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Physical Treatment Under MHA vs MCA — MRCPsych Paper B MCQ

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HardMental Health LawPhysical Treatment Under MHA vs MCAMRCPsych Paper B

A 42-year-old man is detained under section 3 of the Mental Health Act 1983 for treatment of schizophrenia. He develops acute appendicitis, which is unrelated to his mental disorder. Because of a delusional belief, he lacks decision-specific capacity to consent to surgery, although he is not actively resisting it. There is no valid and applicable advance decision, health and welfare attorney or deputy, and the clinical team agrees that appendicectomy is in his best interests. Which legal authority should ordinarily be relied on for the operation?

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Correct answer: D — Mental Capacity Act 2005, through a best-interests decision

The correct answer is D. The MHA regulates treatment for mental disorder and physical treatment that is part of, ancillary to, or intended to alleviate or prevent worsening of its symptoms or manifestations. Appendicitis is expressly unrelated to this patient's schizophrenia, so neither section 63 nor the urgent-treatment provisions in section 62 provide authority. The fact that psychosis causes his incapacity does not expand the scope of the MHA. As he lacks decision-specific capacity, treatment may ordinarily proceed under the Mental Capacity Act 2005 if it is in his best interests. A Court of Protection order is not automatically required merely because treatment is invasive, although court involvement may be needed where capacity or best interests are seriously disputed. A nearest relative has no general authority to consent to physical treatment.

Reference: Department of Health, Mental Health Act 1983: Code of Practice, paragraphs 13.37–13.38, 2015. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/396918/Code_of_Practice.pdf