The Commission safeguards the interests of people with mental illness and learning disabilities, and earlier this year issued detailed guidance on the administration of covert medicine. Here Lynn McBean, communications manager, describes the work of the organisation.

The Mental Welfare Commission (MWC) is an independent organisation set up by the Scottish Parliament, with a range of duties under mental health and incapacity law. We draw on our experience as health and social care staff, service users and carers.

What we do

Through our work, we aim to ensure that care, treatment and support are lawful, and that they respect the rights and promote the welfare of individuals with mental illness, learning disabilities and related conditions. We do this by empowering individuals and their carers, and influencing and challenging service providers and policy-makers.

Why we do it

Individuals may be vulnerable because they are less able at times to safeguard their own interests. They can have restrictions placed on them in order to receive care and treatment. When this happens, we make sure it is legal and ethical. We believe individuals with mental illness, learning disabilities and related conditions should be treated with the same respect for their equality and human rights as all other citizens.

They have the right to:

• be treated with dignity and respect
• ethical and lawful treatment and to live free from abuse, neglect or discrimination
• care and treatment that best suit their needs
• recovery from mental illness
• lead as fulfilling a life as possible.

Our work in practice

Much of our work is at the complex interface between the individual’s rights, the law and ethics, and the care the person is receiving. We work across the continuum of health and social care and:

• Find out whether individual care and treatment is in line with the law and good practice
• Challenge service providers to deliver best practice in mental health and learning disability care
• Follow up on individual cases where we have concerns and may investigate further
• Provide information, advice and guidance to individuals, carers and service providers
• Aim to have a strong and influential voice in service policy and development
• Promote best practice in applying mental health and incapacity law to individuals’ care and treatment.

Covert medication – recent MWC guidance

One of the many ways in which we promote best practice is to produce good practice guides for practitioners.

We have recently updated our guidance, Covert Medication. It is a difficult and complex issue where our expertise in applying legal and ethical principles to individuals’ care and treatment is often needed. The use of covert medication appears to be increasing. It was therefore a good time to revise and reissue our guidance, with the valuable co-operation of the Care Inspectorate in the revision work.

Covert medication is the administration of any medical treatment in disguised form. This usually involves disguising medication by administering it in food and drink. As a result, the individual is unknowingly taking medication. This is likely to be due to a refusal to take medication when it is offered, but where treatment is necessary for the individual’s physical or mental health.

We have developed our guidance from reading existing good practice statements and the requirements of the law in Scotland. We advise anyone considering covert medication to follow our guidance. It applies only to situations in which an individual lacks capacity to make a decision regarding medical treatment and refuses treatment. Covert medication must never be given to someone who is capable of deciding about medical treatment.

The practitioner with primary responsibility for the individual’s medical treatment has the ultimate responsibility to decide whether or not to authorise covert administration of medication. This decision should be taken following consultation. Before deciding, the practitioner must:

• consider the necessity of giving the medication
• carefully assess the person’s capacity to make a decision about the treatment
• apply the correct legal principles and procedures, in particular Part 5 of the Adults with Incapacity (Scotland) Act 2000.

There are occasions where covert administration of medication can be considered the best way to provide an individual with necessary medical treatment. It must be given safely and in accordance with the law. By following our guidance, practitioners will be able to demonstrate that they have done their best to comply with legal and ethical principles when giving treatment in this way.

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