Journal of Psychiatric and Mental Health Nursing, 2005, 12, 317324

The powers and duties of psychiatric nurses under the Mental Health Act 1983: a review of the statutory provisions in England and Wales
G. D. HOULIHAN
SRN RMN BN(Hons) LLM PGCE RNT FLS

Senior Lecturer, School of Care Sciences, University of Glamorgan, Pontypridd, South Wales, UK

Correspondence: G. D. Houlihan School of Care Sciences University of Glamorgan Pontypridd South Wales CF37 1DL UK E-mail: ghouliha@glam.ac.uk

HOULIHAN G. D. (2005) Journal of Psychiatric and Mental Health Nursing 12, 317324 The powers and duties of psychiatric nurses under the Mental Health Act 1983: a review of the statutory provisions in England and Wales This paper examines the powers and duties that psychiatric nurses have under the Mental Health Act 1983 with respect to the care and treatment of mentally disordered people. This statute saw for the rst time specic reference to the powers and duties of psychiatric nurses. These powers and duties are primarily concerned with the nurses role in relation to consent to treatment, the administration of medication, the right to be consulted and to ensuring that detained patients are informed of their rights under the 1983 Act. The 1983 Act also provides and extends the powers of psychiatric nurses to detain certain inpatients with mental disorder against their will. In order to avoid the potential charges of treatment without consent and unlawful detention, it is vital that psychiatric nurses, when caring for this client group, have a sound working knowledge of their powers and duties under current legislation. The legal denitions of mental disorder are explored as well as the issue of treatabilty for mental disorder in clinical practice. Keywords: Mental Health Act 1983, nurse, powers and duties, psychiatry
Accepted for publication: 21 February 2005

Introduction
The statutory provisions for the compulsory care and treatment of mentally disordered patients in the United Kingdom are contained within the 1983 Act. Aligned with the 1983 Act is the Mental Health Act 1983 Code of Practice (Department of Health and Welsh Ofce 1999). The Code of Practice (Department of Health and Welsh Ofce 1999) seeks to interpret the main provisions of the 1983 Act and in so doing sets out guidelines for good practice when applying the legislation. Although these guidelines are not binding legally, failure to comply with them can be used in evidence in any legal proceedings. No one may be detained under the 1983 Act unless suffering from mental disorder. The 1983 Act seeks to provide appropriate care for the mentally disordered and to safeguard those who are not
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mentally disordered against wrongful detention (Fennell 1996). The 1983 Act is based upon a legal classication of mental disorder and is arranged in 10 parts, some of which are particularly relevant to psychiatric nursing practice. There are three basic civil admission procedures under the 1983 Act where a person can be compulsorily detained. The short-term powers are: admission for assessment with or without treatment for up to 28 days (1983 Act section 2) which is not renewable; emergency admission for assessment for up to 72 h (1983 Act section 4); and the longer term power to admit for treatment for up to 6 months, renewable for a further 6 months, and thereafter for periods of up to 12 months at a time (1983 Act section 3). The 1983 Act is divided into 10 parts, these relate to various aspects of care for those individuals subject to the
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provisions of the Act. The 1983 Act also builds on and extends the provisions of the Mental Health Act (1959), with the main objective of improving the rights of patients. This is especially the case with respect to consent to treatment (Part IV) and the care of mentally disordered offenders (Part III) (Bluglass 1985). Although, the basic structure and philosophy of the 1959 Act remains unchanged, the 1983 Act saw the introduction for the rst time specic reference to the powers and duties of psychiatric nurses. Before considering these powers and duties, it is important and necessary to identify how the 1983 Act seeks to dene mental disorder.

The 1983 Act denes four more specic categories of mental disorder. For admission under long-term powers of detention under section 3 for treatment or for a criminal court to sentence a person to a hospital order the person must be suffering from one of the following four more narrowly dened forms of mental disorder.

