The provisions in the Act for community counselling orders and community treatment
orders" allow treatment and care outside the hospital setting, either without
hospitalisation or following it. They also provide for the consequences of breach of
community counselling or treatment orders, including apprehension by the police who are
empowered to enter premises using reasonable force alvd
-
to
-
apprehend the person without
a warrant. The purpose of such apprehension is to take the person to the appropriate
health care agency. In the case of a community treatment order, this may include a
hospital. In the case of a community counselling order, a person can not be forced to take
medication. A non-compliant person could, however, be subject to involuntary admission
procedures where these are appropriate.
The Mental Health Act makes special provision in relation to specific forms of treatment
for mental illness, particularly psychosurgery and electro convulsive therapy (ECI), both
of which are the subject of elaborate safeguards. Certain forms of treatment, including
deep sleep and insulin coma therapy, are prohibited. These provisions of the Act apply
not only to patients in public hospitals but also to private psychiatric patients or patients
in general hospitals'.
Safeguards concerning ECT include the mandatory administration of anaesthesia"; a
requirement that at least two medical practitioners be present during the therapy'
s
; and
the requirement that ECT be administered only at a hospital or a place approved by the
Director-Genera1
25
. There are also detailed requirements for obtaining informed consent
prior to the administration of ECT, including the provision of "a fair explanation ... of
the techniques or procedures to be followed"; "a full description ... of possible attendant
discomforts and risks"; and "a full disclosure ... of appropriate alternative treatments, if
any
.26
.
Where a person is considered incapable of giving informed consent or has refused and is
in a life threatening emergency, two medical practitioners, one of whom must be a
psychiatrist, must certify that ECT therapy is reasonable and proper and necessary
immediately to save the patient's life. This must be followed up by a written report to the
Mental Health Review Tribunal. If the patient still does not consent, the Mental Health
Review Tribunal can determine whether ECT therapy is necessary or desirable for the
safety or welfare of the patient
n
.
Psychosurgery cannot be performed unless the Psychosurgery Review Board consents,
regardless of whether the person concerned consents. The Psychosurgery Review Board
consists of seven part-time members, including a legally qualified President, a neuro-
surgeon, a neurologist or neuro-scientist, a clinical psychologist, a person nominated by
the Council for Civil Liberties and two psychiatrists'. Before consenting to
psychosurgery, the Board must conduct a public hearing at which the would-be patient
may be legally represented. The Board must be satisfied that the patient is capable of
giving informed consent; that the psychosurgery proposed has clinical merit; that the
doctors are properly qualified; and that the hospital is a proper place at which to perform
it. Where the Board is not satisfied that a patient is capable of giving consent but is
satisfied of the other matters set out above, the Board must state a case for the Supreme
Court which may determine whether a patient is capable of giving informed consent and,
if not, whether it should give consent on the person's behalf.