Risk, Capacity & Safeguarding — MCQs
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An 85-year-old woman with advanced dementia (MMSE 4/30) is admitted with aspiration pneumonia. She requires nasogastric feeding but repeatedly pulls out the tube. Her daughter has Lasting Power of Attorney for Health and Welfare and insists on aggressive treatment. The clinical team believes NG feeding is prolonging suffering. Under the Mental Capacity Act 2005, what is the correct approach?
A 50-year-old man with chronic alcohol dependence presents to the Emergency Department expressing suicidal ideation after losing his job. He has made no specific plans. He has a history of three previous suicide attempts, all involving overdoses when intoxicated. His current blood alcohol level is 180 mg/dL. What factor in his presentation represents the highest risk for completed suicide?
A 32-year-old man with schizophrenia is being assessed for capacity to consent to depot antipsychotic medication. He states that the medication is poisonous and refuses treatment. He can repeat back information about the medication but insists it will harm him due to his persecutory beliefs. He understands he has been unwell recently. What is the most appropriate conclusion regarding his capacity?
A 37-year-old woman with severe postpartum depression is admitted following disclosure of intrusive thoughts about harming her 6-week-old baby. She is distressed by these thoughts, recognizes they are wrong, and has not acted on them. She is refusing separation from her baby despite the clinical team's concerns. What is the most appropriate safeguarding action?
A 65-year-old man with newly diagnosed early-stage dementia (MMSE 24/30) wishes to create a Lasting Power of Attorney (LPA) for health and welfare, appointing his daughter as attorney. During assessment, he understands what an LPA is and trusts his daughter. However, he cannot reliably recall this information 10 minutes later. What is the most appropriate conclusion regarding his capacity to create the LPA?
A 48-year-old homeless man with alcohol dependence presents to the Emergency Department expressing suicidal thoughts. He has no fixed address, is estranged from his family, and has poor engagement with services. He agrees to a safety plan and voluntary admission but there are no psychiatric beds available. Which intervention would most effectively reduce his short-term suicide risk?
A 23-year-old man with first-episode psychosis is admitted informally to a psychiatric ward. On day 3, he states he wishes to leave immediately, believing staff are poisoning his food. He is actively psychotic, has not eaten for 48 hours, and has deteriorating physical health. He has capacity to make decisions about his accommodation. What is the most appropriate legal course of action?
In the Mental Capacity Act 2005, which of the following principles is NOT one of the five statutory principles?
A 54-year-old man with motor neurone disease and full cognitive capacity is assessed regarding future care planning. He states he wishes to refuse all life-sustaining treatment including ventilation when his respiratory function deteriorates. What is the most appropriate legal mechanism to document this decision?
A 40-year-old woman with emotionally unstable personality disorder is assessed following superficial self-cutting to her forearms. She reports chronic suicidal ideation but denies current intent to end her life. She has had 15 similar presentations in the past year. What is the most appropriate approach to assessing her suicide risk in this presentation?
Risk, Capacity & Safeguarding UK Medical PG Practice Questions and MCQs
Question 111: An 85-year-old woman with advanced dementia (MMSE 4/30) is admitted with aspiration pneumonia. She requires nasogastric feeding but repeatedly pulls out the tube. Her daughter has Lasting Power of Attorney for Health and Welfare and insists on aggressive treatment. The clinical team believes NG feeding is prolonging suffering. Under the Mental Capacity Act 2005, what is the correct approach?
- A. The daughter's decision as attorney must be followed regardless of clinical opinion
- B. A best interests decision must be made considering clinical opinion and the attorney's views (Correct Answer)
- C. The Court of Protection must make all decisions about life-sustaining treatment
- D. Treatment should be withdrawn as she is physically resisting by removing the tube
- E. An Independent Mental Capacity Advocate must be appointed to make the decision
Explanation: ***A best interests decision must be made considering clinical opinion and the attorney's views*** - Under the **Mental Capacity Act 2005**, all decisions for a patient lacking capacity must be made in their **best interests**, which is a collaborative process rather than a unilateral choice by any single party. - The **best interests** framework requires a balanced consideration of the patient's **past and present wishes**, the clinical risks and benefits, and the views of relevant persons like the **Lasting Power of Attorney (LPA)**. *The daughter's decision as attorney must be followed regardless of clinical opinion* - Although a **Health and Welfare LPA** can make decisions about life-sustaining treatment, they are legally bound to act only in the patient’s **best interests**, not their own personal preference. - Physicians are not obligated to provide treatment that is clinically non-beneficial or **futile**, even if requested by an attorney; disagreements should be resolved through mediation or legal review. *The Court of Protection must make all decisions about life-sustaining treatment* - The **Court of Protection** is generally a last resort for when a **consensus** cannot be reached among the clinical team and the family/attorney. - It is not required for **all** life-sustaining treatment decisions if the attorney and the clinical team can agree on what constitutes the patient's best interests. *Treatment should be withdrawn as she is physically resisting by removing the tube* - Pulling out a tube in the context of **advanced dementia** may be a reflexive or confused action rather than an **incapacitous expression** of a consistent wish to refuse treatment. - While physical resistance is a factor to consider in the **burden vs. benefit** assessment, it does not automatically override the best interests process. *An Independent Mental Capacity Advocate must be appointed to make the decision* - An **IMCA** is typically only appointed when a patient lacking capacity has **no family or friends** to represent them during serious medical treatment decisions. - Since the patient has a **daughter with LPA**, her views are already represented, making the appointment of an IMCA unnecessary in this specific context.
