Short-term detention for mental disorder under the Mental Health (Care and Treatment) (Scotland) Act 2003 requires an approved medical practitioner to certify that a condition specified in Section 44(4)(b) of the Act is met: namely that ‘because of the mental disorder, the patient's ability to make decisions about the provision of medical treatment is significantly impaired’.

Many practising clinicians will realise that there are myriad reasons why patients with mental disorder will not, for example, take necessary medication. These include family attitudes and previous adverse experiences, as well as factors caused by the mental disorder itself such as delusional beliefs. Clinical discussions surrounding a recent tribunal I attended have crystallised this for me.

Was it really the view of the Scottish Parliament that a patient who refuses medication for a severe psychotic exacerbation on grounds not actually caused by this illness should remain untreated?