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SOAD — MRCPsych Paper B MCQ

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ModerateMental Health LawSOADMRCPsych Paper B

A 45-year-old man in England is detained for treatment under section 3 of the Mental Health Act 1983. Three months have elapsed since medication for mental disorder was first administered during his current continuous period of detention. He has capacity to decide about antipsychotic medication but now refuses it. The medication is not immediately necessary within the urgent-treatment provisions. What is required before antipsychotic medication can continue against his wishes?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — A section 58 certificate from a Second Opinion Appointed Doctor

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · C = shown as D · A = shown as E

B is correct. For medication for mental disorder, section 58 applies once three months have elapsed from the first administration of medication during the current continuous period of liability to detention. A patient with capacity who refuses treatment may then receive it only if a Second Opinion Appointed Doctor (SOAD) certifies that the proposed treatment is appropriate under section 58(3)(b). Section 63 does not provide unrestricted authority because it is subject to section 58. Hospital managers may review detention but do not authorise medication. A nearest relative cannot consent on behalf of a capacitous adult, and a court order is not routinely required. The urgent-treatment exception has been excluded; otherwise, section 62 may permit immediately necessary treatment without prior compliance with section 58.

Reference: Department of Health and Social Care, Code of practice: Mental Health Act 1983, chapter 25 (treatment requiring consent or a second opinion), 2015. https://www.gov.uk/government/publications/code-of-practice-mental-health-act-1983