Question 112: A 50-year-old man with chronic alcohol dependence presents to the Emergency Department expressing suicidal ideation after losing his job. He has made no specific plans. He has a history of three previous suicide attempts, all involving overdoses when intoxicated. His current blood alcohol level is 180 mg/dL. What factor in his presentation represents the highest risk for completed suicide?
- A. Male gender and age over 45 years
- B. Recent job loss as a significant life stressor
- C. Current intoxication with elevated blood alcohol level
- D. History of three previous suicide attempts (Correct Answer)
- E. Chronic alcohol dependence syndrome
Explanation: ***History of three previous suicide attempts*** - A **previous suicide attempt** is the single strongest clinical predictor of a future completed suicide. - Each attempt significantly increases the statistical risk, as a history of prior attempts suggests a higher likelihood of future attempts and completion. *Male gender and age over 45 years* - While **male gender** and **age over 45** are established demographic risk factors for suicide, they are considered less potent predictors than a history of actual attempts. - These are **static risk factors** that indicate a general predisposition, but not the direct behavioral risk shown by past self-harm. *Recent job loss as a significant life stressor* - **Significant life stressors** like job loss can be **precipitating factors** (triggers) for suicidal ideation or behavior. - However, such stressors alone do not carry the same weight as a history of actual suicide attempts, which demonstrates a prior engagement in self-harm behavior. *Current intoxication with elevated blood alcohol level* - **Acute intoxication** with alcohol can increase suicidal risk by impairing judgment, reducing inhibitions, and increasing impulsivity. - While a serious immediate risk factor, it is a **transient state** and does not outweigh the long-term, consistent predictive power of a history of previous suicide attempts. *Chronic alcohol dependence syndrome* - **Chronic alcohol dependence** is a significant **predisposing risk factor** for suicide, contributing to depression, impulsivity, and social/financial problems. - However, it is a background risk factor, and the act of previously attempting suicide three times is a more direct and potent indicator of immediate and future lethality risk.
Question 113: A 32-year-old man with schizophrenia is being assessed for capacity to consent to depot antipsychotic medication. He states that the medication is poisonous and refuses treatment. He can repeat back information about the medication but insists it will harm him due to his persecutory beliefs. He understands he has been unwell recently. What is the most appropriate conclusion regarding his capacity?
- A. He has capacity because he can retain and repeat the information provided
- B. He has capacity because he understands he has been unwell
- C. He lacks capacity because he cannot use or weigh the information due to his delusions (Correct Answer)
- D. He lacks capacity because he is refusing recommended treatment
- E. Assessment cannot be completed until his psychosis is fully treated
Explanation: ***He lacks capacity because he cannot use or weigh the information due to his delusions*** - Under the **Mental Capacity Act**, a patient must be able to **use and weigh** information as part of the decision-making process; persecutory delusions that the medicine is 'poison' prevent this rational appraisal. - Although the patient can understand and retain information, his **delusional beliefs** directly impair his ability to reason through the benefits and risks of treatment. *He has capacity because he can retain and repeat the information provided* - Being able to **retain information** is only one of four essential criteria for capacity; passing this stage does not guarantee overall capacity. - The assessment fails at the **using and weighing** stage, as the patient cannot integrate the medical facts with his delusional reality. *He has capacity because he understands he has been unwell* - General **insight** into having a mental illness does not mean a patient has the specific capacity to make a decision about a particular **antipsychotic medication**. - Capacity is **decision-specific** and **time-specific**, requiring the patient to process the specific details of the proposed treatment. *He lacks capacity because he is refusing recommended treatment* - According to the Mental Capacity Act, an **unwise decision** or refusal of medical advice is not, by itself, evidence of a lack of capacity. - Capacity is determined by the **process of decision-making**, not the outcome or the decision itself. *Assessment cannot be completed until his psychosis is fully treated* - Capacity must be assessed at the **time the decision is required**, regardless of whether the underlying condition is currently being treated. - It is a legal requirement to support the patient to make a decision, but if the **psychosis** currently impairs their cognitive process, a determination of incapacity is made in the present.
