Community treatment orders: implications of the drafting of the Mental Health Act 2007 for emergency detention of community patients.

Since the introduction of Community Treatment Orders by the Mental Health Act 2007, their use has increased year on year. Clinical experience has, however, demonstrated a weakness in the drafting of the Act, particularly in respect of patients who may be admitted informally for treatment of their mental health while also on a Community Treatment Order and then require detention under the terms of the Mental Health Act 2007. This paper describes these potential problems, particularly with regard to the inability to detain a Community Patient using sections 4 or 5 of the MHA 2007. The authors explore the difficulties that may arise from this, including the need to balance the principle of using the least restrictive option, and the rights of the patient against the potential risks to both the patient and the public. The authors propose possible considerations and options in these circumstances.

Chemotherapy for Hodgkin's lymphoma in a patient receiving clozapine for treatment-resistant schizophrenia: use of the Mental Capacity Act 2005.

Treatment resistance occurs in approximately 30% of individuals with schizophrenia and is commonly treated with clozapine. Nodular sclerosing Hodgkin's lymphoma is a subtype of Hodgkin's lymphoma predominantly affecting those under 50 years of age. In this case report, an individual with treatment-resistant schizophrenia developed nodular sclerosing Hodgkin's lymphoma and is treated with concurrent clozapine and systemic chemotherapy. The aim of this case report is to act as guidance for clinicians and to outline the difficulties of treating individuals with psychiatric illness under the Mental Capacity Act 2005 when the proposed treatment could lead to high levels of morbidity and mortality.