance problems. However, this support must never compromise or be at the expense of patient or public safety

9 Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues

To achieve this, you must:

9.1 provide honest, accurate and constructive feedback to colleagues

9.2 gather and reflect on feedback from a variety of sources, using it to improve your practice and performance

9.3 deal with differences of professional opinion with colleagues by discussion and informed debate, respecting their views and opinions and behaving in a professional way at all times

9.4 support students' and colleagues' learning to help them develop their professional competence and confidence

10 Keep clear and accurate records relevant to your practice

This applies to the records that are relevant to your scope of practice. It includes but is not limited to patient records.

To achieve this, you must:

10.1 complete all records at the time or as soon as possible after an event, recording if the notes are written some time after the event

10.2 identify any risks or problems that have arisen and the steps taken to deal with them, so that colleagues who use the records have all the information they need

10.3 complete all records accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements

10.4 attribute any entries you make in any paper or electronic records to yourself, making sure they are clearly written, dated and timed, and do not include unnecessary abbreviations, jargon or speculation

10.5 take all steps to make sure that all records are kept securely

10.6 collect, treat and store all data and research findings appropriately

11 Be accountable for your decisions to delegate tasks and duties to other people

To achieve this, you must:

11.1 only delegate tasks and duties that are within the other person's scope of competence, making sure that they fully understand your instructions

11.2 make sure that everyone you delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care

11.3 confirm that the outcome of any task you have delegated to someone else meets the required standard

12 Have in place an indemnity arrangement which provides appropriate cover for any practice you take on as a nurse, midwife or nursing associate in the United Kingdom

To achieve this, you must:

12.1 make sure that you have an appropriate indemnity arrangement in place relevant to your scope of practice

For more information, please visit: www.nmc.org.uk/indemnity

Preserve safety

You make sure that patient and public safety is not affected. You work within the limits of your competence, exercising your professional 'duty of candour' and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate.

13 Recognise and work within the limits of your competence

To achieve this, you must, as appropriate:

13.1 accurately identify, observe and assess signs of normal or worsening physical and mental health in the person receiving care

13.2 make a timely referral to another practitioner when any action, care or treatment is required

13.3 ask for help from a suitably qualified and experienced professional to carry out any action or procedure that is beyond the limits of your competence

13.4 take account of your own personal safety as well as the safety of people in your care

13.5 complete the necessary training before carrying out a new role

14 Be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place

To achieve this, you must:

14.1 act immediately to put right the situation if someone has suffered actual harm for any reason or an incident has happened which had the potential for harm

14.2 explain fully and promptly what has happened, including the likely effects, and apologise to the person affected and, where appropriate, their advocate, family or carers

14.3 document all these events formally and take further action (escalate) if appropriate so they can be dealt with quickly
The professional duty of candour is about openness and honesty when things go wrong. "Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress." Joint statement from the Chief Executives of statutory regulators of healthcare professionals.
15 Always offer help if an emergency arises in your practice setting or anywhere else

To achieve this, you must:

15.1 only act in an emergency within the limits of your knowledge and competence

15.2 arrange, wherever possible, for emergency care to be accessed and provided promptly

15.3 take account of your own safety, the safety of others and the availability of other options for providing care

16 Act without delay if you believe that there is a risk to patient safety or public protection

To achieve this, you must:

16.1 raise and, if necessary, escalate any concerns you may have about patient or public safety, or the level of care people are receiving in your workplace or any other health and care setting and use the channels available to you in line with our guidance and your local working practices

16.2 raise your concerns immediately if you are being asked to practise beyond your role, experience and training

16.3 tell someone in authority at the first reasonable opportunity if you experience problems that may prevent you working within the Code or other national standards, taking prompt action to tackle the causes of concern if you can

16.4 acknowledge and act on all concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so

16.5 not obstruct, intimidate, victimise or in any way hinder a colleague, member of staff, person you care for or member of the public who wants to raise a concern

16.6 protect anyone you have management responsibility for from any harm, detriment, victimisation or unwarranted treatment after a concern is raised

For more information, please visit our website at www.nmc.org.uk/raisingconcerns.

