Mental Health Act 1983 [Original Text]
The Mental Health Act 1983 covers the assessment, treatment and rights of people with a mental health condition. It applies to the people of England and Wales.
Treatment of Anorexia Nervosa under Mental Health Act 1983 [Original Text]
For many anorexic patients, compulsory measures will be unnecessary – the decision whether to use the Mental Health Act 1983 (MHA 1983) arises when the physical health or the survival of a patient may be seriously threatened by food- or fluid-refusal.
Anorexia Nervosa, described in the 10th revision of the International Classification of Diseases (ICD-10) under the heading of Eating Disorders:
Might an anorexic be detained under MHA 1983?
Mental disorder is broadly defined in MHA 1983 – it is a matter for the clinical judgment of the medical practitioners who carry out the medical assessments whether, in the case of a particular patient, the criteria for admission are met.
Standard texts of psychiatry agree that anorexia nervosa is classifiable as a mental disorder and patients can therefore be detained in hospital under the provisions of the MHA 1983.
Detention is justified in rare cases of serious threat to health, where compulsory feeding may be necessary to combat both the physical complications and the underlying mental disorder.
The revised MHA 1983 Code of Practice advises an application for compulsory admission to be made by an Approved Mental Health Practitioner (AMHP) rather than the patient’s Nearest Relative.
An AMHP will have the same responsibilities and duties when assessing a patient with anorexia nervosa as s/he would have with a patient suffering from any other form of mental disorder – the least restrictive alternative should be used when providing compulsory treatment. However, in the case of an anorexic, this principle may be compromised by the need to treat his/her self-imposed starvation.
In what circumstances can treatment be given compulsorily for a detained anorexic patient?
Where a patient with anorexia nervosa is detained under MHA 1983, then, in accordance with Chapter 23 of the MHA 1983 Code of Practice, valid consent should always be sought for the medical treatment proposed.
Medical treatment under MHA 1983 ‘includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care…’ the purpose of which is to alleviate, or prevent a worsening of the disorder or one or more of its symptoms or manifestations – thus it covers a broad range of activities, potentially including feeding by naso-gastric tube etc.
Anorexia nervosa and the capacity to consent
Every adult is presumed to have the capacity to decide whether to accept medical treatment, even if s/he refuses treatment for reasons that seem irrational or non-existent – a person is not to be considered incapable of giving consent merely because s/he suffers from mental disorder.
The MHA 1983 Code of Practice sets out the basic principles that determine whether a patient possesses the capacity to consent.
There is a consensus that some patients with anorexia nervosa – who might have the intellectual capacity to understand the nature, purpose and likely effect of treatment – may be unable to give valid consent, perhaps because their capacity to consent is compromised by fears of obesity or by denial of the consequences of their actions.
Section 63
MHA 1983, section 63 states that:
They should also be aware that their actions must not contravene
Does such treatment include the authority to feed the patient compulsorily?
MHA clearly allows the administration of medicines in the absence of consent as a treatment for mental disorder.
The House of Lords has ruled that feeding a patient by artificial means may constitute ‘medical treatment’. It follows, and has been accepted by the Courts, that naso-gastric feeding may be a medical process, forming an integral part of the treatment for anorexia nervosa.
Summary
In every case there will have to be:
Laws of Malaysia: Act 615 (Mental Health Act 2001) [Original Text]
Admission of involuntary patient into psychiatric hospital
10.
The Mental Health Act 1983 covers the assessment, treatment and rights of people with a mental health condition. It applies to the people of England and Wales.
Treatment of Anorexia Nervosa under Mental Health Act 1983 [Original Text]
For many anorexic patients, compulsory measures will be unnecessary – the decision whether to use the Mental Health Act 1983 (MHA 1983) arises when the physical health or the survival of a patient may be seriously threatened by food- or fluid-refusal.
