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MHA vs AD — MRCPsych Paper B MCQ

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HardMental Health LawMHA vs ADMRCPsych Paper B

A 42-year-old patient with schizophrenia is detained under section 3 of the Mental Health Act 1983. They currently lack capacity to consent to antipsychotic medication. While capacitous, they made a valid and applicable advance decision refusing all antipsychotic medication if they subsequently lacked capacity. Antipsychotic medication was first administered four months ago during the current period of detention. A second opinion appointed doctor has now certified the proposed treatment under section 58. Electroconvulsive therapy is not proposed, and the treatment is not being given as immediately necessary treatment under section 62. Which statement best describes the legal position?

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

Reveal the answer and explanation

Correct answer: B — The medication may be administered under Part 4 despite the advance decision.

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

B is correct. For a patient detained under section 3, medication for mental disorder is governed by Part 4 of the Mental Health Act rather than the ordinary Mental Capacity Act consent framework. A valid and applicable advance decision may therefore be overridden where the MHA authorises treatment. Because medication has been given for more than three months, section 58 applies, and treatment without consent requires SOAD certification, which is present here. The advance decision should nevertheless inform consideration of less restrictive alternatives. A is incorrect because the refusal is not determinative for this Part 4 treatment. The Court of Protection and nearest relative do not provide the required consent, excluding C and D. Section 62 is reserved for immediately necessary treatment and is unnecessary here, excluding E. Different safeguards apply to ECT under section 58A.

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