Navigating the complexities of consent and treatment rights in mental health settings

The case of Nottinghamshire Healthcare NHS Foundation Trust v MC is a helpful decision involving complex issues concerning the treatment and consent of patients detained under the Mental Health Act. It considers the legal framework under section 63 Mental Health Act (MHA) which covers medical treatment of a patient’s mental disorder without consent.

The case involves MC, a 53-year-old man who has been detained under sections 37/41 Mental Health Act in Rampton High Security Hospital operated by the Foundation Trust since January 2005. He suffers from type 1 diabetes (insulin dependent) and his compliance with treatment has been poor during his time in custody. As a result of his poor diabetes management, he suffers from severe hypertension and peripheral vascular disease. In January 2024, MC required a below the knee amputation. While he is non-compliant with blood tests to support with monitoring his blood glucose control, he does not refuse all treatment. For example, MC is sometimes willing to take his insulin in the evening, but he refuses to have his blood sugar levels checked prior to the administration of that insulin by a healthcare worker.

MC has been described as now having ‘end stage complications of diabetes’. He has refused to engage with the treatment plan for his multiple serious complications associated with his poorly controlled diabetes. He refuses most of his daily insulin and its associated testing and refuses to take his medication for his hypertension. 

The Trust’s position is that MC’s refusal to accept medical treatment for diabetes is a manifestation of his severe personality disorder. Treatment for those medical conditions fall within the scope of section 63 MHA and from that it follows that his consent is not required for treatment to be given. Given that MC does not wish to receive treatment, he would have to be subject to restraining and administration of treatment forced upon him which carry the risk of exacerbating the consequence of some his physical conditions.

The Trust applied under the inherent jurisdiction for declaratory relief concerning the medical care and treatment of MC, namely that:

• his treatment fell within scope of section 63 MHA as it constituted treatment for manifestations of his serve personality disorder; and
• it was lawful for MC's treating clinicians not to use force to provide him with medical treatment for his physical health needs even if this leads to adverse health consequences including MC's early death.

Legal framework

The case provides a helpful analysis of the legal framework and case law concerning the principles of section 63 MHA, treatment without consent where adults may have treatment or other measures imposed on them without their consent (as summarised in Mills & Reeve’s reported decision in Nottinghamshire Healthcare NHS Trust v RC) and the section 63 procedure. 

High Court decision

The Court made declarations sought by the Trust that: 

• The treatment of MC’s physical health conditions fell within the scope of section 63 of the MHA as it constituted treatment for manifestations of his severe personality disorder; and
• It was lawful for MC’s clinicians not to use force to provide medical treatment for his physical health needs against his will, even if it led to his premature death.

Comment

This is a ‘finely balanced’ case and one which is fact specific. Balancing patients’ rights and treatment in mental health settings within the legal framework is complex, do contact us if require support or would like to discuss a section 63 matter. 

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