17 Raise concerns immediately if you believe a person is vulnerable or at risk and needs extra support and protection

To achieve this, you must:

17.1 take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse

17.2 share information if you believe someone may be at risk of harm, in line with the laws relating to the disclosure of information

17.3 have knowledge of and keep to the relevant laws and policies about protecting and caring for vulnerable people

18 Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations

To achieve this, you must:

18.1 prescribe, advise on, or provide medicines or treatment, including repeat prescriptions (only if you are suitably qualified) if you have enough knowledge of that person's health and are satisfied that the medicines or treatment serve that person's health needs

18.2 keep to appropriate guidelines when giving advice on using controlled drugs and recording the prescribing, supply, dispensing or administration of controlled drugs

18.3 make sure that the care or treatment you advise on, prescribe, supply, dispense or administer for each person is compatible with any other care or treatment they are receiving, including (where possible) over-the-counter medicines

18.4 take all steps to keep medicines stored securely

18.5 wherever possible, avoid prescribing for yourself or for anyone with whom you have a close personal relationship

Prescribing is not within the scope of practice of everyone on our register. Nursing associates don't prescribe, but they may supply, dispense and administer medicines. Nurses and midwives who have successfully completed a further qualification in prescribing and recorded it on our register are the only people on our register that can prescribe.

For more information, please visit: www.nmc.org.uk/standards

19 Be aware of, and reduce as far as possible, any potential for harm associated with your practice

To achieve this, you must:

19.1 take measures to reduce as far as possible, the likelihood of mistakes, near misses, harm and the effect of harm if it takes place

19.2 take account of current evidence, knowledge and developments in reducing mistakes and the effect of them and the impact of human factors and system failures (see the note below)

19.3 keep to and promote recommended practice in relation to controlling and preventing infection

19.4 take all reasonable personal precautions necessary to avoid any potential health risks to colleagues, people receiving care and the public
Human factors refer to environmental, organisational and job factors, and human and individual characteristics, which influence behaviour at work in a way which can affect health and safety - Health and Safety Executive. You can find more information at www.hse.gov.uk
Promote professionalism and trust
20 Uphold the reputation of your profession at all times
You uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code. You should be a model of integrity and leadership for others to aspire to. This should lead to trust and confidence in the profession from patients, people receiving care, other health and care professionals and the public.

To achieve this, you must:

20.1 keep to and uphold the standards and values set out in the Code

20.2 act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment

20.3 be aware at all times of how your behaviour can affect and influence the behaviour of other people

20.4 keep to the laws of the country in which you are practising

20.5 treat people in a way that does not take advantage of their vulnerability or cause them upset or distress

20.6 stay objective and have clear professional boundaries at all times with people in your care (including those who have been in your care in the past), their families and carers

20.7 make sure you do not express your personal beliefs (including political, religious or moral beliefs) to people in an inappropriate way

20.8 act as a role model of professional behaviour for students and newly qualified nurses, midwives and nursing associates to aspire to

20.9 maintain the level of health you need to carry out your professional role

20.10 use all forms of spoken, written and digital communication (including social media and networking sites) responsibly, respecting the right to privacy of others at all times

For more guidance on using social media and networking sites, please visit: www.nmc.org.uk/standards

21 Uphold your position as a registered nurse, midwife or nursing associate

To achieve this, you must:

21.1 refuse all but the most trivial gifts, favours or hospitality as accepting them could be interpreted as an attempt to gain preferential treatment

21.2 never ask for or accept loans from anyone in your care or anyone close to them

21.3 act with honesty and integrity in any financial dealings you have with everyone you have a professional relationship with, including people in your care

21.4 make sure that any advertisements, publications or published material you produce or have produced for your professional services are accurate, responsible, ethical, do not mislead or exploit vulnerabilities and accurately reflect your relevant skills, experience and qualifications

21.5 never use your status as a registered professional to promote causes that are not related to health

