Abstract
Aims and methodTo understand circumstances in which urgent treatment provisions are used in clinical practice, by means of a retrospective study. A list of patients to whom Sections 62, 64B and 64G of the Mental Health Act 1983 were applied during the 1-year study period was obtained from the information technology department. Case notes were traced for detailed information on the circumstances of use of these provisions.ResultsThe most common reason for urgent treatment was to continue the established treatment plan rather than to start a new treatment (45% Section 62, 84% Section 64). The urgent treatment provisions were most commonly used because of a delay in examination by a second opinion appointed doctor in 45% cases for Section 62 and 84% cases for Sections 64B and 64G.Clinical implicationsThis is probably unlawful use of the urgent treatment provisions.
Highlights
One of the protections for patients required by the Act is that once 3 months have elapsed since the person first received medication for mental disorder as a detained patient, medication may only be given if the treatment is authorised by either the clinician in charge of the patient’s care or an independent doctor called a second opinion appointed doctor (SOAD) if the patient lacks capacity or refuses
Our study indicates that urgent treatment provisions are increasingly being used for a full treatment plan while waiting for a SOAD to authorise the plan
This is in contrast to previous studies where electroconvulsive therapy (ECT) or rapid tranquillisation were the most common interventions used under Section 62.2,3 Haw & Shanmugarutnum did not indicate that any of these instances were due to delay in the SOAD authorising the treatment,[3] Johnson & Curtice indicated that in 18% of their cases the urgent treatment provision was used to administer ECT owing to a delay in obtaining SOAD authorisation.[2]
Summary
There were 58 instances of use of Section 62, in 39 patients, in the study period of 1 year (this was because Section 62 was used on more than one occasion for some patients). The reasons documented on the urgent treatment form, detailing the need to use the respective provisions, are summarised opposite. Section 64B/G Section 64B/G was used on 25 occasions (78%) to prevent serious deterioration of the patient’s condition, 6 times (19%) because of delayed SOAD assessment and once (3%) to alleviate serious suffering by the patient. Three instances (5%) occurred when Section 62 had to be used to add medications which were erroneously missed on a T3 form by the SOAD. In six instances (10%) it was used to administer ECT On another six occasions (10%) it was required for new, urgent medication (rapid tranquillisation). On four occasions (7%) it had to be used when patients treated in accordance with a T2 form withdrew their consent
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