Content area
Full Text
Correspondence to Dr Robert Wheeler, Paediatric Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; [email protected]
Introduction
Taken together, Sections 145 and 63 of the Mental Health Act 1983 (MHA) provide for treatment without consent of physical illness ancillary to the mental disorder with which a patient presents. On a daily basis, clinicians make both the decision that the Act’s authority can be applied to their patient’s case, and whether or not it should be applied without the patient’s consent. But in the unusual circumstances where there is uncertainty as to the applicability of the MHA to the ancillary treatment of physical illness, the assistance of a court may be sought. In so doing, the law (and thence the courts) may justify compulsion if the treatment is within the scope of s63. But the law never prescribes it; the clinician is presented with authority that he or she could use but is left to decide whether it should be employed. This paper explores how the clinical question is set before the courts, and whether the distinction between symptom, manifestation and consequence is sufficiently understood by the courts. This is relevant to the context of self-neglect and its close cousin self-harm: the question of whether the relevant ailment was caused by neglect or self-inflicted harm will determine whether compulsion under the MHA is applicable; and furthermore, whether or not compulsion is clinically acceptable.
Case of CC, and the context of previous decisions
In the recent case of CC,1 a 34-year-old man had suffered from type 1 diabetes since he was 15, and had complications of this due to his poor compliance with treatment, including retinal disease and soft tissue infection. At 28 he was informally admitted to the hospital with a personality disorder; depression and features of psychosis. Six months later, he was detained under the MHA and has remained thus. In 2019, CC had presented with anaemia and was found to have renal failure, requiring subsequent haemodialysis. No medical evidence adduced to assert that his renal failure was either caused by diabetes or exacerbated by his poor compliance appears in the court report, other than that of a psychiatrist who attributes the renal disease thus: ‘His diabetic control has been...