21.6 cooperate with the media only when it is appropriate to do so, and then always protecting the confidentiality and dignity of people receiving treatment or care

22 Fulfil all registration requirements

To achieve this, you must:

22.1 meet any reasonable requests so we can oversee the registration process

22.2 keep to our prescribed hours of practice and carry out continuing professional development activities

22.3 keep your knowledge and skills up to date, taking part in appropriate and regular learning and professional development activities that aim to maintain and develop your competence and improve your performance

For more information, please visit: www.nmc.org.uk/standards

23 Cooperate with all investigations and audits

This includes investigations or audits either against you or relating to others, whether individuals or organisations. It also includes cooperating with requests to act as a witness in any hearing that forms part of an investigation, even after you have left the register.

To achieve this, you must:

23.1 cooperate with any audits of training records, registration records or other relevant audits that we may want to carry out to make sure you are still fit to practise

23.2 tell both us and any employers as soon as you can about any caution or charge against you, or if you have received a conditional discharge in relation to, or have been found guilty of, a criminal offence (other than a protected caution or conviction)

23.3 tell any employers you work for if you have had your practice restricted or had any other conditions imposed on you by us or any other relevant body.

23.4 tell us and your employers at the first reasonable opportunity if you are or have been disciplined by any regulatory or licensing organisation, including those who operate outside of the professional health and care environment
When telling your employers, this includes telling (i) any person, body or organisation you are employed by, or intend to be employed by, as a nurse, midwife or nursing associate; and (ii) any person, body or organisation with whom you have an arrangement to provide services as a nurse, midwife or nursing associate. For more information, please visit our website at www.nmc.org.uk
23.5 give your NMC Pin when any reasonable request for it is made

24 Respond to any complaints made against you professionally

To achieve this, you must:

24.1 never allow someone's complaint to affect the care that is provided to them

24.2 use all complaints as a form of feedback and an opportunity for reflection and learning to improve practice

25 Provide leadership to make sure people's wellbeing is protected and to improve their experiences of the health and care system

To achieve this, you must:

25.1 identify priorities, manage time, staff and resources effectively and deal with risk to make sure that the quality of care or service you deliver is maintained and improved, putting the needs of those receiving care or services first
Throughout their career, all our registrants will have opportunities to demonstrate leadership qualities, regardless of whether or not they occupy formal leadership positions.
25.2 support any staff you may be responsible for to follow the Code at all times. They must have the knowledge, skills and competence for safe practice; and understand how to raise any concerns linked to any circumstances where the Code has, or could be, broken

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Read the NMC Code, code of conduct for nurses and midwives, online

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All adults are presumed to have sufficient capacity to decide on their own medical treatment, unless there is significant evidence to suggest otherwise.

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Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination.
This must be done on the basis of an explanation by a clinician.

Consent from a patient is needed regardless of the procedure, whether it's a physical examination or something else.

The principle of consent is an important part of medical ethics and international human rights law.

Defining consent

For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision.

The meaning of these terms are:

voluntary - the decision to either consent or not to consent to treatment must be made by the person, and must not be influenced by pressure from medical staff, friends or family

informed - the person must be given all of the information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead

capacity - the person must be capable of giving consent, which means they understand the information given to them and can use it to make an informed decision

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected.

This is still the case even if refusing treatment would result in their death, or the death of their unborn child.

If a person does not have the capacity to make a decision about their treatment and they have not appointed a lasting power of attorney (LPA), the healthcare professionals treating them can go ahead and give treatment if they believe it's in the person's best interests.

But clinicians must take reasonable steps to discuss the situation with the person's friends or relatives before making these decisions.

Read more about assessing the capacity to consent, which explains what someone can do if they know their capacity to consent may be affected in the future.

How consent is given

Consent can be given:

verbally - for example, a person saying they're happy to have an X-ray

in writing - for example, signing a consent form for surgery

Someone could also give non-verbal consent, as long as they understand the treatment or examination about to take place - for example, holding out an arm for a blood test.

Consent should be given to the healthcare professional responsible for the person's treatment.

