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MHA vs Advance Decisions — MRCPsych Paper B MCQ

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HardMental Health LawMHA vs Advance DecisionsMRCPsych Paper B

In England, a 35-year-old man with bipolar disorder made a valid and applicable advance decision refusing lithium if he lost capacity during a manic relapse. He is now acutely manic, lacks capacity to consent to lithium and is detained under section 3 of the Mental Health Act 1983. More than three months have elapsed since medication for mental disorder was first administered during his current continuous period of liability to detention. A second opinion appointed doctor has certified that lithium is appropriate and that he lacks capacity to consent. Which statement is correct?

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

Reveal the answer and explanation

Correct answer: C — Lithium may be given despite the advance decision because the requirements of section 58 have been met.

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

B is correct. Lithium is medication for the patient's mental disorder, so the Mental Health Act Part 4 treatment provisions apply. A valid and applicable advance decision can ordinarily refuse psychiatric treatment under the Mental Capacity Act, but it does not prevent compulsory treatment authorised under Part 4 for a detained patient. During the initial three-month medication period, section 63 is generally relevant. After that period, section 58 requires either certified consent or SOAD certification; the stated certification therefore permits lithium despite the advance refusal. The Court of Protection and nearest relative do not provide the routine authority for this treatment. Section 62 is an emergency provision and is unnecessary where section 58 has been satisfied. By contrast, ECT under section 58A ordinarily cannot override a valid applicable advance refusal, except in specified emergencies.

Reference: Department of Health, Mental Health Act 1983: Code of Practice, chapters 9, 24 and 25, 2015. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/396918/Code_of_Practice.pdf