Advance Directive Mental Health UK

The Complicated Overlap

Using an Advance Decision to Refuse Treatment for psychiatric care in England sits at the intersection of two statutes that sometimes pull in opposite directions: the Mental Capacity Act 2005 and the Mental Health Act 1983.

Under the Mental Capacity Act, a valid ADRT refusing treatment is legally binding on clinicians. Under the Mental Health Act, a patient detained under Section 2 or Section 3 can be treated for their mental disorder without consent — even if they have an ADRT refusing that treatment.

This creates a significant exception to the general principle that an ADRT must be followed.

What the Mental Health Act Overrides

If you are detained ("sectioned") under the Mental Health Act, the clinical team can administer treatment for the mental disorder for which you are detained, even if your ADRT explicitly refuses that treatment. The ADRT does not prevent compulsory treatment for your mental disorder under the Mental Health Act.

The override can apply to medication and other treatment for the mental disorder; electroconvulsive therapy is subject to separate safeguards and exceptions. It does not extend to treatment for unrelated physical conditions — an ADRT refusing surgery for a broken leg would still apply, even if you are detained under the Mental Health Act for a psychiatric condition.

This distinction matters. An ADRT can refuse physical treatments while you are sectioned. It cannot refuse treatment for mental disorder where the Mental Health Act authorises it.

What an ADRT Can Still Achieve

Despite the Mental Health Act override, an ADRT in a mental health context is not worthless. It serves several practical functions:

Voluntary care settings. If you are receiving psychiatric treatment voluntarily — not under a section — your ADRT is fully binding. Clinicians must respect your treatment refusals just as they would in any other medical setting.

Treatment preferences. Even under compulsory detention, your ADRT and any Advance Statement can still inform discussions about your care, but the Mental Health Act may permit treatment for the mental disorder without your consent.

Post-crisis planning. An ADRT can record treatments you would refuse after an acute episode. Use an Advance Statement for preferences about depot injections, community care, and treatments you find most and least tolerable. This gives clinical teams a documented framework for your care once the immediate crisis passes.

Physical health during detention. As noted, the Mental Health Act override only covers treatment for the mental disorder itself. Your ADRT still applies to all other medical interventions.

Advance Statements for Psychiatric Care

Because the ADRT's legal force is limited in compulsory settings, many mental health practitioners recommend pairing it with a detailed Advance Statement. While not legally binding, an Advance Statement that clearly articulates your treatment preferences, past experiences with medication, and what has worked or failed for you carries significant weight in clinical practice.

When a best-interests assessment does apply, clinicians must consider your known views and preferences. A well-drafted Advance Statement makes it harder for a clinician to claim ignorance of what you would have wanted.

Capacity and the Assessment Question

A key complication in mental health settings is the assessment of decision-specific capacity. Under the Mental Capacity Act, capacity is assessed relative to the specific decision at hand — not globally. A person with schizophrenia may lack capacity to refuse antipsychotic medication during an acute psychotic episode but retain capacity to make decisions about their finances, their living arrangements, or their treatment for a broken ankle.

The clinician must assess your capacity for each specific treatment decision. Outside compulsory-treatment powers, if you retain capacity — even during a period of mental illness — you can refuse treatment in real time, and no ADRT is needed. In a detention context, the Mental Health Act may still permit specified treatment for mental disorder. For treatment governed by the Mental Capacity Act, the ADRT activates only when you lack decision-specific capacity.

The England ADRT Guide covers the full legal framework for advance decisions in both physical and mental health contexts, including how to draft an ADRT that maximises its practical effect within the constraints of the Mental Health Act.

See more England guides →