Liberty safeguards in hospitalBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2430 (Published 15 June 2009) Cite this as: BMJ 2009;338:b2430
- Nitin Gupta, consultant psychiatrist1
- 1South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Margaret Stanhope Centre, Burton on Trent DE13 0RB
The interplay of deprivation of liberty safeguards and the Mental Capacity Act is probably most complex in general hospitals.1 People with delirium, dementia, or severe aphasia or who are in coma will lack the capacity to consent to admission or prolonged stay because of their underlying cognitive state.2 Delirium and other neuropsychiatric disorders are often subject to chemical restraint in general hospitals, especially in adult critical care units.3 Such restraint is done in a patient’s best interest but could be regarded as deprivation of liberty under the Mental Capacity Act.
In managing a patient who has delirium in a general ward or intensive care, doctors may need to consider the use of the amended Mental Health Act 2007. However, this may not be immediately possible in an emergency—for example, the patient suddenly becoming aggressive and unmanageable. If a patient experiences repeated episodes of aggression/agitation alternating with lucid intervals, repeated use of restraint is likely to amount to deprivation.4 The Mental Health Act 2007 could be used again, but practice may not be straightforward, especially when a hospital consultant acting in the best interest of such patients tries to ensure that they do not leave hospital before they have recovered or adequate community support has been set up.2 Under the act the hospital consultant has to subsume the role of responsible medical officer.2
Hospital consultants need to be aware of these issues and work with their mental health counterparts in drawing up guidelines (and perhaps protocols). Training and educational programmes for general hospital staff may also be appropriate.
Cite this as: BMJ 2009;338:b2430
Competing interests: None declared.