CONSENT TO TREATMENT See: · Sections 56-64 of the Act · The Memorandum · The Code of Practice · Mental Health Act Manual, Richard Jones The following rules covering treatment for detained patients DO NOT refer to: Leave of Absence A patient who is on authorised leave of absence is still “liable to be detained” and therefore remains subject to the consent to treatment provisions. General Rules As a general rule, excluding Electro-convulsive Therapy (ECT) and special treatment, patients on long-term detention orders (including Section 2) can be treated for mental disorder for three months with or without their consent. This means treatment for mental disorder only. After three months a Form 38 must be completed by the RMO if the patient consents to the treatment to be administered. If the patient does not consent or is unable to give consent to treatment, the Mental Health Act Commission (MHAC) must be contacted for a second opinion. If treatment is to continue, a Form 39 must be completed by the Commission doctor. Completion of Forms 38 & 39 Only a RMO (or Part IV doctor) can complete Form 38. Only a MHAC doctor can complete Form39. The Mental Health Act Commission prefer the class of drug and its BNF code to be stated (anti-psychotic drugs 4.2.1, anti-psychotic depot injections 4.2.2, anti-manic drugs 4.2.3) as opposed to specific drug names. The number of drugs, the route and the dosage range (within BNF range) should be given. MHAC Doctor / Second Opinion Approved Doctor The MHAC doctor is required to speak to the following people who are involved with the patient’s care in the hospital: 1. A qualified nurse 2. A doctor (preferably the patient’s RMO) 3. Another professional who has been concerned with the patient’s treatment (e.g. O/T, psychologist, social worker etc) The MHAC doctor will require: 1. The case notes 2. A copy of Section papers 3. The Treatment Plan 4. A blank Form 39 Time Limits If a period of three weeks or more occurs between a Form 39 being completed and the treatment being administered, it is good practice to request a new second opinion. NB When calculating the three-month treatment period for patients detained under Section 2 followed by Section 3, the 28 days under Section 2 count as part of the three-month period. Change of Treatment If the RMO wishes to change the treatment prescribed, the patient’s consent must be sought. If the patient consents, the RMO must complete Form 38. Where the patient is incapable of giving consent, or refuses to consent, the MHAC must be contacted. Nurses and the Administration of Medication The following is based on the Mental Health Act Commission, Practice Note 2 “Nurses, the administration of medicine for mental disorder and the Mental Health Act”. Nurses administering medication to detained patients who are subject to the provisions of Section 58 of the Act must ensure they are legally entitled to administer that medication by ensuring all necessary legal requirements have been met, that is Form 38 or 39 is completed. A copy should be kept with the medicine card and reference should be made to it at the time of administering any medication for mental disorder. The nurse should: 1. Check the medicine card for date of entry of prescription and dosage. 2. Ensure that if within the three-month period the time has not been exceeded. If it is beyond the three-month period then a valid Form 38 or 39 must be present. Blood Samples Under the Act “treatment for mental disorder” does not explicitly include the taking of blood samples. This can cause many problems, especially with the use of Clozapine. In this case a patient detained under Section 3 who is not consenting could be given Clozapine (a treatment for mental disorder) against their will but not the blood tests which are required for this treatment. The Mental Health Act Commission in June 1993 issued a Practice Note (number 1) on this problem. It states: Any authoritative interpretation of the law can be given only by the Courts. In the absence of any judicial decision, the Commission’s view of any interpretation can at best only be informed opinion and must not be treated as, or substituted for professional legal advice. Having considered the legal, pharmacological and medical advice received, the Commission concludes that the administration of medical treatment under Part IV of the Mental Health Act includes such measures as are necessary and appropriate to ensure that the medicine is administered efficaciously and safely in accordance with good medical practice. In the case of ECT this will generally include taking blood samples by venepuncture to evaluate the patient’s physical state prior to treatment, including the estimation of pseudo-cholinesterase. In lithium prophylaxis this will include venepuncture to secure samples for the estimation of serum lithium concentrations and an evaluation of the patient’s thyroid status following the recommendations and guidance in the British National Formulary. With regard to Clozapine treatment, this will include strict haematological monitoring by the Clozaril Patient Monitoring Service as required by the product licence. Not withstanding the authority to administer medical treatment in the absence of the patient’s consent provided by Part IV of the Mental Health Act 1983, it is a matter for the individual judgement of the responsible medical officer in conjunction with the clinical team to determine whether this authority should be exercised in an individual patient. This is an interim opinion and subject to further guidance should the issue of undertaking venepuncture as an element in the administration of treatment to a non- consenting patient under Part IV of the Mental Health Act become the subject of judicial review.
Pages to are hidden for
"CONSENT TO TREATMENT"Please download to view full document