Section D Challenging the decision to prescribe medication

How to challenge a decision or settle a disagreement

You may want to write down the questions and concerns that you have so you do not forget important points during any meetings. Be prepared with information that supports your views, such as national guidance suggested in this resource (in Section B).

Start by discussing your views with the professional who wants to prescribe the medication. If you still disagree, then you can ask for a second opinion from a different professional. You do not have a legal right to a second opinion, but a doctor will consider your request and whether a second opinion is appropriate. If your relative is detained under a section of the Mental Health Act, then new and existing medication will be checked by a Second Opinion Appointed Doctor, arranged by the Care Quality Commission.

If a decision was made without consulting you or if your views were not taken into account, see the resource ‘Ensuring that all professionals act in accordance with their obligations under the Mental Capacity Act 2005 towards disabled adults’ that contains two template letters that can be sent to the decision maker.

A disagreement may need to be resolved in the Court of Protection. Before going to the Court, family members should take specialist legal advice. Your relative will be represented in Court by an official solicitor, which will be arranged for them.

Scenarios:

Mr and Mrs Chopra were told by their daughter Maya’s residential college that she needed go on medication because of her self-injurious behaviour. The college reported that the staff could not cope with her behaviour. An appointment with a psychiatrist had been arranged so Maya’s parents asked to come to the appointment. The psychiatrist was willing to prescribe Maya medication from the start of the appointment. Mr and Mrs Chopra explained that Maya very rarely hit herself when she was at home with them. They said they wanted to look at other options first and discussed some of the problems they knew Maya had with the noisy environment at college and the lack of time spent outdoors. The college agreed to implement some of Mr and Mrs Chopra’s suggestions and the decision to prescribe medication was put on hold. Unfortunately, the following week Maya became very distressed at school and hit her head against a hard surface, causing a large bruise. The college phoned Mr and Mrs Chopra to tell them about the incident and that the psychiatrist had given them a prescription for medication. Having researched the Mental Capacity Act, Mr and Mrs Chopra objected to the medication being given and said that as Maya is over 16 they would like an urgent meeting to decide what would be in Maya’s best interests. They attended a meeting at the college with Maya’s teacher, support manager and the psychiatrist. Alternatives to medication were discussed again and they talked about the recent incident and how staff could prevent Maya getting so distressed in future. The teacher supported the parents and believed the college could improve how they implement alternative support strategies. The decision was made that it would not be in Maya’s best interests to start taking medication, because it was not the least restrictive option for her.

Robert, a 14 year old boy with learning disabilities and autism, was already taking a low dose of antipsychotic medication. The CAMHS team suggested he should also start a new, additional medication to reduce his anxiety, which was often leading to him hit others or run off. Robert’s mum Jackie was worried about the possible interactions between the two medications and wanted to try other ways to reduce his anxiety. She spoke to the pharmacist, who suggested she ask for a second opinion. Jackie emailed CAMHS explaining her concerns and asking them to arrange a second opinion. They organised for a doctor from outside the service to review Robert’s file. This doctor recommended that a functional assessment of Robert’s behaviour be carried out and Positive Behaviour Support be used to understand the causes of his anxiety and help him cope. The doctor also suggested that in addition to not starting a new medication, the antipsychotic medication he takes should be gradually reduced and stopped. The functional assessment found that Robert’s has sensory differences and a need for routine and predictability, so personalised support strategies were suggested to Jackie and to Robert’s school to help him address needs.