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Home | Articles | Psychiatry | Compulsory Admission and Treatment

Compulsory Admission and Treatment

Last updated 23rd February 2024

General Principles

  1. Patient must have refused voluntary treatment.
  2. Patient must have known/suspected psychiatric disorder – this covers DTs, & acute psychosis secondary to drugs but not drug dependency.
  3. Patient must require hospital admission or to stay in hospital in the interest of their health and safety, or the health and safety of others.
  4. The Dumfries & Galloway Social Work Regional Statutory Mental Health Team Briefing Note is a useful document.

Emergency Detention

  1. The Emergency Detention Certificate allows you to detain a patient for up to 72 hours under the Mental Health Care & Treatment Scotland Act 2003 – click on link below to download.
  2. Any registered doctor (but not the FY1) can complete it – the form is straightforward and requires that 6 detention criteria are satisfied.
  3. It is best but not absolutely necessary to contact a Mental Health Officer (MHO) who is usually a duty social worker with training in psychiatry. Switchboard will put you through.
  4. Nearest relative should, where possible, also be involved in discussion, but cannot give or refuse consent under new act.
  5. In an emergency doctor may act unilaterally. This is ok provided all possible steps to contact MHO are taken asap. Failure to obtain consent from MHO or to explain why consent not obtained, means that detention is unlawful.
  6. The Emergency Detention Certificate does not give authority to treat against patient’s wishes, although life saving treatment can be given under common law if patient is a danger to himself or to others.
  7. There are other detention orders eg Short Term Detention Order, but these aren’t usually necessary in the scenarios commonly encountered on the medical wards important to inform of detention and any urgent treatment given
  8. You must send the completed Emergency Detention Certificate to the Mental Health Act Administrators as soon as possible after the patient has been detained.  Phone Andrew Muir on Ext 34101 to arrange – he will probably send a porter across to collect.  Andrew will then forward to Mental Welfare Commission.  Please note that the ORIGINAL form must be sent and NOT A COPY.

Compulsory Treatment

  1. In an emergency this can be done under Common Law ie you can treat a patient without their permission if they have refused voluntary treatment, have a known or suspected psychiatric disorder and are a danger to themselves or to others.
  2. Better is to use Section 243 of the Mental Health Care & Treatment Scotland Act 2003, subsections 2 and 3 of which are given in the box below
  3. There are other ways of giving treatment wthout permission eg Compulsory Treatment Orders (CTOs) but these arent usually appropriate in the event of an emergency
  4. Important to inform Mental Health Administrator, Mr Andrew Muir ext 34101, of detention and any urgent treatment given so that he can inform consultant psychiatrist, who in turn should inform the Mental Welfare Commission.

Section (2)

  • Where it is necessary as a matter of urgency for medical treatment to be given to the patient for any of the purposes mentioned in subsection (3) below, the treatment may, providing that it does not entail ECT and only if it is unlikely to entail unfavourable and irreversible physical or psychological consequences to the patient, be given notwithstanding that the patient
    • (a) does not consent or
    • (b) is incapable of consenting to the treatment

Section 3

  • The purposes of such treament are:
    • (a) saving the patient’s life;
    • (b) preventing serious deterioration in the patient’s condition; .
    • (c) alleviating serious suffering on the part of the patient; and .
    • (d) preventing the patient from
      • (i) behaving violently or
      • (ii) being a danger to the patient or to others.

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