Question 114: A 37-year-old woman with severe postpartum depression is admitted following disclosure of intrusive thoughts about harming her 6-week-old baby. She is distressed by these thoughts, recognizes they are wrong, and has not acted on them. She is refusing separation from her baby despite the clinical team's concerns. What is the most appropriate safeguarding action?
- A. Remove the baby immediately and refer to children's social services for care proceedings
- B. Arrange mother and baby unit admission where she can be supervised with her infant (Correct Answer)
- C. Allow her to keep the baby with enhanced observations on the general psychiatric ward
- D. Refer to children's social services but allow unsupervised contact pending their assessment
- E. Detain her under Section 2 and place the baby in foster care
Explanation: ***Arrange mother and baby unit admission where she can be supervised with her infant*** - Admission to a **Mother and Baby Unit (MBU)** is the gold standard as it allows for **specialist psychiatric treatment** while maintaining the **mother-infant bond** in a safe, supervised environment. - Since the thoughts are **ego-dystonic** (the patient is distressed and recognizes they are wrong), she is low risk for intentional harm, making separation potentially more damaging to her recovery. *Remove the baby immediately and refer to children's social services for care proceedings* - **Immediate removal** is disproportionate and highly traumatic when the patient shows **insight** and distress regarding her intrusive thoughts. - Safeguarding aims to use the **least restrictive** method possible; an MBU provides safety without the permanent disruption of social services care proceedings. *Allow her to keep the baby with enhanced observations on the general psychiatric ward* - **General psychiatric wards** are not appropriately staffed or equipped to handle the safety and **developmental needs of an infant**. - MBUs are specifically designed with **specialized nursing** to monitor interactions and ensure the baby's safety while the mother recovers. *Refer to children's social services but allow unsupervised contact pending their assessment* - **Unsupervised contact** is clinically unsafe when a mother is experiencing **severe postpartum depression** and intrusive thoughts of harm. - A **safeguarding referral** is mandatory, but clinical management must ensure the infant is protected via **constant supervision** until the mother's mental state stabilizes. *Detain her under Section 2 and place the baby in foster care* - While **detention** under the Mental Health Act may be necessary if she refuses treatment, it does not mandate **foster care** if a specialist MBU bed is available. - **Foster care** should be a last resort when clinical strategies, like MBU admission, are available to keep the **family unit intact** safely.
Question 115: A 65-year-old man with newly diagnosed early-stage dementia (MMSE 24/30) wishes to create a Lasting Power of Attorney (LPA) for health and welfare, appointing his daughter as attorney. During assessment, he understands what an LPA is and trusts his daughter. However, he cannot reliably recall this information 10 minutes later. What is the most appropriate conclusion regarding his capacity to create the LPA?
- A. He has capacity as he understands the information at the time of explanation
- B. He lacks capacity as he cannot retain the information for a reasonable period (Correct Answer)
- C. He has capacity if his daughter is present to remind him of the information
- D. He should wait until his dementia progresses further before creating an LPA
- E. An independent assessor should make the final decision about whether he can create the LPA
Explanation: ***He lacks capacity as he cannot retain the information for a reasonable period*** - Under the **Mental Capacity Act (MCA)**, a person must be able to **understand**, **retain**, **use/weigh**, and **communicate** information to have capacity. - While the retention period only needs to be long enough to make the decision, failing to recall the information after only **10 minutes** suggests he cannot hold it long enough to complete the decision-making process. *He has capacity as he understands the information at the time of explanation* - Understanding alone is insufficient; any person assessed for capacity must also satisfy the **retention** and **weighing** criteria concurrently. - Capacity is **decision-specific** and **time-specific**, and the inability to retain data prevents the person from weighing the pros and cons logically. *He has capacity if his daughter is present to remind him of the information* - Capacity must be demonstrated by the **individual** themselves; having a third party act as an external memory does not fulfill the legal requirements of the MCA. - Relying on the intended **attorney** (the daughter) to provide information during the assessment could also present a **conflict of interest** or risk of undue influence. *He should wait until his dementia progresses further before creating an LPA* - As dementia is a **progressive neurodegenerative** condition, waiting will lead to further cognitive decline and guaranteed loss of legal capacity. - An **LPA** must be created while a person still has capacity; once capacity is lost, the family would need to apply for **Deputyship** via the Court of Protection. *An independent assessor should make the final decision about whether he can create the LPA* - While a **Certificate Provider** is required to sign the LPA form, the clinical assessment of the four pillars of the MCA already confirms he lacks capacity due to poor **retention**. - A decision regarding capacity should be based on the established **diagnostic and functional tests** within the MCA framework, which this patient has failed.