Anorexia Nervosa, described in the 10th revision of the International Classification of Diseases (ICD-10) under the heading of Eating Disorders:
"Anorexia nervosa is a disorder characterised by deliberate weight-loss, induced and/or sustained by the patient. The disorder occurs most commonly in adolescent girls and young women, but adolescent boys and young men may be affected more rarely, as may children approaching puberty and older women up to the menopause. Anorexia nervosa constitutes an independent syndrome in the following sense:For a definite diagnosis, ICD-10 suggests that all these criteria should be met:
a) the clinical features of the syndrome are easily recognised so that diagnosis is reliable with a high level of agreement between clinicians;
b) follow-up studies have shown that, among patients who do not recover, a considerable number continue to show the main features of anorexia nervosa in a chronic form".
- Body weight maintained at least 15% below expected body weight;
- Self-induced weight-loss by:
a. Avoidance of fattening foods;
b. Vomiting;
c. Purging;
d. Excessive exercise;
e. Use of appetite suppressants/diuretics; - Body image distortion with a dread of fatness;
- Widespread endocrine disorder involving the hypothalamic/pituitary/gonadal axis;
- If the onset is pre-pubertal, pubertal events are delayed or arrested.
- The occurrence of depressive/obsessional symptoms;
- The presence of features of a personality disorder;
- The importance of distinguishing somatic causes of weight loss in young patients:
a. Chronic debilitating diseases;
b. Brain tumors;
c. Intestinal disorders (Crohn’s Disease/malabsorption syndrome).
Might an anorexic be detained under MHA 1983?
Mental disorder is broadly defined in MHA 1983 – it is a matter for the clinical judgment of the medical practitioners who carry out the medical assessments whether, in the case of a particular patient, the criteria for admission are met.
Standard texts of psychiatry agree that anorexia nervosa is classifiable as a mental disorder and patients can therefore be detained in hospital under the provisions of the MHA 1983.
Detention is justified in rare cases of serious threat to health, where compulsory feeding may be necessary to combat both the physical complications and the underlying mental disorder.
The revised MHA 1983 Code of Practice advises an application for compulsory admission to be made by an Approved Mental Health Practitioner (AMHP) rather than the patient’s Nearest Relative.
An AMHP will have the same responsibilities and duties when assessing a patient with anorexia nervosa as s/he would have with a patient suffering from any other form of mental disorder – the least restrictive alternative should be used when providing compulsory treatment. However, in the case of an anorexic, this principle may be compromised by the need to treat his/her self-imposed starvation.
In what circumstances can treatment be given compulsorily for a detained anorexic patient?
Where a patient with anorexia nervosa is detained under MHA 1983, then, in accordance with Chapter 23 of the MHA 1983 Code of Practice, valid consent should always be sought for the medical treatment proposed.
Medical treatment under MHA 1983 ‘includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care…’ the purpose of which is to alleviate, or prevent a worsening of the disorder or one or more of its symptoms or manifestations – thus it covers a broad range of activities, potentially including feeding by naso-gastric tube etc.
Anorexia nervosa and the capacity to consent
Every adult is presumed to have the capacity to decide whether to accept medical treatment, even if s/he refuses treatment for reasons that seem irrational or non-existent – a person is not to be considered incapable of giving consent merely because s/he suffers from mental disorder.
The MHA 1983 Code of Practice sets out the basic principles that determine whether a patient possesses the capacity to consent.
There is a consensus that some patients with anorexia nervosa – who might have the intellectual capacity to understand the nature, purpose and likely effect of treatment – may be unable to give valid consent, perhaps because their capacity to consent is compromised by fears of obesity or by denial of the consequences of their actions.
Section 63
MHA 1983, section 63 states that:
'The consent of a patient shall not be required for any medical treatment given to him for the mental disorder from which he is suffering, not being a form of treatment to which section 57, 58 or 58A above applies, if the treatment is given by or under the direction of the approved clinician in charge of the treatment.’Treatment for many anorexic patients might include a behavioural programme designed to help them overcome the compulsion of food refusal. If so, practitioners should be aware of their own ethical and legal obligations, and of the need to avoid treatments that might be degrading or inhumane, such as the restriction of movement or natural functions.
