Knowledge of mental health legislation in junior doctors training in psychiatry

We read with interest the study by Wadoo et al ¹ focusing on the knowledge of mental health legislation in junior doctors training in psychiatry. As rightly stated by the authors, this is a concerning issue due to the possibility of inappropriate use of legislation that could potentially threaten patients’ fundamental rights.

We would like to highlight a couple of issues which are concerning. We felt that doctors’ knowledge of various aspects of the Mental Health Act will increase after they become Section 12(2) approved and attend the mandatory training. We feel that most of the sections of the Act are only used by doctors after they are Section 12(2) approved; however, there are certain aspects of the law which apply before the approval. These are mostly used in emergencies, when junior doctors are often the first port of call, often outside working hours when the support from senior and more experienced staff might not be as readily available.

We were anxious at the lack of knowledge of Section 5(2), where 65% of the trainees felt that they needed to examine the patient and 60% knew about the requirement to fill out a form.

We feel that junior doctors in training are frequently called to prescribe medications for agitated or disturbed patients. In the current study the trainees’ knowledge about the consent to treatment fell to 20% (statement in the study is: ‘after 3 months, second opinion must be obtained if the patient does not consent’). It can be concluded that the doctor may not be aware whether the patient's current consent to treatment form (T2) or a second opinion (T3) is covering the emergency medication. There is a risk a patient may be prescribed medication without consent and without the legal paperwork completed. We felt that such scenarios, apart from damaging the therapeutic relationship, could possibly lead to complaints or litigation against individual staff or the managing trust.

Although it is reassuring that experience results in improved knowledge of the legislation, we agree that training in mental health law and its clinical implications should be emphasised at an earlier stage in the junior doctors’ career. Regular testing of competencies, as set out in the Royal College of Psychiatrists’ curriculum, should follow attendance at mandatory formal training at induction and refresher courses.