Gemma Buston
PGY3 doctor, UK
Title: The arbitrary distinctions between treatments for mental illnesses and physical conditions under s63 of the Mental Health Act 1983 (UK) disempower patients with mental illnesses.
Biography
Biography: Gemma Buston
Abstract
The Mental Health Act 1983 Code of Practice provides a definition of mental illness as “any disorder or disability of the mind”.This vague definition leaves healthcare professionals with a large amount of flexibility when diagnosing a mental illness. While the Code of Practice recognises that presence of a “mental disorder does not necessarily mean that a patient lacks capacity to give or refuse consent”, section 63’s lack of consideration for consent demonstrates disregard for the patient’s autonomy: “The consent of a patient shall not be required for any medical treatment given to him for the mental disorder from which he is suffering…if the treatment is given by or under the direction of the approved clinician in charge of the treatment.”This author reviewed several cases brought before the UK courts regarding the implementation of section 63: Nottinghamshire Healthcare NHS Trust vs RC; Tameside and Glossop Acute Services Trust v CH; St George’s Healthcare Trust v S; R (on the application of B) v Ashworth Hospital Authority; B v Croydon Health Authority; R v Collins and Anor; and An NHS Trust vs Dr A.The review raises several issues including: the lack of clear definition of “mental illness”, its symptoms and consequent “medical treatment”; the use of section 63 to overrule pregnant patients; and the difficulties encountered when deciding whether a patient is experiencing mental illness or merely engaging in a political protest.In all cases reviewed, the overwhelming finding was that the courts always agreed with the doctors. While emphasis on patient choice and respect for patient autonomy is commonplace within medical practice, mental health practice seems to be lagging behind. As long as mental health law favours doctors’ opinions over the opinions of patients with a mental health diagnosis, such patients will be placed at a significant disadvantage.