Appropriate and Effective Treatment Under the Mental Health Act

Robson is in his 40s and has paranoid schizophrenia. He has been assessed to lack capacity with respect to decision making about treatment for his condition. Over the past 20 years he has been detained under Section 3 of the Mental Health Act (MHA 1983, as amended 2007) many times but has never gained insight into his illness and has not engaged with treatment. He is currently detained at an inpatient unit. In the past and during his current admission he has been treated with a depot antipsychotic medication which is administered by an injection every 2 weeks, but because he resists, he needs to be restrained to administer the injection. The treating team considers that the current depot medication prevents his mental state from deteriorating. However, they are now considering whether to try clozapine, which is recommended by the National Institute for Health and Care Excellence (NICE) to treat patients with ‘treatment-resistant’ schizophrenia, i.e., if they have not responded to two different antipsychotic medications. Clozapine would have to be administered orally, and Robson would have to have regular blood tests to monitor him as the treatment has serious and potentially fatal side effects. The team hopes that this new medication may result in an improvement in Robson’s mental health and enables him to gain insight into his condition, thus promoting engagement with his treatment plan.

• Should a person be compulsorily detained under the MHA if the treatment provided does not improve his mental condition?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)

Clinical Ethics and Law, Second edition. Carolyn Johnston, Penelope Bradbury, Series editor: Janice Ryme