1. Mental illness
Interestingly, neither the 1983 Act nor the Code of Practice (Department of Health and Welsh Ofce 1999) denes mental illness. However, in W v L (1974) Lord Justice Lawton stated that because the words mental illness are ordinary words of the English language, and have no particular legal or medical signicance, they should be construed in the way that ordinary sensible people would construe them. Hoggett (1996) nds this ruling unhelpful arguing that this man must be mad test fails to acknowledge any of the more appropriate and useful medical denitions of mental illness. Cavadino (1991) concurs with this view by suggesting that the lay public have limited and often distorted beliefs about mental illness. Therefore, it is argued that greater emphasis should be given within the 1983 Act to the medical meaning of mental illness. Fennell (1997) also argues that if a lay view were enough to determine the question, any distinction between the different forms of mental disorder would soon disappear, and the legal concept of mental illness would become signicantly less well dened than the clinical equivalent.

Denition of mental disorder

Section 1(2) of the 1983 Act provides a broad denition of mental disorder as mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind. This denition applies to the short-term powers of detention which include the powers to admit a patient for assessment or as an emergency admission. This statutory denition of mental disorder is important, as unless a person can be diagnosed as mentally disordered according to that denition, the statutory provisions of the 1983 Act cannot be applied to them. Nevertheless, because the denition is so broad, any other disorder or disability of mind would be grounds to admit people with neurotic disorders, personality disorders (not amounting to psychopathy), behavioural disorder and people who have been mentally disabled by head injuries. The scope of the denition also provides for the shortterm admission of people with a learning disability on the grounds of arrested or incomplete development of mind or any other disorder or disability of mind. However, for a person with a learning disability to be admitted under long-term powers of detention they must also demonstrate abnormally aggressive or seriously irresponsible conduct. This effectively excludes most people with learning disability from admission to hospital under long-term powers of detention. This satised the original concerns of the lay organizations, especially the learning disability charity MENCAP, that people with a learning disability might be liable to be detained under long-term powers. However, Thomas (1996) argues that this has resulted in some vulnerable offenders with a learning disability remaining in prison and being denied the care and treatment they require because they do not full the additional criteria that their impairment of intellectual and social functioning is associated with abnormally aggressive or seriously irresponsible conduct.
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2. Severe mental impairment

This is as a state of arrested or incomplete development of mind which includes severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible behaviour on the part of the person concerned.

3. Mental impairment
This is dened as a state of arrested or incomplete development of mind (not amounting to severe mental impairment) which includes signicant impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible behaviour on the part of the person concerned. The change in denition introduced in the 1983 Act has meant that people with learning disabilities are not liable to detention or reception into guardianship or supervision under those sections of the 1983 Act which require a specic diagnosis (sections, 3, 7, 36, 38, 47, 48), unless their conduct is abnormally aggressive or seriously irresponsible.

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The Code of Practice (Department of Health and Welsh Ofce 1999) also emphasizes that no patient should be given the legal classication mental impairment without an assessment by a consultant psychiatrist in learning disabilities and without a formal psychological assessment. This appraisal should be carried out by the whole multidisciplinary team, within which the nursing staff should have an active part.

hospital would not prevent deterioration in the patients condition. This has been established at common law in R v Cannons Park Mental Health Review Tribunal ex parte A (1994), where it was held that treatment which was likely to prevent deterioration in the patients condition rather than alleviate it satised the wording of the 1983 Act.

General duties and powers of nurses

Staff in psychiatric hospitals are under a duty imposed by section 127 of the 1983 Act, not to ill-treat or wilfully neglect any inpatient. Breach of this duty is a criminal offence and is contrary to the Nursing and Midwifery Council (2002) Code of Professional Conduct which states that as a registered nurse or midwife . . . you must protect and support the health of individual patients and clients. The common law also imposes a duty on hospital staff to take reasonable care of the patients in their charge (Fennell 1984, Jones 2002). In R v Newington (1990) it was held that for there to be a conviction of ill-treatment under section 127, the Crown would have to prove: (1) deliberate conduct by the accused which could properly be described as ill-treatment irrespective of whether it damaged or threatened to damage the patients health; (2) a guilty mind involving either an appreciation by the accused that they were inexcusably ill-treating a patient, or that they were reckless as to whether they were inexcusably acting in that way; and (3) that the patient was a mentally disordered person within the meaning of section 1 of the 1983 Act. The Court found that for the offence to have been committed there is no need for the prosecution to show that the treatment caused actual injury to the victim (Jones 2002). Thus, ill-treatment may include inadequate feeding, heating and the use of harsh words as well as what would be ordinarily understood to be ill-treatment (Gunn 1990).

