Use of Section 62 in clinical practice

Sir : Like Johnson & Curtice (Psychiatric Bulletin, April 2000, 24, 154), we have also audited the use of Section 62 (urgent treatment). We studied all Section 62 forms completed at St Andrew's Hospital during 1997. A total of 55 forms were audited, 53 authorising medication and two authorising electroconvulsive therapy (ECT). This contrasts with Johnston & Curtice who found Section 62 was used exclusively for ECT. These findings are likely to be due to differences in patient characteristics between the two studies. St Andrew's has many tertiary NHS referrals including forensic patients, whereas Johnson & Curtice were studying patients of a local psychiatric service.

In our audit, aggression towards self or others and generally disturbed behaviour were the most common reasons for using Section 62. Antipsychotics followed by benzodiazepines were the most frequently administered medicines. In 33 instances patients receiving treatment authorised by Form 39 urgently required additional medication to that certified. Fourteen patients withdrew their consent to treatment at the same time displaying an urgent need for medication. A disproportionate number of Section 62 cases involved adolescent female patients. In virtually all cases treatment authorised by Section 62 appeared genuinely urgent.

We are concerned about the Government Green Paper Reform of the Mental Health Act 1983. It proposes that the threshold for administering emergency medication be increased such that merely preventing violence or self-harm would not be sufficient grounds to authorise urgent treatment. This raises concern about staff and patient safety particularly in forensic settings. Psychiatrists will no longer be able to give urgent ECT to patients who lack capacity or do not consent but must wait for authorisation from a second opinion appointed doctor (SOAD). In our audit SOADs took a mean of 4.8 days to visit and complete Form 39 after Section 62 had been used. If made law this measure is likely to increase the suffering and morbidity of severely depressed patients.