A recent visit to the Wickham Unit (a low-secure rehabilitation unit) at Blackberry Hill Hospital, Bristol, by the Mental Health Act Commission raised a controversial issue regarding the legal prescribing of medication for individuals who are detained under the Mental Health Act. There was a case of a patient who had consented to treatment and had a Form 38 completed in accordance with Section 58 of the Mental Health Act 1983, among others for clozapine. He was experiencing hypersalivation as a side-effect so was prescribed hyoscine hydrobromide. It was not thought necessary to include this on the Form 38 as hyoscine is not a psychotropic drug. The Commissioner, however, stated that the hyoscine was not authorised, meaning the medication had been unlawfully administered, and the Avon and Wiltshire Mental Health Partnership NHS Trust had to advise the patient about his right to seek legal advice.

Hyoscine appears twice in the British National Formulary, in the chapter on the central nervous system under ‘Drugs used in nausea and vertigo’ and in the chapter on anaesthesia under ‘Antimuscarinic drugs’. Hyoscine is not classified under ‘Antimuscarinic drugs used in parkinsonism’. Antimuscarinic drugs used for anaesthesia is quite distinct from ‘Antimuscarinic drugs used in parkinsonism’. We do regard the latter as needing to be documented on the legal paperwork, such as precyclidine, because of an accepted recognition of good practice. Is it now the case that for any side-effect caused by psychotropic medication that is being treated by drugs, these drugs need to be listed on Forms 38/39? If so, should our patient's senna and metformin be listed as well, as the constipation and diabetes he has is likely (but of course not necessarily) to be a result of the clozapine?