The Mental Health Act 1983 – Can I Refuse Treatment?

If you are detained in a hospital under the Mental Health Act 1983 (MHA), one of the first questions you might ask is: Can I refuse treatment? It’s a natural and important question because treatment—especially medication—can feel overwhelming, and you want to know your rights.

What is the Mental Health Act 1983?

The Mental Health Act 1983 is a law in England and Wales that lets doctors and hospitals care for people with mental health problems when they need treatment but do not want to have it voluntarily. This law gives hospitals the power to detain people who may be at risk to themselves or others and provide treatment to help them recover.

Being detained under the MHA means you might be kept in hospital against your will, and doctors might give you treatment even if you don’t want it. But it’s not as simple as “anything goes.” The law has rules to protect you and your rights.

Can You Refuse Treatment if Detained?

This is the big question. The short answer is: It depends on the type of treatment and your legal status under the MHA.

Let’s break it down.

What Does the Law Say About Treatment Without Consent?

Under Section 63 of the Mental Health Act 1983, doctors can give you medical treatment for your mental disorder without your consent if certain conditions are met. This is called treatment without consent.

So, if you are detained under certain sections of the MHA, a doctor can give you medication or other treatments, even if you say “No.”

When Does Section 63 Apply?

Section 63 applies if you are detained under these sections of the MHA:

Section 2 – This is usually for assessment and treatment for up to 28 days.
Section 3 – This is for treatment and can last up to six months or longer.
Some Criminal Sections – Like Section 37 (hospital order), Section 37/41 (hospital order with restrictions), and Section 47/49 (transfer from prison to hospital).

If you are detained under these sections, doctors have the power to treat you without your agreement for your mental disorder.

When Does Section 63 NOT Apply?

There are situations where Section 63 does not apply, meaning doctors generally need your consent before giving treatment. These include:

If you are detained under Section 4 (emergency admission for up to 72 hours).
If you are held under the holding powers in Section 5 (short-term holding by hospital staff).
If you are on a Community Treatment Order (CTO) – which means you are being treated mostly in the community, not hospital.

In these cases, doctors usually need your consent to provide treatment.

Are There Limits to Treatment Without Consent?

You might worry that doctors can give you any treatment without asking. That’s not true. There are important safeguards in the MHA that protect you, especially for certain types of treatment.

Special Treatments That Need Extra Protection

Certain treatments are more serious or have more risks. For these, the MHA says you must give consent, or there must be other protections in place. These treatments include:

Neurosurgery for mental disorder (for example, surgery on the brain)
Psychosurgery (surgery intended to change how your brain works)
Hormone treatment to reduce male sex drive (used in some cases for specific disorders)
Electro-convulsive therapy (ECT)

What Does the Law Say About These Treatments?

Under Section 57, neurosurgery, psychosurgery, and hormone treatment can only be done if you consent and there is a second opinion from another doctor.
Under Section 58, medication given after three months of treatment needs your consent, or a second doctor must give an opinion that it is appropriate.
Under Section 58A, ECT can only be given with your consent unless it is an emergency (more on this later).

What About Emergency Situations?

Sometimes, there may be an emergency where treatment must be given quickly to save your life or prevent serious harm. The MHA covers this under Section 62, which allows doctors to override some of the usual safeguards and give urgent treatment without your consent.

This can happen with medication or ECT if the doctor believes it is necessary immediately to save your life or prevent a serious deterioration.

What Does This Mean for You?

If you are detained in hospital under the MHA, the doctor can give you most common treatments like medication for your mental health without asking you first, especially if you are detained under Section 2 or Section 3.

However:

For some treatments, like ECT or brain surgery, you must give your consent or the treatment can only be given in an emergency.
If you refuse treatment, the hospital will usually try to talk to you and explain why the treatment is needed. They want you to agree voluntarily if possible.
If you continue to refuse, the hospital can sometimes give treatment without your consent, but only if the law allows it (Section 63).
There are protections to make sure that treatments given without consent are appropriate and monitored carefully.

What Are Your Rights While Detained?

Even though doctors can sometimes give you treatment without your agreement, you still have rights:

You have the right to be involved in decisions about your treatment as much as possible.
You can ask questions and get explanations about your treatment.
You can request a second opinion doctor to review your treatment if you disagree.
You have the right to appeal your detention to a Mental Health Tribunal.
You can get help from an Independent Mental Health Advocate (IMHA) who supports you to understand your rights and speak up.
You have the right to make a complaint if you feel your rights are being ignored or treatment is not appropriate.

What Should You Do If You Want to Refuse Treatment?

If you are feeling uncertain or want to refuse treatment:

Talk to your doctor or nurse — explain your concerns and ask them to explain the treatment fully.
Ask for a second opinion — you can request this if you are not sure about your treatment.
Ask for an advocate — they can help you understand your rights and communicate your wishes.
Get advice from a solicitor or legal advisor if you want to challenge your detention or treatment.
Keep records of what treatment you have been given and what you have agreed to or refused.

What Happens if You Refuse Treatment?

If you refuse treatment:

The hospital staff will try to understand your reasons.
They will explain the benefits and risks of the treatment.
If the law allows, treatment may still be given without your consent.
For some treatments, your refusal can delay or prevent it, especially if consent is legally required.
If treatment is given without your consent, it should be the least restrictive option and only for as long as necessary.

How Can You Get Support?

Being detained and receiving treatment without consent can be very stressful. It’s important to have support:

Independent Mental Health Advocates (IMHAs): Free service to help you understand your rights and support you.
Friends and family: You can ask them to visit and support you.
Mental Health Tribunal: You can appeal your detention and treatment decisions here.
Solicitors or legal advisers: They can represent you legally.
NHS Complaints Procedure: If you believe your care or rights have been violated, you can make a formal complaint.

Summary: What You Need to Know About Refusing Treatment Under the MHA 1983

Key Question	Simple Answer
Can doctors treat me without consent?	Yes, for most treatments if detained under Section 2, 3, or some criminal sections.
Can I refuse all treatments?	Not all. Some treatments legally require your consent.
What treatments need my consent?	Neurosurgery, psychosurgery, hormone therapy, and ECT (except emergencies).
Can doctors override my refusal in an emergency?	Yes, in life-threatening situations.
What if I’m detained under Section 4, 5, or CTO?	Doctors usually need your consent to treat you.
What rights do I have?	Right to information, second opinion, advocate, appeal, and complaint.
How can I get help?	Independent advocates, legal advisors, family, and Mental Health Tribunal.

Final Thoughts

Being detained under the Mental Health Act 1983 is a serious matter, and it is natural to want control over your treatment and body. While the law allows doctors to give treatment without your consent in many cases, it also provides important safeguards to protect you from unnecessary or harmful treatment.

Remember, your doctors and the hospital should involve you in decisions as much as possible and respect your views. If you feel confused or unhappy about your treatment, speak up. Use your rights to get advice and support.