administration of medicine is vital, as is ensuring that the legally relevant infor-
mation and documentation is readily available for inspection.
In recent years, it has become apparent that one particular issue on the
application of section 63 can cause difficulty. This is in determining whether a
particular treatment is, indeed,forthe patient's mental disorder as opposed to a
physical disorder or condition. Two situations can be highlighted where the
boundary between treatment for physical conditions or for a mental disorder has
resulted in legal discussion. The first concerns the treatment of anorexia nervosa,
particularly where the patient is an adult #where the patient is a child the treatment
might be given without recourse to the MHA in some circumstances). The Mental
Health Act Commission, in its Fourth Biennial Report, stated that in its view severe anorexia nervosa falls within the definition of mental disorder.' [7] If this is the case, then an individual may be admitted to hospital, provided all other criteria are satisfied, under section 2 MHA for assessment #which may be followed by treat- ment), or alternatively section 3 MHA for treatment, where an assessment has already been carried out and reflects the current situation [8]. It is also the view of the Mental Health Act Commission thattreatment of anorexia nervosa necessary
for the health or safety of the patient, including involuntary feeding and main-
tenance of hydration, is permissible in patients whose anorexia is causing serious
concern' [9].
The only basis on which this opinion may be predicated is that these forms of
activity fall within the definition of treatment within the Act and that section 63 is
the relevant section authorising treatment. No-one, it is submitted, can dispute
that, given the wide definition of medical treatment in the Act, involuntary feeding
does fall within treatment'. Anorexia nervosa is a mental disorder. But the essential question, as required by the wording of section 63, is whether the treatment isforthe mental disorder from which the patient is suffering. The courts have held that, if treatment is capable of being ancillary to core treatment ± i.e. it is nursing careconcurrent with the core treatment or as a necessary prerequisite to
such treatment or to prevent the patient from causing harm to himself or to alle-
viate the consequences of the disorder,' ± it will be upheld as lawful under section
63 [10].
The second area of discussion is in relation to compulsory caesarean sections. A
series of cases has been presented to the courts where the question of whether
treatment is for a physical problem or for a mental disorder has been the issue [11].
While different outcomes have resulted from these cases, there appears to be an
adherence to the principles put forward inBv.Croydon Health Authority#1994) in
that the treatment for the physical condition must be ancillary to the treatment for
the mental disorder for it to be regarded as treatmentforthe patient's mental
disorder and thus the treatment can be given under section 63 #to a detained
patient) without her consent. Hence inTameside and Glossop Acute Services Trustv.
CH#1996), the caesarean was sanctioned on the basis that:
`. .. an ancillary reason for the induction and, if necessary, the birth by caesarean
section is to prevent a deterioration in the [patient's] mental state. Secondly,
there is the clear evidence ... that in order for the treatment of her schizophrenia
to be effective, it is necessary for her to give birth to a live baby. Thirdly, the162 Nursing Law and Ethics