overall structure of her treatment requires her to receive strong anti-psychotic
medication. The administration of that treatment has been necessarily inter-
rupted by her pregnancy and cannot be resumed until her child is born. It is not,
therefore, I think stretching language unduly to say that achievement of a
successful outcome of her pregnancy is a necessary part of the overall treatment
of her mental disorder.' [12]By contrast inRv.Collins, Pathfinder Health Services Trust, St George's NHS Trust ex
parte S#1998) [13], despite the patient being detained under the provisions of
section 2 of the MHA, the court refused to accept that the caesarean section was
lawful:
`Section 63 of the [MHA] may apply to the treatment of any condition which is
integral to the mental disorder. .. provided the treatment is given by, or under
the direction of, the responsible medical officer. The treatment administered to S
was not so ordered; she was neither offered nor did she refuse treatment for
mental disorder. ... In the final analysis, a woman detained under the Act for
mental disorder cannot be forced into medical procedures unconnected with
her mental condition.' [14]With respect, this appears to be much the more appropriate approach. It is difficult
to imagine that, when Parliament passed section 63, it expected that its inter-
pretation would be so wide as to include caesarean sections. If there is an inability
to treat under the MHA owing to lack of nexus between the disorder and the
treatment required, that will necessitate an understanding of the common law
provisions affecting patients who lack capacity to consent. These will be
considered later in this chapter and have also been dealt with in Chapter 7.
Treatment under section 58
The second group of treatments for mental disorder consists of electro-convulsive
therapy #ECT) and the continuation of the administration of medication, by any
means, for mental disorder three months after the person was first administered
that medication when a detained patient. As can be seen, this latter situation
follows on from the treatment that can lawfully be given under section 63. The
treatments covered by section 58 are very common [15] with continuation of
medication being the most frequently used. For nurses, it is essential that they
ensure their involvement is lawful, whether the nurse is involved in the distribu-
tion of medicine for self-administration or is actually undertaking the adminis-
tration of the medication.
Once the nurse has identified that the patient is detained, the nurse must then
establish if the administration of medication requires a form in the patient's notes.
Having ascertained that the section 63, three month time frame has expired, a
formal record must exist before further medication can lawfully be provided. Two
alternatives exist for the legality of administration to be established. First, the
patient must have consented to it. For that consent to be valid under section 58, it
must be verified by either the patient's own doctor #the rmo) or a Second Opinion
Approved Doctor #a SOAD, who will be appointed as such by the Secretary of State
Mental Health Nursing 163