My brother is depressed. He won’t talk about it, see a shrink or take medication (big no-no, see below). He’s been this way for a year and a half now, although he was probably “properly” depressed for 6 months or more before the full breakdown. He’s also been living with my parents for this time.
He’s been sectioned once (about a year ago), but was released after he refused treatment and was determined not to be a threat to himself or others.
As I can’t discuss it with him (he just walks away), I assume that the following is what he’s thinking. He has Crohns disease (roughly, ulceration of the digestive tract), which meant he needs to take the steroid prednisolone. This has led to a lot of thinning of his hair and has some nasty side effects re: moods and depression (when taken). I suspect that in the last of his (infrequent) visits to the specialist before he flipped, he was told he’d probably need a colostomy in the future.
At that point, he seems to have decided that all his problems were due to prednisolone and medication in general. This includes anything, natural remedies (such as aloe vera juice) or drugs, and is not restricted to medication for his Crohns. He’s stopped taking prednisolone, but is not rational enough to try to moderate his diet to control it (which would probably not be possible in his case - he has extensive and severe Crohns). I personally think that, after years of denying it was a problem (he wouldn’t talk about it, and we’re a fairly open family), he’s suddenly decided that his life is over, all he can look forward to is pain and he’ll never find a partner.
Anyway, my question is can we make a case that he is a threat to himself? Any damage suffered in his regular flare-ups is permanent and will, if not treated at the time of the flare-up, eventually lead to an inability to process solids. I’d rather force him to be sectioned, strapped down and medicated than see him continue to die by inches.
It depends on what is termed ‘Capacity’ - has he the capacity to make the decision on his health. The presumption is that all adults and many children (Gillick competence) have capacity to make such decisions unless there are specific reasons why they may be deemed to have lost capacity.
I believe that case law is quite firm on the case that the Mental Health Act 1983 cannot now be used alone to enforce treatment for physical illness, only for ‘mental illness’ and conditions directly consequent on mental illness (dehydration etc.)
If your brother has a non-psychotic depressive illness, it is most unlikely that he would be deemed to have lost capacity. It would probably require a legal hearing to determine that he had lost capacity to make such a decision. There is a remote possiblity that if he was psychotic and had a delusion about his medical care that made him refuse treatment, that some doctors and social workers might try to use the MHA, but IMHO I think that that would now be promptly overturned by a Tribunal, and the case referred to the courts for decision.
Recent cases have involved:
-a woman forced to have a caeserian section under the MHA- now overturned- a woman can refuse a caeser even unreasonably.
-treatment of anorexics made increasingly difficult under MHA.
-Ian Brady- wanted to starve himself- treatment not given under MHA but under common law after court decision.
I am now retired and do not have the ‘Bible’ - Sweet and Maxwell on case law in Mental Health, so above is from memory.
Do ask for any clarification- I’m on line on and off throughout the day.
He’s moody, unreasonable, sullen, grunts rather than talks, but he’s not psychotic.
I suspect his case would be treated in a similar fashion to a depressed anorexic. When he was sectioned, he “woke up” and demanded legal representation etc… He was out within two days. Unfortunately, now he won’t go and see his doctor for blood tests because of the failed sectioning.
The current “plan” is to wait until he collapses/ruptures and then medicate him (for both problems) whilst he’s unconcious. It’s a shitty system.
I think that you might find that the doctors would be unwilling to intervene if he had made his resistance to treatment clear recently. The case of Ms. B (on respirator, wanting it switched off) heard recently has made doctors more careful about the concept of ‘doctor knows best’. In that case the judge set nominal damages against the Trust (about £1000 IIRC) and this was a sign if other doctors acted that way, damages in future might be substantial- Trust solicitors may well advise that treatment without consent would expose the Trust to risk.
Additionally, one must see the patient’s POV- so far he has been ‘mistreated’ by his doctor and psychiatrists, so he is avoiding them. If he finds himself ‘mistreated’ again, he may decide to make a living will that would ensure no treatment.
It may be the case that all will have to accept that he has the right to mis-lead his life like anyone else- his depression is just a sise issue.