Mental health law briefing 230 – Anorexia Nervosa: The court authorises discharge rather than treatment
It is settled law that Section 63 Mental Health Act may be used to compel feeding of patients suffering from anorexia nervosa, who are detained under the Mental Health Act. However, the Court has recently approved a proposed treatment plan authorising discharge of such a patient into the community.
Miss W is a 28 year old woman who has suffered from eating disorders for 20 years. Since the age of 11, she has had six admissions to hospital as an in-patient in five different units. Her current admission commenced over 2½ years ago and yet she continued to lose weight so that at the time of the hearing, weighed less than 30 kilograms, with a BMI of 12.6.
The Local Health Board applied to the Court of Protection for approval of a plan to discharge her into the community with a close package of support for her and her family. Although potentially counter intuitive, it was felt that continued hospital treatment was unlikely to provide benefit to the patient.
The Court’s decision
Although the Court acknowledged that there is a strong presumption that it is in a person’s best interest to receive treatment to keep them alive, that is not an absolute presumption and there may be circumstances where it is not in the individual’s best interests, potentially because it is futile or unduly burdens them. Although Miss W was detained under Section 3 of the Mental Health Act, her RC felt that everything had been tried to achieve weight gain without success.
Initially, the Local Health Board applied to the Court in relation to two proposals, the first to re-feed the patient under sedation (which could potentially be for a period of up to six months) and the second, to discharge her on the basis that she was not currently treatable and therefore remaining on the ward was not appropriate.
By the time of the hearing, the first proposal was no longer maintained. Expert evidence supported the proposal to discharge her, which was also in accordance with her wishes and her family’s views. The Court therefore confirmed that discharge was the least worst option and the plan was approved.
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Partner and Head of Healthcare
 Betsi Cadwaladru University Local Health Board v W  EWCOP13
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