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Emergency Treatment — MRCPsych Paper B MCQ

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HardMental Health LawEmergency TreatmentMRCPsych Paper B

In England, an adult detained under section 3 of the Mental Health Act 1983 has severe depressive illness with life-threatening refusal of food and fluids. She lacks capacity to consent to ECT and has no valid and applicable advance decision refusing ECT. A second-opinion appointed doctor assessment has been requested, but the responsible clinician judges that the first treatment is immediately necessary to save her life and that waiting for certification would cause dangerous delay. Which provision permits the usual ECT safeguards to be bypassed for this emergency treatment?

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Correct answer: C — Section 62 – urgent treatment

Section 62 is correct. It is the urgent-treatment exception that disapplies the usual section 58A ECT safeguards when ECT is immediately necessary to save life, or—provided it is not irreversible—to prevent serious deterioration. Here, the clinician has explicitly judged that delay for SOAD certification would be dangerous and that ECT is immediately life-saving. Section 58A is ordinarily the relevant provision for ECT in a detained adult who lacks capacity, requiring SOAD certification, but it is not the emergency exception. Section 63 is the general treatment authority for mental disorder; it does not independently override the specific safeguards for treatments governed by section 58A. Section 58 concerns medication after 3 months, while section 57 concerns specified treatments, principally neurosurgery.

Reference: Department of Health, Mental Health Act 1983: Code of Practice, 2015, chapter 25 (treatment safeguards and emergency treatment under section 62). https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/329778/DoH_Code_of_Practice_accessible.pdf