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Feeding under MHA — MRCPsych Paper B MCQ

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HardMental Health LawFeeding under MHAMRCPsych Paper B

In England, a 20-year-old woman with severe anorexia nervosa is detained for treatment under section 3 of the Mental Health Act 1983. Her physical health is at serious risk. Following a decision-specific assessment, she is judged to have capacity to refuse nasogastric feeding and continues to refuse it. After attempts to achieve collaborative oral refeeding, the multidisciplinary team considers nasogastric feeding necessary, proportionate and the least restrictive effective intervention. It is included in her treatment plan under the direction of the approved clinician in charge. Which statement most accurately describes the legal position?

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

Reveal the answer and explanation

Correct answer: D — Section 63 can authorise nasogastric feeding as treatment for anorexia nervosa despite her refusal.

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

B is correct. Nasogastric feeding aimed at reversing starvation caused by anorexia nervosa is treatment for the mental disorder. For a patient detained under section 3, section 63 permits such treatment without consent when it is given by or under the direction of the approved clinician in charge. A capacitous refusal must be taken seriously but does not provide an absolute veto over section 63 treatment. The Court of Protection is not required merely because the patient refuses, and loss of capacity is not a prerequisite. A nearest relative has no power to consent to treatment on the adult patient's behalf. Compulsion is not automatic: clinical necessity, proportionality, the least restrictive approach, competent multidisciplinary delivery and careful review remain essential.

Reference: Royal College of Psychiatrists, Medical Emergencies in Eating Disorders: Guidance on Recognition and Management (CR233), section 5(d) and Appendix 2, 2022: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr233-medical-emergencies-in-eating-disorders-%28meed%29-guidance.pdf?sfvrsn=2d327483_59