![FD24F00084 - [2025] EWHC 920 (Fam)](https://backend.juristeca.com/files/emisores/logo_0FrGysm.png){kind=logo}
Treatment Without Consent
Treatment Without Consent
As summarised by Mostyn J in Nottinghamshire Healthcare NHS Trust v RC [2014] EWCOP 1317 (“Nottinghamshire”) at §13, there are three circumstances where adults may have treatment or other measures imposed on them without their consent:
Adults lacking capacity who pursue a self-destructive course may have treatment forced upon them in their best interests pursuant to the terms of the Mental Capacity Act 2005;
Similarly, adults who have capacity but who can be categorised as ‘vulnerable’ and who as a consequence of their vulnerability have been robbed of the ability to give a true consent to a certain course of action, may also have treatment or other measures imposed on them in their best interests pursuant to the inherent jurisdiction of the High Court (see DL v A Local Authority [2012] 3 WLR 1439, and Re SA (Vulnerable adult with capacity: marriage) [2006] 1 FLR 867);
Under the MHA a detained patient may have treatment imposed on him pursuant to section 63 which provides, so far as is relevant to this case:
“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”.
Section 63 MHA must be read in conjunction with section 145 MHA as follows:
“medical treatment” includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care (but see also subsection (4) below);
Any reference in this Act to medical treatment, in relation to mental disorder, shall be construed as a reference to medical treatment the purpose of which is to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations
Counsel specifically referred me to Guidance outside the case law. First The MHA Code of Practice (published in 2015), prepared in accordance with section 118 MHA by the Secretary of State for Health, at §23.5 where it is set out that:
“Symptoms and manifestations include the way a disorder is experienced by the individual concerned and the way in which the disorder manifests itself in the person’s thoughts, emotions, communication, behaviour and actions. It should be remembered that not every thought or emotion or every aspect of the behaviour, of a patient suffering from mental disorder will be a manifestation of that disorder” (emphasis added)
Second, in the latest edition of the Mental Health Act Manual (27th Edition), at §1-849, Professor Richard Jones explains that:
“If a patient’s refusal to pay attention to his personal hygiene or to be treated for a physical condition is assessed as being a manifestation or symptom of his mental disorder, the patient can be washed and/or treated under the authority of the Croydon case as both nursing and specialist care come within the definition of ‘medical treatment’ in s.145(1)”
In R (on the application of B) v Ashworth Hospital Authority [2005] UKHL 20 it was held by the House of Lords (Lady Hale at §29), that section 63 MHA authorised a patient to be treated for any mental disorder from which he was suffering, irrespective of whether this fell within the form of disorder from which he was classified as suffering in the application, order or direction justifying his detention.