Treatment outside of Statute in S136 suites

Law and practice Other
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As everybody should know, S136 does not allow for treatment with medications whether consenting or not.

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[I own copyright to the image, just in case]

Scenario this week:

  1. Male patient in early 30s with only rudimentary linguistic competence in English.
  2. Arrived in the UK a few months ago from somewhere in the Middle East.
  3. Picked by police in a place other than a dwelling, when relatives called for help.
  4. Florid features of psychosis and mania from history and presentation.
  5. No interpreter to be found.
  6. So, no one could communicate well with him.
  7. Was about to breach 24 hour limit - as I extend by 12 hrs under S136B.
  8. About 7 coppers present and three police vans remain outside the unit for most of the day.
  9. Punched a copper - who had to go off ill.
  10. P was previously on lithium and non-compliant.
  11. Not of capacity to decide on extended stay at 136 or any other facility - even after trying to test capacity with a ‘medic’ who spoke his language.
  12. Told that P is of high risk of violence - if not medicated. I agree.

So what’s the problem?

  1. P not of capacity for decisions about treatment due to florid illnesss impairing communication in his native language (not a prejudgement - it was determined)

  2. Risk of violence very high if not treated fast for a manic illness.

  3. Two med recs just after 136B extension (one is mine) agree he needs admssion under S2.

  4. ‘No beds’ - yuh know the usual - where tails wag the Parliamentary head. So that’s going nowhere fast!

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  5. Noctors inform me that senior psychiatrists’ standard practice is to treat under MCA 2005. To which I go ‘That’s fine for them - not for me. Sorry. MCA 2005 is not for treatment of mental disorders where the MHA 1983 would be engaged for treatment in a hospital.’ But who am I - NOBODY - I’m just a locum so NO AUTHORITY. Oh yes - locums are meant to do as told, don’t you all know this? So I’m a ‘recalcitrant nobody’ for not falling in line.

  6. So this is the big gap between the two Acts created by the ‘tails’ that wag the head.

  7. Oral medication: lorazepam and promethazine precribed by somebody - not me - without a jot of a capacity assessement because of no interpreter. P is seemingly immune to the latter oral meds over 24 hours.

So what do I do or not do?

  1. I say that he needs to be treated rapidly as if in a manic illness and to contained clearly linked risk of seriosu violence form a mental disorder.
  2. I decide that common law is more appropriate than to use MCA 2005 which would be void at the outset due to the particular circumstances - and I declare that MCA 2005 is not a substitute for where the MHA 1983 cannot reach.
  3. I decide that is necesssay and proportionate for a one-off dose off lorazepam 1mg IM, to be followed by oral doses - if he takes them - and then review.
  4. Nope - not possible under rapid tranq policy which states that patient must be actually violent. Don’t ask - accept it fact. So the noctor solution is that I must write a PRN stat dose i.e. for noctors to wait on actual violence or near actual violence.
  5. Well no - I’m not doing that sort of delegation under common law - and worse yet waiting for someone to be injured with actual violence. But hey - I understand that noctors have to follow orders; afraid of losing their PIN apparently. But… but it’s fine to act illegally otherwise once covered by policy.

I’m not saying I am right. There may be 50 reasons why I am wrong in my decision-making. Always look for the big picture.