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Anorexia Nervosa and MHA — MRCPsych Paper B MCQ

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HardMental Health LawAnorexia Nervosa and MHAMRCPsych Paper B

In England, a 20-year-old woman has established anorexia nervosa. She has life-threatening physiological instability secondary to malnutrition and requires inpatient nutritional rehabilitation and medical monitoring. The nature and current degree of her mental disorder are established, appropriate treatment is available, and treatment cannot be delivered safely without admission. She has decision-specific capacity to refuse admission and treatment, and does so. Which is the most appropriate legal basis for compulsory admission for treatment?

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

Reveal the answer and explanation

Correct answer: E — Mental Health Act 1983, section 3

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

A is correct. NICE states that where physical health is at serious risk from an eating disorder, the person does not consent, and safe treatment requires inpatient care, the Mental Health Act 1983 compulsory-treatment framework should be used. In this case the diagnosis, severity and necessary treatment plan are already established, making section 3—the treatment section—the best answer. Capacity to refuse does not preclude detention under the Mental Health Act. DoLS is an MCA safeguard for people who may lack capacity to consent to care arrangements, so it cannot authorise detention here. Section 2 is principally for assessment when the diagnosis, nature/degree of disorder or treatment plan is not sufficiently established. The Children Act is inapplicable to this adult, and a capacitous refusal is not an absolute bar to MHA detention.

Reference: National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69), recommendation 1.12.1, 2017 (updated 2020; last reviewed 2024). https://www.nice.org.uk/guidance/NG69/chapter/recommendations