4. Psychopathic disorder
This controversial diagnosis (Herschel 2002) is dened in the 1983 Act as a persistent disorder or disability of mind (whether or not including signicant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible behaviour on the part of the person concerned. The issue of whether psychopathic disorder is a mental disorder continues to be debated as does the issue of whether it is amenable to any form of treatment (Jones 2002). The signicance of the word persistent is that there must be signs that the disorder has existed for some time before a patient is classied as suffering from psychopathic disorder. However, the existence of mental disorder alone is never enough to justify detention of the patient. According to the 1983 Act the mental disorder must be of a nature or degree which warrants detention in hospital for assessment (or for assessment followed by treatment) and such that the patient ought to be detained in the interests of his health or safety or for the protection of others. Also, a patient may only be admitted for treatment under section 3 if the treatment cannot be provided unless he is detained under this section. In R v Hallstrom (1986) it was held that admission for treatment under section 3 is intended for those whose condition is believed to require treatment as an inpatient.

Treatability for mental disorder

A person suffering from psychopathic disorder or mental impairment can only be admitted under the 6-month admission for treatment power (1983 Act section 3) or under a hospital order (1983 Act section 37) or transferred from prison after sentence (1983 Act section 47) if medical treatment in hospital is likely to alleviate or prevent deterioration in his condition. However, under section 145 of the 1983 Act medical treatment is dened broadly to include nursing, care, habilitation and rehabilitation under medical supervision, thus conferring signicant discretion on the psychiatrist in charge of treatment to say whether a patient is treatable. It would be hard to sustain the argument that nursing care and habilitation or rehabilitation in

Duty to give patients information regarding their rights under the 1983 Act
Under section 132 of the 1983 Act, hospital managers have a duty to take all practical steps to ensure that patients understand which provision of the 1983 Act they are detained under and the effects of that provision. This includes any rights to appeal to a Mental Health Review Tribunal which provides for an independent review of the patients detention. This duty is frequently carried out by psychiatric nursing staff and the information should be given every time the patients legal status changes. These steps should be taken as soon as possible after commencement of detention, and should be given both verbally and in writing. Particular information should be provided with respect to who has the power of discharge and in respect to
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the patients right to complain to the Mental Health Act Commission. The effect of part IV of the 1983 Act should be explained concerning consent to treatment and the right to a second opinion for certain treatments. A record should be kept of the information given, including how, when, where and by whom it was given (Code of Practice (Department of Health and Welsh Ofce 1999)). It is also the duty of the hospital manager, who is often a nurse, to arrange for the review of the patients detention. Information should also be given to the patients nearest relative regarding the patients rights and also with respect to the power of discharge that the nearest relative has. The 1983 Act, therefore, gives detained patients the right to get verbal and written information about the powers under which they are held, and about appeal procedures, consent to treatment, correspondence and other matters, but makes no such provision for informal patients. This discrepancy is perhaps most obvious in secure psychiatric facilities, where ofcial leaets are given and explained to all patients except the minority who are resident informally (Sugarman & Collins 1992). A postal survey by The National Association for Mental Health (MIND) collected information on 516 people, 80% of whom had been admitted informally at some time; a signicant number of these felt they had not received enough information about their treatment generally in the past (cited in Rogers et al. 1993). The situation of informal psychiatric inpatients in England and Wales remains a cause for concern, as the basic right to treatment by consent is not set out in statute for them. Many patients are illinformed about their informal status and would benet from a right to information like that provided for patients who have been detained compulsorily under the 1983 Act. Because the nurse is often called upon to meet these important duties, it is vital they are adequately prepared. This may not be the case in many instances. In reality mental health legislation is not given the necessary emphasis either in pre or post-registration nurse training. This is especially the case when compared to approved social workers who receive 60 days specic training in all aspects of the application of the 1983 Act.