This could be a:

nurse arranging a blood test

GP prescribing new medication

surgeon planning an operation

If someone's going to have a major procedure, such as an operation, their consent should be secured well in advance so they have plenty of time to understand the procedure and ask questions.

If they change their mind at any point before the procedure, they're entitled to withdraw their previous consent.

Consent from children and young people

If they're able to, consent is usually given by patients themselves.

But someone with parental responsibility may need to give consent for a child up to the age of 16 to have treatment.
Find out more about how the rules of consent apply to children and young people

When consent is not needed

There are some exceptions when treatment may be able to go ahead without the person's consent, even if they're capable of giving their permission.

It may not be necessary to obtain consent if a person:

needs emergency treatment to save their life, but they're incapacitated (for example, they're unconscious) - the reasons why treatment was necessary should be fully explained once they have recovered

immediately needs an additional emergency procedure during an operation - there has to be a clear medical reason why it would be unsafe to wait to obtain consent

with a severe mental health condition, such as schizophrenia, bipolar disorder or dementia, lacks the capacity to consent to the treatment of their mental health (under the Mental Health Act) - in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental health condition

needs hospital treatment for a severe mental health condition, but self-harmed or attempted suicide while competent and is refusing treatment (under the Mental Health Act) - the person's nearest relative or an approved social worker must make an application for the person to be forcibly kept in hospital, and 2 doctors must assess the person's condition

is severely ill and living in unhygienic conditions (under the National Assistance Act 1948) - a person who's severely ill or infirm and living in unsanitary conditions can be taken to a place of care without their consent

Consent and life support

A person may be being kept alive with supportive treatments, such as lung ventilation, without having made an advance decision, which outlines the care they'd refuse to receive.

In these cases, a decision about continuing or stopping treatment needs to be made based on what that person's best interests are believed to be.

To help reach a decision, healthcare professionals should discuss the issue with the relatives and friends of the person receiving the treatment.

They should consider:

what the person's quality of life will be if treatment is continued

how long the person may live if treatment is continued

whether there's any chance of the person recovering

Treatment can be stopped if there's an agreement that continuing treatment is not in the person's best interests.

The case will be referred to the courts before further action is taken if:

an agreement cannot be reached

a decision has to be made on whether to stop treatment for someone who's been in a state of impaired consciousness for a long time (usually at least 12 months)

It's important to note the difference between stopping a person's life support and taking a deliberate action to make them die.

For example, injecting a lethal medicine would be illegal.

Complaints

If you believe you have received treatment you did not consent to, you can make an official complaint.
Find out more about how to make a complaint

Page last reviewed: 08 December 2022
Next review due: 08 December 2025

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Find out what consent is, how it can be given, when it's needed, as well as situations when it's not needed.

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404 - Page Not Found | Mind, the mental health charity - help for mental health problems

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The Mental Health Act 1983

If you have severe mental illness, you might be held under the Mental Health Act. This is sometimes called 'sectioning'. We explain why you may be detained, and what rights you have.
***** New emergency coronavirus legislation has been introduced. It means that there are some temporary changes to some of the information included below. You can read about the changes by clicking here. *****

Overview

The Mental Health Act says when you can be detained in hospital and treated against your wishes.

You can be detained if professionals think your mental health puts you or others at risk, and you need to be in hospital.

If you are detained, NHS staff may be able to give you treatment, even if you don't want it.

There are different sections of the Mental Health Act. These are used for different reasons.

When you are detained, you have the right to appeal, and the right to get help from an independent advocate.

About the Mental Health Act

The Mental Health Act says when you can be taken to hospital, kept there, and treated against your wishes. This can only happen if you have a mental disorder that puts you, or others, at risk.

You should only be detained under the Mental Health Act if there are no other ways to keep you, or others, safe.

Being detained under the Mental Health Act is sometimes called being 'sectioned', because the law has different sections.

Your rights under the Mental Health Act depend on which section you are detained under.

This page does not cover criminal law sections. Click the links below to find our more about each section:

What is a mental disorder?

