represents the minimum interference necessary to prevent the patient from
behaving violently or being a danger to himself or others.
#3) For the purposes of this section treatment is irreversible if it has unfavour-
able physical or psychological consequences and hazardous if it entails
significant hazard.'Frequently, this section has caused debate. However, it should very rarely be used.
It can only apply where the patient is detained and where one of the four forms of
treatment is proposed: that is, psychosurgery, the surgical implantation of hor-
mones to reduce male sexual drive, the administration of medicines after the first
three months, and ECT. The provisions of section 62 apply to no other form of
treatment. It would appear difficult to see how neurosurgery is likely to be
necessary in an emergency, especially in the light of the few cases that are con-
sidered for section 57 treatments. Additionally, it is difficult to see how the
requirements to the section can ever be satisfied in relation to the administration of
medicines. Even if a patient has only once been administered a medicine for
mental disorder, the three month rule operates at which point an assessment of
that patient's needs for medication, including prn #as required) medication should
be made and, depending on the outcome, a Form 38 or 3 9brought into being. It is,
therefore, the case that section 62 may only be of any real use with regard to the
provision of ECT in an emergency, where, for example, a patient is in a catatonic
stupor and might otherwise die. Despite the stringent conditions for using section
62, and the requirement in the Code of Practice to monitor why and for how long
section 62 treatment is continued, the Mental Health Act Commission has often
commented on the inappropriate use made of this section [25].
9.2 Treatment outside the Mental Health Act 1983
For the nurse, the questions are often fairly straightforward when the person is a
detained patient and the treatment falls within the MHA. However, the position is
not so clear cut where the treatment falls outside the remit of the Act. The nurse
may be involved in the care of a person who is an informal patient, or who is
detained under an emergency section of the MHA, or who is a patient for whom
treatment is proposed for a physical disorder. In these situations, the MHA treat-
ment provisions will be of no assistance.
9.2.1 First stage: Is the patient competent?
If treatment is to be provided in these circumstances, it must be ascertained
whether the person is competent to consent to treatment. It must always be
assumed that the patient is competent, regardless of their medical history or any
`label' that may be attached to them. It is only if it is shown that the patient is not
competent that anything other than the consent of the patient may be relied upon.
Despite the clear importance of this requirement, the matter did not receive
judicial attention until the 1990s. The issue of competence was considered
peripherally inGillickv.West Norfolk and Wisbech AHA and the DHSS#1985) where
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