Nigel Turner's HyperGUIDE to the Mental Health Act

Section 58

Treatment Which Requires Consent OR a Second Opinion

Section 58 sets out requirments in respect of treatments which can be given to people who are detained under certain Sections without their consent, or in cases where the person is not able to give their informed consent to that treatment. [Some treatments cannot necessarily be given even if the person consents, see Section 57.]

The treatments which fall under Section 58 requirements are:

medication for the person's mental disorder, if 3 months have gone by since the person first had the treatment during their current period of detention under the Act. In the first 3 months the treatment can be given without consent, and without the Section 58 requirements being necessary. The 3-month period starts when medication for the mental disorder is first given and the "clock keeps running" even if there is a break in the medication, the Section is renewed or the type of medication changes. [This category of treatment is written into the Act itself].
electro-convulsive therapy [ECT]. This form of treatment involves passing an electric current through the (anaesthetised) patient's brain, inducing a type of seizure, and is felt to be beneficial in certain types of depression. Some doctors use it for other forms of mental illness. [This is a category added by the Secretary of State for Health - further categories could be added].

Section 58 deals with three possibilities:

that the person concerned is capable of understanding the nature, purpose and likely effects of the treatment and consents to it.
that the person concerned is capable of understanding the nature, purpose and likely effects of the treatment and does not consent to it.
that the person concerned is not capable of understanding the nature, purpose and likely effects of the treatment and therefore cannot consent to it.

In case 1 above, the Responsible Medical Officer [RMO] has to certify in writing that understanding and consent are present. In cases 2 and 3, a doctor is appointed by the Mental Health Act Commission to give a second opinion. The appointed doctor must consult two people who have been professionally involved in the patient's medical treatment, one of whom must be a nurse and the other can be neither a doctor nor a nurse. The second opinion appointed doctor can then:

certify that, despite lack of consent or lack of understanding, the patient should nevertheless be given the treatment, having regard to the likelihood of it alleviating or preventing a deterioration of the patient's condition, or
if the second opinion is that understanding and consent are present, certify that case 1 applies.

Plans of Treatment

The certificates mentioned in this section must state the plan of treatment in fairly precise terms. In the case of medication, this will mean stating what types of medication are to be given and a range of doses. In the case of ECT it will mean details of the number of treatments. If the plan of treatment is to be changed, fresh certificates are needed.

Doctors and Nurses needs to satisfy themselves that proper certificates are in place. If, where Section 58 applies, they provide treatment which is outside the scope of the Section 58 certificate, it is possible that this might constitute an assault.

The provisions of Section 58 do not prevent treatment being given in an emergency, as set out in Section 62.

Certain types of medication require patients to undergo regular blood tests. The Mental Health Act Commission has issued specific guidance on such treatments.

Overview page. Contents page. Introduction page.

This page last revised 6 May 1996
While every effort has been made to ensure the accuracy and reliability of information in these pages, they are not intended to be relied upon as an authoritative statement of the law. The author cannot accept liability for errors or omissions.