9.1.2 Second stage: does the treatment fall within the MHA?
Nurses must be able to satisfy themselves that the treatment proposed is treatment
that may lawfully be carried out under the MHA. Medical treatment is widely
defined by the Act in section 145#1):
```[M]edical treatment'' includes nursing, and also includes care, habilitation and
rehabilitation under medical supervision. ..'For the purposes of assessing the legality of the particular activity in question,
treatment is classified into three different groups covered by sections 57, 58 and
- The following discussion will deal with these sections in reverse order since
section 63 is, in most cases, the first that would be considered to permit treatment
of a detained individual. Sections 58 and 57 deal respectively with what can be
suggested to be more invasive treatments or treatments that are recognised as
giving rise to greater concern. For these treatments to be given either the procedure
stated in section 57 or 58 must be followed or the urgent treatment provisions in
section 62 must be applied.
Treatment without consent
Treatment provided under the remit of section 63 is treatment for mental disorder
given by or under the supervision of the patient's responsible medical officer
#rmo), and does not require the patient's consent. Treatment will generally be by
means of drug therapy, although the definition of treatment in the MHA is a wide
one, as has been seen above.
Patients, therefore, can be provided with any form of medical treatment which is
for their mental disorder without their consent. This proposition does not apply to
the special forms of treatment that fall under sections 57 and 58 #that is psycho-
surgery, surgical implantation of hormones to reduce male sexual drive, electro-
convulsive therapy and medication continued after the first three months of
administration); for these the special procedures outlined belowmustbe followed.
Patients can be given medication for their mental disorder, under section 63, for
three months before the special procedure under section 58 has to be followed, in
relation to medication. The three month period commences when medication was
first given, which will not necessarily be the same time as when the patient was first
detained. As the Mental Health Act Code of Practice states:
`16.12 The 3 month period starts on the occasion when medication for mental
disorder was first administered by any means during a period of continuing
detention. .. The medication does not necessarily have to be administered
continuously throughout the three months.'For the nurse participating in the administration of medication, it will be necessary
to establish first, that the patient is detained; secondly, that the medication is being
given for the patient's mental disorder; and, thirdly, that the treatment is being
given less than three months since it started. It will not be possible to check the
notes for a form, since none is required under section 63; this requirement only
applies to treatment excluded from this section. Thus clearly recording the first
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