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Managing patients with deliberate self harm who refuse treatment in accident and emergency departments

BMJ 1999; 319 doi: (Published 02 October 1999) Cite this as: BMJ 1999;319:916

Advice and procedure require correction

  1. Alastair Hull, specialist registrar in psychiatry (,
  2. Fabian Haut, specialist registrar in psychiatry
  1. Royal Dundee Liff Hospital, Dundee DD2 5NF
  2. Department of Psychological Medicine, John Radcliffe Hospital, Oxford OX3 9DU
  3. Mental Health Act Commission, Maid Marian House, Nottingham NG1 6BG
  4. Leeds General Infirmary, Leeds LS1 3EX
  5. Birmingham Heartlands Hospital, Birmingham B9 5SS
  6. Department of Accident and Emergency Medicine, Leicester Royal Infirmary NHS Trust, Leicester LE1 5WW

    Education and debate p 905

    EDITOR—In their lesson of the week on managing patients with deliberate self harm who refuse treatment in the accident and emergency department Hassan et al recommend that doctors must be fully conversant with the law on assessing capacity to consent to treatment and its application.1 It is equally important in these difficult cases to be familiar with the application of the Mental Health Act 1983 or Mental Health (Scotland) Act 1984, which Hassan et al seem not to be. They state: “If the overdose is considered to be a consequence of a mental disorder then the patient can also be treated medically for the overdose under the terms of the Mental Health Act.” This statement is reiterated in their proposed algorithm, recommended for use at accident and emergency departments. This is simply not the case.

    The Mental Health Act is for the treatment of mental disorders. It does not authorise the treatment of a physical disorder even if it arises as a consequence of a mental disorder. Therefore the Mental Health Act is of no help in the immediate medical management of patients presenting with deliberate self harm and refusing treatment, other than to permit detention in hospital if the patient is considered to be suicidal as a result of mental disorder.

    Treatment for the overdose will remain under common law based on assessment of competency to refuse treatment and the need to preserve life.

    The Mental Health Act states that treatment can be administered only if a patient is not capable of giving informed consent, provided that it is in the patient's best interest, is urgently necessary, and is in accordance with a practice accepted at the time by a responsible body of medical opinion skilled in the particular form of treatment in …

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