You can only be detained if you have a 'mental disorder'. The Mental Health Act does not say exactly what can be classed as a 'mental disorder'. So, when they're using the Mental Health Act, health professionals will decide if someone's mental health meets this definition.

You cannot be detained for drug or alcohol addiction. But you can be detained if alcohol or drugs cause mental health problems. For example, if you have delusions because of using cannabis.

Find out more information about 'Drugs, alcohol and mental health' here.

How can I be detained?

Who decides if I should be detained?

Usually, 3 people have to agree that you need to be detained. But this may not be the case if the situation is urgent.

The 3 people are normally:

If possible, at least one of the doctors should have met you before.

The AHMP can only agree this if they have seen you in the past 14 days.

The doctors must either have seen you at the same time, or within five days of each other.

If all 3 people agree that you need to be detained, the AMHP will apply to a local hospital for a bed.

Your nearest relative can also apply for you to be detained, but this is rare. There is more information about your nearest relative below.

What is an AMHP?

AMHPs are mental health professionals who carry out certain duties under the Mental Health Act. They are given specialist training to do this.

An AMHP might be a:

social worker,

nurse,

occupational therapist, or

psychologist.

A doctor cannot be an AMHP.

Where am I assessed?

This depends on where you are. The assessment might take place at your home, in a public place, or in hospital.

If you are at home, the AMHP should introduce themselves, and the doctors, to you. They should explain why they have come to see you.

The AMHP can apply to court for a warrant if you refuse to let them in, or if they think it's necessary for another reason. A warrant lets the police enter your home to take you somewhere safe. This is called a 'section 135'. If your home can be made a safe place, you may be kept there while an assessment is arranged.

If you are away from home in a public place, the police can take you to a safe place under 'section 136'. A safe place might be:

The links below can tell you more about each type of section:

How do they assess me?

When you are safe, the professionals will decide if you need to be detained. They will ask you questions, and think about all of your circumstances. They may ask you:

how you are feeling,

if you have plans to harm yourself or others,

about your lifestyle, daily routine, and living conditions,

if you have been taking your medication, and

if you have been using drugs or alcohol.

What happens if I am detained?

If you are not already in hospital, the AMHP will arrange for you to go there as soon as possible. In some cases the police will go with you.

Staff should tell you which section you are detained under, and what your rights are. They should also give you a 'Patient Information Leaflet' about your rights. If you find it hard to understand, let them know.

It is likely that you will be taken to a specialist ward for people with mental health problems. They may call this an 'acute ward' or a 'psychiatric ward'. In most hospitals, the door to the ward will be locked.

Sometimes the hospital might be a long way from home. But guidance says that the AMHP should try to find you a hospital bed as close as is 'reasonably possible' to where you would like to be.

In hospital, you will be introduced to your 'responsible clinician'. This is the person who is in charge of your care and treatment. They are usually a psychiatrist, but they can be other professionals too.

What is a nearest relative?

The 'nearest relative' is a legal term used in the Mental Health Act. It is not the same as your next of kin.

Your nearest relative has certain rights if:

Find out more about your 'nearest relative' here. {{needs link}}

Can I avoid being detained?

People often get detained because their mental health is putting them or others at risk, and they won't accept treatment. Taking steps to improve your mental health can reduce the chance of being detained.

If it is likely you will be assessed soon, think about the possibility of accepting treatment, and reducing risky behaviour. During the assessment, you may want to explain how things are at home, and what support you already have.

If the professionals think you are at risk, talk to them about other options for reducing these risks.

The professionals should listen to what you have to say, and consider all alternatives to detaining you. These alternatives might be treatment from local mental health services, or you agreeing to go to hospital.

If you want a friend or family member with you during a Mental Health Act assessment, let the approved mental health professional (AMHP) know.

What support can I get?

Being taken to hospital against your will can be stressful and upsetting and you may feel that you need a lot of support.

Friends, family, and carers

Your friends and family can visit you in hospital if you want. There may be set visiting times.

