Enforced administration of medication after s2 recommendations and application

Patient is in hospital ED Department
Recommendations in place for a Section 2 MHA
Waiting for a psychiatric bed to be identified
First time with Mental Health problems
Anti Psychotic Medication prescribed
Not reviewed by a qualified Mental Health professional after 48 hours
Can patient be restrained and given this medication against their will with no legal framework in place

Not under Part IV of the Mental Health Act as the person is not under the remit of the Act until and unless all the papers are completed and the person is admitted to hospital. This would be the case even if the person was reviewed by a mental health professional every 10 minutes.
Any decision to treat without consent, and particularly against the person’s wishes, would need to made (and appropriately recorded) in the context of the Mental Capacity Act, which has some very specific requirements around capacity, best interests and restraint.


Thank you for your response

Steve, surely a patient who is being transported to hospital on the basis of a completed application is within “the remit of the Act”.

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Hi Richard
Patient waiting in the ED Department (3 days)
Mental Health For A Section 2 Recomendations in place
No psychiatric bed available
Patient fluctuating capacity
My question was
Can anti psychotic medication be administered without the patients consent (forcibly under restraint)
with no legal framework.

Of course you are right, Richard. It applies to anyone liable to be detained (excluding certain sections such as s4, s5, s135, etc.)

On what legal basis if an MCA assessment hasn’t been completed? If using the MCA please remember risk to others does not apply as a grounds for intervention.

Not detained and the purpose of restraint appears to be for psychiatric treatment so there is no reason to assume such an approach couldn’t amount to assault and battery if relying on common law or the MHA. This is unless there is something else that has happened that isn’t mentioned. So the hospital considering this would appear to need to take urgent legal advice if this is their plan.

A little confusing about the second medical recommendation. Hopefully what has been omitted is that the patient has also been seen by an AMHP who agrees an application is appropriate so the patient will be liable for detention by the AMHP with 2 medical recommendations in place when a hospital is identified.

If not, who provided the second recommendation and why? If it is to speedily provide the independent medical recommendation then this is ordinarily arranged by the AMHP as, from the Code of Practice, 14.45 Unless there is good reason for undertaking separate assessments, patients should, where possible, be seen jointly by the AMHP and at least one of the two doctors involved in the assessment.

But again, context will be all as there may be factors such as a doctor with relevant specialist knowledge could only be available at a certain time to interview in person but could then be available to discuss the patient by other mediums with the AMHP to help them decide whether to make an application. So the AMHP considered this appropriate to therefore vary from the recommended guidance within the Code Of Practice and plans to document accordingly.

But unless it is consistent with the code of practice or the AMHP has good cause to vary from it then it would not be for the health service to arrange for two medical recommendations so the AMHP can simply turn up and sign an application.

This doesn’t prevent the AMHP meeting with the patient separately if that is helpful within the context of the assessment but the expected practice is that part of their conversation with the patient will be with the benefit of one doctor’s contemporaneous medical input if they are considering making an application under s2 or s3.

In terms of the remit of the remit of the Act. If the AMHP has a hospital address to detain the person to then ED can count as part of the conveyance while an ambulance is arranged. Unfortunately the person is only liable for detention so not yet under S2 so no power to treat as yet as AMHPs are not appropriately qualified Responsible Clinicians with authority to treat under the Act. So back to the MCA as common is no longer likely to apply as this person has been assessed under the Act.

But until the admitting hospital is identified the patient is outside the remit of the Act.

It is why one local general hospital has very occasionally agreed to admit a patient - following consultation with its liaison team - to manage the risk to others and initiate urgent psychiatric treatment while urgently looking for a psychiatric bed. Although this predated the latest pressures on services.

Sorry for not being clear
Recommendation was approved by 2 Mental Doctors and an AMHP

There are similarities between this topic and Forced treatment after MHA assessment but before hospital admission.