Case Studies / IMHA Client O

IMHA Client O

Client O with a treatment-resistant eating disorder, was concerned about an upcoming Best Interest Meeting to decide whether;

a) She would be detained under the Mental Health Act against her will at a specialist residential eating disorder unit or
b) She would continue to live at home receiving palliative non-intervention-based support from the Community Eating Disorder Team

Barriers faced in being heard:

Client O believed her wishes and feelings were not being considered because she had been assessed as lacking the capacity to make decisions regarding her treatment, due to her eating disorder – which she refuted. This led to the client’s non-engagement at previous Best Interest Meetings. Client O maintained that she had been coerced into consenting to a previous admission to a specialist unit, which had had a traumatic effect on her psychological well-being. Therefore, she did not want to be compelled to return to one again.

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Advocacy undertaken:

  • Met with Client O on several occasions to discuss her concerns, clarify her desired outcome and agree on a plan for the Best Interest Meeting.
  • Researched relevant case law and explained to the client that the Court of Protection had regularly ruled that in eating disorder cases, otherwise capacitous individuals lacked insight into making decisions about their treatment. However case law also supported guidance that the wishes and feelings of a client must be considered when relevant to the specific decision being made.
  • Researched Court of Protection decisions for clients with treatment-resistant eating disorders and informed Client O that the Court had ruled that an Eating Disorder patient’s views about a specialist unit and their previous experience at that unit must be taken into consideration at a Best Interest Meeting.
  • The Advocate emphasised this had previously resulted in a judgment that forcing a treatment-resistant patient with a history of unsuccessful attendances at a specialist unit into a similar unit against their will would not be considered to be in their best interests.
  • Advocate and Client O jointly prepared a statement incorporating the case-law, which Client O instructed the Advocate to read at the beginning of the meeting.
  • After reading the statement aloud during the meeting, the Advocate invited Client O to make further comments which she did.
  • Advocate also supported Client O to participate in further discussion by making clarifying statements and answering questions.

Outcomes:

It was not in the best interests of Client O to be detained and forced to reside in the specialist unit. The decision-maker said this was based primarily on the case put forward by Client O in their statement but noted it was also in line with Client O's wishes. After the meeting, despite continuing to feel aggrieved at the capacity decision, Client O accepted the legal precedent and was happy with the outcome. Client O felt her autonomy had been safeguarded during the meeting and was pleased her wishes had been considered. Client O said she felt better able to participate fully in this Best Interest Meeting than previously and was more confident in advocating for herself at future meetings.