There may be situations when doctors can stop someone visiting you. But they would need to show that this is necessary for safety or security reasons and they should explain these reasons to you. If a doctor stops someone visiting you, when it's not necessary, it could be a breach of your rights.

While you're in hospital, you should be able to keep in touch with your family by telephone, email, or social media.

Emotional support lines

You may want to talk to someone about the way you feel. Ask the ward staff if you can use a phone to call a listening service, like Samaritans (telephone: 116 123).

Independent Mental Health Advocate (IMHA)

You can get help from an IMHA if you are under sections 2 or 3 of the Mental Health Act.

IMHAs help you to tell staff about your concerns, and find out what your rights are. They can also help you to understand your treatment. They are independent of the hospital staff.

Staff should tell you about help from an IMHA as soon as possible after you are detained.

If you think you would find it helpful to speak to an IMHA, ask staff about how to get in touch with one. You may have to ring a number to make an appointment. IMHAs can meet with you in private, if you would like them to.

You can't get help from an IMHA if you are:

under an emergency section (Section 4),

under holding powers of the Mental Health Act (Section 5), or

in a place of safety under police powers (Section 135 or 136).

Solicitor

If you are under sections 2 or 3, and you think you should not have been detained, you can appeal to a tribunal. A solicitor can help you do this. This help should be free under legal aid.

Civil Legal Advice can tell you more about legal aid, and help you to find a solicitor. Their number is in the 'Useful Contacts' section of this page.

There may also be a list of solicitors on the ward.

Use the links below to find more information about:

Going into hospital {{needs link}}

Going into hospital- for carers, friends, and relatives {{needs link}}

Sections 2, 3, 4 & 5

Section 2 - Assessment

Under section 2, you can be kept in hospital for up to 28 days. This section gives doctors time to decide:

An approved mental health professional (AMHP) is more likely to use section 2 than section 3 if:

you have never been assessed in hospital before, or

you have not been assessed for a long time.

A psychiatrist may offer you treatment. If you refuse treatment, the staff may be able to give it to you without your permission.

When can I be detained?

You can be detained if:

How will I be detained?

An approved mental health professional (AMHP) needs to apply to hospital. Your nearest relative can also do this, but this is rare.

An AMHP can only apply if they have seen you in the last 14 days. They also need recommendations from 2 doctors. One of these doctors must have seen you in the last 14 days. And the doctors must not have seen you more than 5 days apart.

How long can I be kept in hospital?

Up to 28 days. But this doesn't mean you will be in hospital for that long. Your doctor should discharge you from section 2 if you no longer meet the criteria for detention.

Hospital staff cannot extend a section 2. If you need treatment in hospital for longer, you will need to go on to a section 3.

You can stay on a section 2 longer than 28 days if the county court is thinking about changing your nearest relative.

What are my rights on a section 2?

You have the following rights when you are under section 2.

You can find more information about 'Discharge from the Mental Health Act'here.

Can they give me treatment I don't want?

Yes. But the staff should ask you to accept treatment first. If you are unhappy about your treatment, talk to the person in charge of your care (your responsible clinician). An Independent Mental Health Advocate (IMHA) may be able to help.

Staff can only give you some treatments, like electro-convulsive therapy (ECT), if certain criteria are met.

Who can discharge me?

You can be discharged by:

your responsible clinician,

the hospital managers,

your nearest relative, and

the tribunal.

What happens next?

If your doctor thinks you should stay in hospital longer than 28 days, and you won't agree to this, they may put you on a section 3.

Section 3 - Treatment

Under section 3, you can be detained in hospital for treatment for up to 6 months. But it can be extended for longer.

When can I be detained?

You can be detained if:

* you have a mental disorder,
* you are unwell enough to be in hospital,
* professionals think you should be in hospital for your own health or safety, or to protect other people,
* appropriate treatment is available for you, and
* you will not get this treatment unless you are detained.

How is a section 3 carried out?

An approved mental health professional (AMHP) needs to apply to hospital. Your nearest relative can also do this, but this is rare.