1998) to detain certain mentally disordered patients against their will for up to 6 hours. For the purposes of section 5(4) of the 1983 Act, a nurse of the prescribed class shall be a nurse registered in any part of the Register maintained under section 7 of the Nurses, Midwives & Health Visitors Act (1997). The parts of the Register are: part 3 (rst level nurses trained in the nursing of persons suffering from mental illness); part 4 [second level nurses trained in the nursing of persons suffering from mental illness (England and Wales)]; part 5 (rst level nurses trained in the nursing of persons suffering from learning disabilities); part 6 [second level nurses trained in the nursing of persons suffering form learning disabilities (England and Wales)]; part 13 (nurses qualied following a course of preparation in mental health nursing); part 14 (nurses qualied following a course of preparation in learning disabilities nursing). This Order has extended the categories of nurse who are prescribed for the purposes of section 5(4) of 1983 Act.

The power
Section 5(4) of the 1983 Act provides that if, in the case of a patient who is receiving treatment for mental disorder as an inpatient in a hospital, it appears to a nurse of the prescribed class that the patient is suffering from a mental disorder to such a degree that it is necessary for their health or safety or for the protection of others for the patient to be immediately restrained from leaving hospital. It must also appear to the nurse that it is not practicable to secure the immediate attendance of a doctor for the purpose of furnishing a report under section 5(2) of the 1983 Act Doctors Holding Power, which allows the patient to be detained for up to 72 hours. It is important to note that it would not be appropriate or justied for a nurse to invoke section 5(4) where the doctor is in the close vicinity of the ward and could attend in a short space of time. The nurse must record the above fact in writing; and in that event the patient may be detained in the hospital for a period of 6 hours from the time when that fact is recorded or until the earlier arrival at the place where the patient is detained, of a doctor having the power to furnish a report under that subsection. The Code of Practice (Department of Health and Welsh Ofce 1999) offers guidance and sets out the circumstances in which a nurse of the prescribed class may lawfully prevent an informal inpatient, receiving medical treatment for mental disorder, from leaving hospital. It recommends that before using the power the nurse should assess the likely

The nurses holding power

The 1959 Act contained no statutory mechanism whereby a nurse could restrain an informal patient from leaving hospital where the nurse in circumstances where the nurses clinical judgement indicated that the patient should be detained in hospital (Fennell 1984). Hence, section 5(4) Nurses Holding Power of the 1983 Act saw the introduction for the rst time in law, statutory powers for nurses of the prescribed class (The Mental Health (Nurses) Order
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arrival time of the doctor as against the likely intention of the patient to leave. It suggests that most patients who express a wish to leave hospital can be persuaded to wait until a doctor arrives to discuss it further; but where this is not possible the nurse must try to predict the impact of any delay upon the patient. The Code of Practice (Department of Health and Welsh Ofce 1999) suggests that the nurse should also assess the consequences of a patient leaving hospital immediately with respect to the harm that might occur to the patient or others. The nurse must take into account the patients expressed intentions, the likelihood of the patient committing suicide, the patients current behaviour and in particular any changes in usual behaviour, the likelihood of the patient behaving in a violent manner, any recently received messages from relatives or friends, any recent disturbance on the ward, and any relevant involvement of other patients. The nurse also needs to assess the patients known unpredictability and any other relevant information from other members of the multidisciplinary team. The assessment should precede any action, however, in acute emergencies the nurse may invoke the power without carrying out the proper assessment. Fennell (1984) points out that section 5(4) does not apply to the situation where the patient is not intending to leave hospital but the ward staff believes the patients behaviour is such that seclusion from the rest of the patients on the ward is appropriate. Placing an informal patient in seclusion would almost invariably amount to detention of the patient for the duration of the period of seclusion. Therefore, nursing staff need to be sure they are acting lawfully if a charge of false imprisonment is to be avoided (Fennell 1984). There is also no right under section 5(4) to give any treatment to the patient without his consent. The power is concerned solely with restraining the patient from leaving hospital. This might give the nursing staff practical problems of patient management during the 6 hours if the patient is grossly disturbed and aggressive. However, depending on the severity of the patients behaviour, it might be possible, under the doctrine of necessity, to seclude or administer a short acting sedative. This would require that the patients mental disorder precluded any rational communication with him, and a reasonable person would conclude that such action would be in the patients best interests (Jones 2002). In practice it is doubtful whether nurses would be prepared to administer treatment under the doctrine of necessity for fear of subsequent litigation. The decision of when to invoke section 5(4) is the personal decision of the nurse who cannot be instructed to exercise this power by anyone else. However, these powers under the 1983 Act appear to be discretionary. The law has

