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The Treatment Test
When you go into hospital you expect to receive treatment – but what does treatment actually mean? When we think about people being admitted to hospital under the Mental Health Act it is a very important question. If you are to be admitted under Section 3 of the Mental Health Act, there has to be appropriate medical treatment available to you. So in this article, I want to look further at what is meant by the word 'treatment', and the word 'available', and the word 'appropriate'!
When we think about treatment for a mental disorder, we might think about oral or intra-muscular medication. We might think of psychological treatment or other talking treatments. The definition is a lot wider than that.
Admitted for Treatment
Firstly let’s see what this part of the Mental Health Act is all about. Really it is saying that if you’re to be admitted to hospital under Section 3 of the Mental Health Act for a period of up to six months, you can only be admitted for treatment, not just to be accommodated and detained in a hospital ward. That sounds reasonable enough but there are reasons behind this safeguard. This ‘treatment’ requirement does not apply to people admitted under the shorter Section 2 for a period of up to 28 days. That section is primarily designed for a period of assessment before deciding what treatment is appropriate.
The Mental Health Act states that someone can only be admitted under Section 3 if appropriate medical treatment is available for him (and her but the MHA only talks about him!). What do those words mean? Let’s go back to where I started and see what treatment means. The Act itself says ‘references to appropriate medical treatment…are references to medical treatment which is appropriate in his case, taking into account the nature and degree of the mental disorder and all other circumstances of his case’. Let’s analyse that for a second, appropriate medical treatment is medical treatment that is appropriate! That doesn’t tell us much more as to what treatment means. I’ll come back to the word appropriate shortly. A little-known section of the Mental Health Act, section 145 has a whole list of definitions of terms that might be open to interpretation. Here it says treatment includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care. Chapter 23 of the Code of Practice (the ‘how to guide’ to the Mental Health Act) draws the distinction between habilitation which it says is about giving someone living skills they’ve never had, and rehabilitation which is about re-equipping someone with skills lost. So we’ve got a wide spectrum of what medical treatment is all about – as I said at the beginning it is not just about medicine. But it’s more than just providing a hospital bed. The Code goes on to say that simply detaining someone does not constitute medical treatment.
Treatment with a Purpose
Finally, on treatment itself, Section 145 goes on to say that ‘medical treatment is…medical treatment the purpose of which is to alleviate, or prevent the worsening of, the disorder or one or more of its symptoms or manifestations.’ Let’s just think about what that means. It doesn’t require us to make any predictions as to whether the treatment will make things better, just that the purpose is to make things better or at least stop them getting worse. I’ve used the word ‘things’ here, perhaps that’s unhelpful, as you can see the definition is about either alleviating the mental disorder itself or if not, at least one of the symptoms or manifestations of the disorder. Richard Jones talks about these terms in his Mental Health Act Manual, reflecting on discussions in Parliament when changes were being made to the Mental Health Act more than ten years ago. So symptoms are more likely to be what the patient experiences, and manifestations might be what other people observe in terms of the person’s mental disorder. So appropriate treatment is treatment with a purpose. But there are other factors to be taken into account in considering if treatment is appropriate. Remember as I said above, the Act tells us it must be appropriate given the nature and degree of the mental disorder, and all other circumstances of the patient’s case. So it’s not just a clinical definition, it’s a holistic definition, taking into account the patient’s physical health, their age, their culture, family relationships, the patient’s view of the treatment and more (there’s a full list of examples of ‘all’ circumstances in Chapter 23 of the Code of Practice.) Now if those circumstances include the importance of finding a hospital nearby, then the range of treatment options may be limited. However, the decision-makers in considering admitting someone under the Mental Health Act must be able to say they have considered all aspects of the person before being able to say they have identified appropriate treatment.
So we’ve dealt with the word treatment, and the word appropriate. There’s one more test - availability. The appropriate medical treatment must be available, and available to the person. It is not sufficient to say it might be available, or available somewhere else, or at some future time. That requirement is reinforced because doctors must write down the name of the hospital where the treatment is available, and that must be the hospital that accepts the person for treatment.
The Reasons for the Test
Why is the wording of this treatment test so important? Consider what was happening before changes to the Mental Health Act. The treatment test then was more rigorous. The disorder had to be ‘treatable’. That meant some people, particularly those with personality disorders, were excluded from hospital treatment. On the other hand, consider what happens if there is no test at all. People may be admitted against their will merely to detain them for their own safety or the safety of others, with no therapeutic intervention at all.
Getting too Technical
Finally, this may seem very technical unless you are involved in operating the Mental Health Act. However, in your role, you may be asking mental health professionals to assess someone in your care. I think it useful to know the criteria they are working to when they assess someone under the Mental Health Act. I think the definitions in the test are also worth thinking about when someone is admitted to any care setting. What is the nature of the care you are providing, what is its purpose, is it appropriate, and is it available?
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