How long will I be in hospital for?

To start with, you can be detained for up to 6 months. But your doctor can discharge you earlier, if they think you are well enough.

If your doctor thinks you need to stay in hospital at the end of the first 6 months, they can renew your section for another 6 months. After that, they can renew it for 1 year at a time.

If your responsible clinician thinks your section should be renewed, they have to assess you in the 2 months before it ends. They will then write a report for the hospital managers.

What are my rights?

You have the following rights when you're under section 3.

* You can appeal to a tribunal once in the first 6 months.
* If your section is renewed, you can appeal once every time it is renewed.
* You can ask the hospital managers to discharge you.
* You can ask for the help of an Independent Mental Health Advocate (IMHA). They can help you to understand your rights, and to get your voice heard.

Can I be treated against my will?

You can be treated against your will for 3 months. After 3 months, staff can only treat you without your consent if a 'second opinion approved doctor' (SOAD) approves the treatment.

If you are unhappy about your treatment, you should talk to your responsible clinician. An Independent Mental Health Advocate (IMHA) may be able to help.

Staff can only give you some treatments, like electro-convulsive therapy (ECT), if certain criteria are met.

Who can discharge me?

You can be discharged by:

* the professional in charge of your care (known as your 'responsible clinician'),
* the hospital managers,
* your nearest relative, and
* the tribunal.

What happens next?

When you leave hospital, you will get free aftercare. This is known as section 117 aftercare. It is likely that mental health services will plan your care under the 'Care Programme Approach'.

You can find more information about:

* Section 117 aftercare here
* Care Programme Approach (CPA) here
* Electroconvulsive therapy (ECT) here
* Discharge from the Mental Health Act here

Section 4 - Emergencies

Section 4 is used in emergencies, where only 1 doctor is available at short notice. Unlike a section 2 or 3, you can be detained with a recommendation from only 1 doctor. You can be kept for up to 72 hours. This gives the hospital time to arrange a full assessment.

When can I be detained?

You can be detained under section 4 if:

* you have a mental disorder,
* you are unwell enough to be in hospital,
* professionals think you should be in hospital for your own health or safety, or to protect other people,
* it is urgent and necessary for you to be in hospital, and
* finding another doctor would cause an "undesirable delay".

How is section 4 carried out?

An approved mental health professional (AMHP) needs to apply to hospital. Your nearest relative can also do this, but this is rare.

You must have been seen by a doctor in the last 24 hours. The doctor will write a report that says you should be detained.

How long can I be detained for?

You can be detained for up to 72 hours. But this does not mean that you will be kept for this long. A second doctor should assess you as soon as possible. They will decide if the section 4 should be changed to a section 2. The AMHP does not need to make another application to change the section 4 to a section 2.

Can I be treated against my will?

You can refuse treatment. Staff can only treat you without your consent if:

* you do not have the mental capacity to make a decision about treatment, and
* the treatment is in your best interests.

Who can discharge me?

You can be discharged by the professional in charge of your care in hospital. They are called your responsible clinician.

You can find out more about Mental capacity and mental illness by clicking here.

Section 5 - Holding powers

Section 5 allows a doctor or nurse to stop you from leaving hospital. They may do this if you are in hospital voluntarily, and you want to leave. But they think you are too unwell to leave.

If you are in hospital voluntarily, and you are on a locked ward, staff either have to:

* let you leave when you want to, or
* use their section 5 powers.

If they stop you from leaving without using section 5, this is against the law.

Staff should only use section 5 when it is not possible or safe to use sections 2, 3, or 4.

Doctor's holding power - section 5(2)

A doctor can hold you in hospital for up to 72 hours, if they write a report explaining why you need to be detained, and send this to the hospital managers. A doctor can do this in any hospital.

Nurse's holding power - section 5(4)

A mental health or learning disability nurse can keep you in hospital for up to 6 hours if:

* they need to immediately stop you leaving hospital, for your own health or safety, or for the protection of others, and
* it is not possible to find a doctor who can section you under section 5(2).