left the decision as to when to invoke section 5(4) up to individual nurses whose knowledge and risk assessment skills may vary. This creates the possibility for a wide range of circumstances in which section 5(4) may be applied depending on the approach taken by the individual nurse. However, when invoking section 5(4) the nurse must be satised that their decision is not contrary to Article 5(1) of the Human Rights Act (1998), which guarantees the right to liberty and security of the person against arbitrary detention or arrest.

Consent to treatment and the nurse

The practice of psychiatric nursing is perhaps more vulnerable to criticism than any other area of nursing. The reasons for this are complex; one factor, however, stands out. While treatment for physical conditions almost always depends upon the consent of the patient, the psychiatric nurse may be called upon to administer treatments to the unwilling. The associated powers may involve assisting in the involuntary detention of a fellow human being for a considerable time, something which is usually reserved for the judiciary in a state governed by law (Fennell 1986). In addition, psychiatric treatment is likely to be aimed at ameliorating a disturbance of mood or behaviour. In so doing, it sets out to alter the functioning of the human mind and this could be seen as interference in human autonomy which will be justied only in the most exceptional circumstances (Fennell 1986). The right of mentally competent adult patients to decide what medical treatment they will have has been recognized in English common law. This right is based on the principles of an individuals right to self-determination and personal autonomy (Re T 1992; Airedale National Health Service Trust v Bland 1993). Consent has been dened in the Code of Practice as the voluntary and continuing permission of the patient to receive a particular treatment, based on an adequate knowledge of the purpose, nature, likely effects and risks of that treatment including the likelihood of its success and any alternatives to it (Department of Health and Welsh Ofce 1999, p. 67). Permission given under any undue pressure or coercion is not regarded as consent in law. Adult patients who have the necessary mental capacity have the right to make their own treatment decisions. To give such patients treatment which involves touching them without obtaining their consent is battery (Fennell 1997). However, if a doctor has obtained consent following an explanation in broad terms of the nature purpose and likely effects of the treatment, there can be no liability in battery (Chatterton v Gerson 1981; Sidaway v Bethlem Royal Hospital Governers 1985).
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The nurse is under a duty to act in the best interests of the patient and to obtain consent before they give any treatment or care which would include psychological treatments such as group therapy and behaviour modication programmes. The nurse must also ensure that the process of establishing consent is rigorous, transparent and demonstrates a clear level of professional accountability. The nurse must also ensure that all discussions and decisions relating to obtaining consent are recorded accurately. Obtaining consent depends largely on the individual circumstances of the patient and the extent to which the patient feels forced by these circumstances to make certain decisions. This may apply particularly in secure environments. The nurse should bear this in mind when making judgements about whether valid consent has been obtained. Valid consent consists of three elements: it is given by a mentally competent person, who may be a person lawfully appointed on behalf of the patient; it is given voluntarily without any coercion; and it is informed.

