Section 58 defines treatments requiring either competent consent or, if this not possible, a second opinion. It applies immediately to ECT, and to drug treatments given beyond 3 months.
Note that the Mental Health Act 2007 has made specific safeguards to the use of ECT:
- except in emergencies, detained patients may in future only be given ECT if they have capacity and agree or, if they do not have capacity, the ECT is authorised by a Second Opinion Appointed Doctor (SOAD
- this means that a detained patient can refuse to have ECT, and, except in emergencies, this can be overturned only if a SOAD agrees that the patient does not have capacity to make the decision and that giving the ECT treatment would be appropriate. In this case, the SOAD also needs to be sure that there is no valid advance decision refusing the use of ECT. If such an advance decision has been made, then ECT cannot be given, except in an emergency
- in the case of young people (aged under 18), even if the patient agrees, unless it is an emergency, they may only be given ECT with the additional agreement of a SOAD. These rules apply to young people whether or not they are detained
- in all these cases, it is only an emergency if the ECT is immediately necessary to save the patient’s life or prevent serious deterioration in their condition