How long can I be detained for?

Under section 5(2)

You can be held for up to 72 hours. The doctor cannot renew or extend it. An approved mental health professional (AMHP) and doctors must assess you as soon as possible to see if you should be detained under section 2 or 3.

Under section 5(4)

A nurse can keep you in hospital for up to 6 hours. This is not renewable. The holding power ends as soon as a doctor arrives.

The doctor may transfer you onto a section 2, 3, or 5(2). Or you may continue as a voluntary patient.

Can I be treated against my will?

You can refuse treatment. Staff can only treat you without your consent if:

* you do not have the mental capacity to make a decision about treatment, and
* the treatment is in your best interests.

If you have the capacity to make your own decisions, staff cannot treat you without your consent, unless they move you to a section 2 or 3.

When does the section end?

Section 5 ends when:

* the time runs out, or
* you are detained under a different section.

If the time runs out, and the staff have not detained you under another section, you should be able to leave.

You can find out more about Mental capacity and mental illness by clicking here.

What happens next?

What happens next?

Discharge

You must be discharged from the Mental Health Act when you don't meet the criteria to be detained anymore. For example, if you are in hospital because your health puts you at risk, you can be discharged when this risk is low enough.

You can choose to stay in hospital, if hospital staff agree that you need to be there.

Most people will not have completely recovered from their illness when they leave hospital. If staff think you are ready to leave, they should plan what will happen next. This is called 'discharge planning'.

Your doctors should start planning your discharge as soon as possible, and you should be involved.Discharge planning should be part of your care plan. Your care plan depends on what staff think will be best for you, and what you want. It might say:

where you will live,

what medication will help you,

what social support you will have, and

which mental health services can help.

You can find more information about 'Discharge from the Mental Health Act' by clicking here.

Aftercare

When you leave hospital, professionals should plan your care under the 'Care Programme Approach' (CPA), if there's a high risk that your mental health will get worse without ongoing care.

If you have been in hospital under section 3, you are entitled to free aftercare under section 117.

You can find more information about:

Care Programme Approach (CPA) by clicking here.

Section 117 aftercare by clicking here.

Community Treatment Order (CTO)

A CTO means that you can leave hospital, but you stay under the Mental Health Act. You have to meet conditions to stay in the community. You may be taken back to hospital if you don't meet the conditions in the CTO, or you become unwell. This is sometimes called 'supervised community treatment'.

You may go on a CTO if you are discharged from section 3. You can't go on a CTO if you are under section 2, or if you are not detained.

You can find more information about 'Community Treatment Order' by clicking here.

Useful contacts

Samaritans
This is a national helpline that gives confidential emotional support for people who are distressed. Local branches offer telephone support and, sometimes, face-to-face support.

Telephone: 116 123. Open 24 hours per day, 7 days a week.
Email: jo@samaritans.org
Website: www.samaritans.org

Civil Legal Advice
Civil Legal Advice can help you to find a solicitor who works under legal aid.

Telephone: 0345 345 4 345. Open Monday-Friday 9am-8pm, and Saturday 9am-12.30pm.
Website: www.find-legal-advice.justice.gov.uk

Further reading

Mental Health Act- Code of Practice
This is a document written by the government, working with an Expert Reference Group of service users and carers. It explains how healthcare professionals should apply the Mental Health Act.

Website:
www.gov.uk/government/uploads/system/uploads/attachment_data/file/435512/MHA_Code_of_Practice.PDF

You can find more information about:

Advocacy by clicking here.

Community Treatment Orders (CTOs) by clicking here.

Complaints by clicking here.

Discharge from the Mental Health Act by clicking here.

Going into hospital by clicking here.

Going into hospital- for carers, friends, and relatives by clicking here.

Legal advice by clicking here.

Nearest relative by clicking here.

Section 117 aftercare by clicking here.

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The Mental Health Act (MHA) says when you can be detained in hospital and treated against your wishes. You can be detained if professionals think your mental health puts you or others at risk, and you need to be in hospital. This is sometimes called 'being sectioned'