Part IV of the Mental Health Act 1983 consent to treatment

Part IV of the 1983 Act has two basic purposes. The rst is to make it clear that treatment may be given to certain detained patients without their consent, and the second, is to subject certain treatments to regulation by a system of second opinions (Fennell 1986).

proposed by the patients doctor. Therefore a psychiatric nurse who, when consulted by the SOAD, advises against a specic plan of treatment, but whose advice is not followed by the SOAD and the patients own doctor, has to accept the course of treatment proposed and carry it out with the doctors directions and with the established professional standard (Dimond 1990). Nevertheless, this right to be consulted should not be used by the nurse to support automatically whatever treatment is proposed by the patients doctor. The nurse should use their professional experience and knowledge to establish the appropriateness of the treatment decision. However, the nurse consulted may not be the most senior nurse on the ward. The requirements are that the nurse should be professionally concerned with the patients medical treatment. Therefore, as part of the key worker system of care delivery, this may well be a junior nurse, unlike section 5(4) of the 1983 Act, which sets out the prescribed rank of nurse who may invoke the holding power. The duty to consult a nurse is only set out in statute in relation to sections 57 and 58 where it is the independent doctor who must consult the nurse. This statutory duty should not detract or minimize what should always be good medical practice; that the doctor in charge of the patients treatment automatically discusses with the relevant nurse his proposed course of treatment and listens to the nurses views and observations of the patients condition.

The nurses right to be consulted

For the rst time the role of the nurse has been recognized by putting a statutory duty on the Second Opinion Appointed Doctor (SOAD) under section 12 of the 1983 Act to consult a nurse before authorizing certain treatments without consent. Under part IV of the 1983 Act the nurse consulted can be any registered nurse, rst or second level, providing that they are professionally concerned with the care of the patient. Student nurses can act neither as a nurse nor a third person. Good practice, rather than the law, may suggest that the nurse consulted should, wherever possible, be a rst level nurse on an appropriate part of the register held by the NMC, that is a registered mental nurse or registered nurse, learning disability (Jones 2002). The essence of consultation is the communication of a genuine invitation to give advice and a genuine consideration of that advice (R v Secretary of State for Social Services, ex parte Association of Metropolitan Authorities 1986). This compulsory rule, to consult a nurse, probably only reects what has been good practice in many hospitals for some time (Dimond 1990). However, the right is only to be consulted. The SOAD could disagree with the nurses views and either support or refuse to support the treatment
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Section 57 treatments
These treatments include psychosurgery and the surgical implantation of hormones for the reduction of male sex drive, which require both consent and approval of a SOAD. This procedure must be observed whether or not the patient is detained. The treatment may only be given if the patient can understand its nature, purpose and likely effects and has consented. The decision as to the patients capacity to consent is made by a team of three people, a psychiatrist and two others appointed by the Mental Health Act Commission. Even if the patient has given valid consent, the treatment may not proceed unless the medical member of the team certies that it ought to be given. Before making this decision the SOAD must consult two other people who have been professionally concerned with the patients medical treatment, one of whom must be a nurse, and the other neither a nurse nor a doctor.

Section 58 treatments
These treatments include electro-convulsive therapy (ECT) and psychotropic drugs after 3 months from the time medicine was rst given during that detention.

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This requires either the patients consent or a second opinion. Patients who are liable to be detained may be treated without consent, subject to the approval of the SOAD, who must consider the likelihood of the treatment alleviating or preventing deterioration in the patients condition. However, whilst section 57 procedures apply to both detained and informal patients, section 58 applies only to the treatment of detained patients with medicines and ECT. Patients detained under provisions which authorise detention for 72 hours or less [sections 4, 5(2), 5(4), 135 and 136] cannot be given treatment without consent for mental disorder under the 1983 Act. Nurses have particular duties regarding the administration of medicines to patients under section 58 of the 1983 Act.

