Inpatient treatment

In circumstances where medication needs to be given in an emergency but no authority to treat is apparent, Section 62 powers can be used to prevent and deuteriation in mental health and/or loss of life.

Covert medication

The key points are as follows:

When consent is not needed?

There are a few 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 1983) – in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental illness
• 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 1983) – 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 a risk to public health as a result of rabies, cholera or tuberculosis (TB)
• 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

You may wish to reflect on the following key points

• Does the patient have mental capacity to consent or refuse?
• Is the patient detained under the Mental Health Act? If yes then consent to treatment provisions applies. If not then the Mental Capacity Act will apply
• Why is it proposed to administer medication covertly and what medication is being considered for covert administration?
• Why is the patient refusing medication?
• Would the medication be necessary to save the patient’s life or to prevent deterioration in their health?
• Would the administration of the medication be in their best interests? Is there likelihood that the patient will recover capacity in the future and be able to make their own treatment decisions in the future? If so, would it be possible to delay the administration of the relevant medication?
• Has the patient made an advance decision, when competent to do so, that addresses the refusal of the relevant medication?

Consent to Treatment
Author: Nick Dorling, Trust Mental Health Law Training Officer

This video will demonstrate an overview of consent to treatment

It is important to note that

• All decisions must be lawful and informed by good professional practice
• Lawfulness necessarily includes compliance with the Human Rights Act 1998 (HRA) and Equality Act 2010.
• All five sets of principles are of equal importance, and should inform any decision made under the Act.
• The weight given to each principle in reaching a particular decision will need to be balanced in different ways according to the circumstances and nature of each particular decision.
• Any decision to depart from the directions of the policy and the Code of Practice must be justified and documented accordingly in the patient’s case notes.
• Staff should be aware that there is a statutory duty for these reasons to be cogent and appropriate in individual circumstances.

The five overarching principles are

Mental Health Act Code of Practice 2015 Guiding Principles

We will look into more details of this on the next slide.

Compulsion in the community
Author: Nick Dorling, Trust Mental Health Law Training Officer

S17, CTO & Guardianship

S17 leave of absence

Patients detained in hospital can leave lawfully only if they are given leave of absence by their Responsible Clinician (RC) under s17 of the Mental Health Act 1983 (MHA CoP 27.3)

S17 leave cannot be given to patients detained under s5(2), s35, s36 and s38. Leave can only be given to restricted patients with the approval of the Ministry of Justice (unless they need emergency leave e.g. for urgent medical treatment)

In the absence of the usual RC, s17 leave can be granted only by the AC who is acting as the patient’s RC (CoP 27.8)

S17 leave should normally be of short duration and not normally for more than 7 days.

If a patient is detained under s3 or s37 and is given leave for more than 7 days, the RC must consider discharge under a Community Treatment Order (CTO).

If treatment needs to be administered without the patient’s consent, the RC should consider recalling the patient to hospital.

The RC’s responsibilities for their patients remain the same while their patients are on leave (CoP 27.24)

The RC may revoke their patient’s leave at any time if they consider it necessary in the interests of the patient’s health or safety or for the protection of others (CoP 27.32)

The RC can extend leave without the patient having to return to hospital.

The RC can renew a patient’s detention while they are on leave if the criteria under s20 are met (CoP 27.32)

Consent to treatment under the Mental Health Act
Author: Nick Dorling, Trust Mental Health Law Training Officer

Introduction

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, organ donation or something else.
The principle of consent is an important part of medical ethics and international human rights law.

What’s going to be covered in this module:

• Treatment under the Mental Health Act
• Who can prescribe medication
• Patients consent and capacity around treatment
• What sections are used to lawfully treat.