v4 Mental Welfare cover - Mental Welfare Commission for Scotland

THE MENTAL WELFARE COMMISSION FOR SCOTLANDAdvice on Reporting an Incident to theCommissionReports should contain the following information• A brief account of the circumstances of theincident.• Information on diagnosis, treatment (if relevant)and the mental state of the person at the timeof the incident.• Information regarding any other person(s)involved in the incident, indicating whetherthey are patients, staff or public.• A note of any changes being considered inprocedure, management, or materialenvironment as a result of the incident.• An indication of any further investigation orenquiry which is being carried out.2.6 CONSENT TO TREATMENTNeurosurgery for Mental DisorderWhen neurosurgery is proposed as a treatment forthe mental disorder of a patient subject to the 1984Mental Health Act, Part X of the Act requires theCommission to arrange the assessment of both theindividual’s ability to consent to it and itsappropriateness for him or her. Commissionersnormally do these assessments. They also carry outequivalent assessments of informal patients; this is bya voluntary agreement with the University ofDundee, which is the centre for this treatmentin Scotland.During the past year, only one new patient wasreferred for assessment. The patient was detainedunder the English Mental Health Act 1983, with along standing treatment-resistant depression, and hadbeen referred to the Dundee Service.The operationproposed was a bilateral anterior cingulotomy.The Commissioners who carried out theassessments confirmed that the patient was capableof understanding the nature of the proposedoperation and had given informed consent to it, andthat the treatment was appropriate.A second patient, who had been assessed for ananterior capsulotomy operation in the previous year,was re-referred. This was because new evidencesuggested that this operation could have a higherrate of adverse effects than the alternative procedureof bilateral anterior cingulotomy. We consideredwhether the proposed change of operation made areassessment necessary. After correspondence withthe patient, we decided that formal reassessment wasnot necessary and that the criteria for going aheadwith the treatment were met.These individuals have now had their operations.Wewill be seeking follow up reports on their progressduring the next year.Mental Health (Care and Treatment)(Scotland) Act 2003Regulations are currently being drafted to providesafeguards for treatments which will be given underthe new mental health legislation. Some new surgicalprocedures, which have been developed for thetreatment of mental disorder, would not be covered bythe sections of the new Act relating to neurosurgery;these are deep brain stimulation and vagus nervestimulation. Because they are recent treatments andinvolve invasive procedures, we think they needspecific safeguards.We have, therefore, recommendedto the Scottish Executive that they should be specifiedas regulated treatments under the Act.Second Opinion WorkSecond Opinions under Sections 48 and 50 of theAdults with Incapacity (Scotland) Act 2000Under Section 48 of the Adults with Incapacity(Scotland) Act 2000, four treatments require theapproval of a second opinion doctor appointed bythe Mental Welfare Commission.The treatments are:drug treatment to reduce sex drive; ECT; abortion;and any medical treatment which is likely to lead tosterilization as an unavoidable result.The number ofsecond opinions carried out in respect of thesetreatments during 2003-2004 is shown in Table 1.Table 1: Second Opinions under Sections 48and 50, 2003-04Section 48 Section 50Medication 17 0ECT 26 0Total 43 020