They should also be aware that their actions must not contravene
- Mental health or other legislation (e.g. MHA 1983, section 127, which concerns ill-treatment or wilful neglect of a patient), or;
- The European Convention on Human Rights (particularly the Article 3 prohibition on torture or inhuman or degrading treatment, and the Article 8 right to respect for one’s private and family life).
Does such treatment include the authority to feed the patient compulsorily?
MHA clearly allows the administration of medicines in the absence of consent as a treatment for mental disorder.
The House of Lords has ruled that feeding a patient by artificial means may constitute ‘medical treatment’. It follows, and has been accepted by the Courts, that naso-gastric feeding may be a medical process, forming an integral part of the treatment for anorexia nervosa.
Riverside Health NHS Trust v FoxThe clinician in charge of the compulsory feeding must be satisfied that the food refusal which is being treated is part of the mental disorder in order to use the authority of s.63. In these circumstances further diagnostic and monitoring procedures may be necessary, including venipuncture (the process of obtaining IV access for IV therapy or obtaining a sample of venous blood), as part of the medical treatment for the mental disorder Authority for such additional procedures might be found under s.63, possibly also justifiable under the common law action that is taken in an emergency as the minimum necessary to prevent serious injury or loss of life.
The Judge observed: ‘until there is steady weight gain no other treatment can be offered for the respondent’s mental condition so I hold that forced feeding if needed will be medical treatment for the disorder’, for the debate whether feeding constitute ‘medical treatment for the mental disorder’.
Summary
In every case there will have to be:
- Proper consideration of the alternatives;
- A multi-disciplinary decision as to the most appropriate way of managing the patient’s overall care;
- A mechanism for ensuring that any compulsory treatment is given under the direction of the approved clinician in charge of the treatment;
- A way to end use of compulsory powers when they are no longer appropriate.
Laws of Malaysia: Act 615 (Mental Health Act 2001) [Original Text]
Admission of involuntary patient into psychiatric hospital
10.
- A person who is suspected to be mentally disordered may be admitted and detained in a psychiatric hospital upon—
a) An application made in the prescribed form to the Medical Director by a relative of the person; and
b) The production of a recommendation in the prescribed form of a medical officer or registered medical practitioner based on a personal examination of the person made not more than five days before the admission of the person that—
i. The person is suffering from mental disorder of a nature or degree which warrants his admission into a psychiatric hospital for the purposes of assessment or treatment; or
ii. The person ought to be detained in the interest of his own health or safety or with a view to the protection of other persons. - The application and the recommendation in subsection (1) are sufficient authority for the person making the application, or a police officer or any other person authorized by the person making the application, to take the person to whom the recommendation relates to a psychiatric hospital.
- Where a person is admitted to a psychiatric hospital under this section, the Medical Director of the psychiatric hospital shall, within twenty-four hours of the person's admission, make or cause to be made on him by a medical officer or a registered medical practitioner such examination as the Medical Director may consider necessary for determining whether or not the continued detention of the person is justified.
- The medical officer or registered medical practitioner who makes the recommendation under paragraph (1)(b) or who admits the patient under subsection (1) shall not examine the patient under this subsection.
- Where upon the examination of the person under subsection (3) the Medical Director—
a) Is not satisfied that the continued detention of the person is justified, he shall discharge the person; or
b) Is satisfied that the continued detention of the person is justified, he shall make an order in the prescribed form signed by him for the detention of the person for a period not exceeding one month. - Where a person who is detained by order issued under paragraph (5) (b) or subsection 9(5) is not sooner discharged, the Medical Director of the psychiatric hospital shall, before the expiration of the order, cause to be made on the person such examination as he may consider necessary for determining whether or not the continued detention of the person is justified.
- The examination of the person under subsection (6) shall be done by two medical officers or registered medical practitioners, as the case may be, one of whom shall be a psychiatrist.
- Where upon the examination of the person under subsection (6), the medical officers or registered medical practitioners, as the case may be—
a) Are not satisfied that the continued detention of the person is justified, they shall discharge the person; or
b) Are satisfied that the continued detention of the person is justified, they shall make an order in the prescribed form signed by them for the detention of the person for a further period not exceeding three months.
0 comments:
Post a Comment