The Mental Welfare Commission in Scotland has available guidance on artificial nutrition in the context of mental health. It is targeted primarily for professionals working in Scotland, but is also of interest to service users and carers.
The guidance covers the use of artificial nutrition in eating disorders, inability to eat, or due to e.g. delusional beliefs, such that health is endangered. The primary mental health legislation is the The Mental Health (Care & Treatment) (Scotland) Act 2003, currently in the process of being amended. Artificial nutrition in the context of the Act might include nasogastric feeding through a tube, PEG feeding (through the abdominal wall) or intravenous feeding. These are contrasted with force feeding: the guidance says that force feeding is prohibited under the Act, and should never be used.
Principles which must be adhered to
The Act provides certain principles which must be adhered to by everyone involved in supporting people with mental health issues. In the context of the provision of artificial nutrition, certain specific conditions apply.
The issue of consent is discussed in the guidance, and readers are directed to separate guidance on consent. It is envisaged that feeding by artificial means without consent should be seen as a treatment of last resort.
Significant impaired decision making ability
Significant impaired decision making ability (SIDMA) is an important capacity issue in treating mental disorder. The Adults with Incapacity (Scotland) Act 2000 covers a wider range of different capacities. SIDMA, like capacity, can fluctuate. The 2003 Act specifies that the medical practitioner must state the reasons for believing the patient has SIDMA before being given compulsory treatment. There is a view that standard tests for capacity fail to capture difficulties relevant to treating anorexia nervosa. In those cases, the person can be seen as retaining their capacity to reason and to make decisions. Separate guidance is available for these cases
Artificial nutrition can be administered where the person gives consent in writing; or a designated medical practitioner (DMP) authorises the treatment; or urgent medical treatment provisions in the Act apply.
Safeguards built into the Act, include allowing the appointment of a Named Person who must be informed and consulted and the right to make a written statement setting out how he or she would or would not want to be treated should he or she be unable to make decisions as a result of a mental disorder. The European Convention on Human Rights, and other specific legislation regarding young people are other sources which must be observed in providing artificial nutrition.