The role of the nurse in the administration of medicines

The Mental Health Act Commission has issued guidance for nurses in administering medicines for mental disorder under the 1983 Act (Mental Health Act Commission 1994). This suggests that the need for a full appreciation by nurses together with other disciplines involved, of the consent to treatment requirements of the 1983 Act and in particular section 58 of the Act, is essential if the rights and interests of patients are to be safeguarded. Further general guidance is found in the NMC (2002) guidelines for the administration of medicines which states that the administration of medicines is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner. It requires thought and the exercise of professional judgement . . . The Mental Health Act Commission (1994) urges health authorities and trusts to include information on consent procedures in their policies and guidelines about the administration of medicine. The guidelines note that during the initial 3 month stabilising period a doctor is legally authorised to prescribe and a nurse to administer medication for mental disorder to patients detained under the 1983 Act. However, the guidelines stress that the 3-month period commences with the date of the rst dose of medication during any continuous period of detention, including any medication given under section 2. Following the 3-month period medicine can only be given if there is a completed statutory form 38 stating that the patient is capable and has consented, or if a SOAD has authorized the medication on statutory form 39. The Mental Health Act Commission (1994) stresses that the nurse administering the prescribed medication to patients detained under the Act and subject to the provisions of section 58 of the Act, must ensure that he or she is legally entitled to administer that medication by ensuring

that all necessary legal requirements have been met. Following the 3-month period the legal authority is embodied in forms 38 and 39. The nurse should fully understand the legal signicance of these documents, and a copy kept with the medicine card. Reference should be made to it at the time of administering any medication used for the treatment of mental disorder. Therefore medication for mental disorder can be prescribed and administered to certain categories of patients detained under the 1983 Act without their consent for a period of 3 months commencing from the day on which such medication was rst administered. Once the 3-month period has expired then such medication for mental disorder can only be administered to detained patients provided the safeguards contained within section 58 have been complied with. Any nurse administering medication for mental disorder to a detained patient under the 1983 Act must be satised that there is a legal authority for them to do so. Section 62 of the 1983 Act provides for urgent treatment to be given to a patient which is immediately necessary to save the patients life, or which (not being irreversible) is immediately necessary to prevent a serious deterioration in the patients condition. This allows for the treatment to be continued pending compliance with section 58, if discontinuation of the treatment would cause serious suffering to the patient. However, regular pro re nata (when required) (PRN) medication should not be administered under section 62 but, depending on whether the patient consents or not it should be included either on a form 38 completed by the patients responsible medical ofcer or on a form 39 completed by the SOAD. Although the nurse has no statutory role to play in giving emergency treatment under section 62 and in giving treatments not coming under sections 57 or 58, the nurse should still apply the professional standards of the profession in ensuring that any treatment they have been asked to carry out should be authorized by the appropriate doctor and contraindications of which the nurse is aware should be pointed out to the doctor. The nurse must ensure that the type, dosage, timing, frequency and route of administration are checked before the drug is given to the patient. The 1983 Act offers no solutions to the problem that has already arisen on several occasions, that is, if the nurse is reluctant to assist in the patients treatment when not satised that the treatment is in the patients best interests. In these cases existing law prevails. For example, in Owen v Coventry Health Authority (1984), a nurse who refused to assist in giving ECT to a patient was held by an industrial tribunal to have been fairly dismissed. It was held that although assisting in ECT can be an area where individual nursing staff can have strongly held objections, they did not
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nd that the disobedience to the instruction was a reasonable one.

Conclusion
It is evident that the psychiatric nurse has now a number of important powers and duties with respect to the care of mentally disordered people, both legally under the 1983 Act, and professionally under the NMCs various professional guidelines. These duties are primarily concerned with the nurses role in respect of consent to treatment and the administration of medication, the right to be consulted and ensuring detained patients are informed of their rights under the 1983 Act. The 1983 Act and the common law also provide and extend the powers of psychiatric nurses to detain patients with mental disorder in hospital against their will. These duties and powers have important implications with respect to accountability for any acts or omissions, taken by the nurse practitioner. This is particularly important in light of proposals for new mental health legislation which may well seek to extend these powers and duties, especially in respect to the detention of mentally disordered people (Draft Mental Health Bill 2004). The purpose of this Bill is to introduce a new legal framework for the treatment of people with mental disorder. However, many of its proposals have failed to take cognizance of the recommendations set out in the Richardson Report (Department of Health 1999); the result of which has been criticism by mental health law cognoscenti (Peay 2000).

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