Question 116: A 48-year-old homeless man with alcohol dependence presents to the Emergency Department expressing suicidal thoughts. He has no fixed address, is estranged from his family, and has poor engagement with services. He agrees to a safety plan and voluntary admission but there are no psychiatric beds available. Which intervention would most effectively reduce his short-term suicide risk?
- A. Provide him with a crisis helpline number and discharge
- B. Admit to a medical ward for overnight observation with psychiatric review in the morning
- C. Arrange temporary accommodation through social services and Crisis Team follow-up within 24 hours (Correct Answer)
- D. Prescribe a small quantity of benzodiazepines and arrange GP follow-up in one week
- E. Refer to alcohol liaison services and arrange community mental health team assessment in 3 days
Explanation: ***Arrange temporary accommodation through social services and Crisis Team follow-up within 24 hours***- Addressing **social determinants** like homelessness is priority; providing stable housing reduces immediate situational stress and environmental risk of suicide.- Intensive **Crisis Team follow-up** within 24 hours ensures clinical monitoring and support in the community when an inpatient bed is unavailable.*Provide him with a crisis helpline number and discharge*- This approach is ineffective for high-risk patients with **multiple risk factors** like alcohol dependence and lack of a social support network.- Self-directed help requires a level of **agency and stability** that this homeless, acutely suicidal patient currently lacks.*Admit to a medical ward for overnight observation with psychiatric review in the morning*- Medical wards are not designed for psychiatric safety and may offer inadequate **ligature risk management** or specialist observation.- While it provides physical safety, it fails to address the underlying **social needs** (homelessness) that will persist upon discharge the following day.*Prescribe a small quantity of benzodiazepines and arrange GP follow-up in one week*- Benzodiazepines carry a high risk of respiratory depression and disinhibition when combined with **alcohol dependence**.- A **one-week follow-up** is too delayed for a patient in acute crisis, significantly increasing the risk of an interval suicide attempt.*Refer to alcohol liaison services and arrange community mental health team assessment in 3 days*- A **three-day wait** is an unsafe delay for a patient expressing active suicidal thoughts combined with chronic instability.- While **alcohol liaison** is necessary for long-term recovery, it does not provide the acute risk mitigation required in an emergency department setting.
Question 117: A 23-year-old man with first-episode psychosis is admitted informally to a psychiatric ward. On day 3, he states he wishes to leave immediately, believing staff are poisoning his food. He is actively psychotic, has not eaten for 48 hours, and has deteriorating physical health. He has capacity to make decisions about his accommodation. What is the most appropriate legal course of action?
- A. He must be allowed to leave as he has capacity and is an informal patient
- B. Detain him under Section 5(2) holding power while arranging Mental Health Act assessment (Correct Answer)
- C. Persuade him to stay voluntarily and increase his antipsychotic medication
- D. Sedate him under common law and arrange Mental Health Act assessment when he is calmer
- E. Apply Deprivation of Liberty Safeguards (DoLS) to prevent him from leaving
Explanation: ***Detain him under Section 5(2) holding power while arranging Mental Health Act assessment*** - **Section 5(2)** allows a doctor to detain an informal inpatient for up to **72 hours** if they pose an immediate risk to themselves or others, providing time for a formal **Mental Health Act (MHA)** assessment. - Despite having capacity regarding accommodation, his **active psychosis** (delusions of poisoned food leading to him not eating) and rapidly **deteriorating physical health** necessitate urgent detention for a full MHA assessment to ensure his safety. *He must be allowed to leave as he has capacity and is an informal patient* - While patient autonomy is crucial under the **Mental Capacity Act**, the **Mental Health Act** provides powers to detain individuals with a mental disorder who pose a significant risk, even if they have specific capacities. - Allowing an **actively psychotic** patient with deteriorating physical health (due to delusions) to leave would be a failure of the **duty of care** and poses an immediate threat to his life. *Persuade him to stay voluntarily and increase his antipsychotic medication* - **Persuasion** is insufficient in this scenario as the patient's actions are driven by fixed **persecutory delusions**, making him unwilling to stay voluntarily, and his physical health is worsening. - Increasing medication without a legal basis to prevent him from leaving does not address the immediate **risk of absconding** or the need for a legal framework to treat him if he continues to refuse care. *Sedate him under common law and arrange Mental Health Act assessment when he is calmer* - Using **common law** for sedation or detention is inappropriate and potentially unlawful when specific statutory frameworks, such as the **Mental Health Act**, are available and designed for such psychiatric emergencies. - Detaining or sedating a patient solely under common law without an immediate MHA assessment in these circumstances risks **unlawful deprivation of liberty** and is not best practice for managing acute mental illness. *Apply Deprivation of Liberty Safeguards (DoLS) to prevent him from leaving* - **Deprivation of Liberty Safeguards (DoLS)** are applied under the **Mental Capacity Act** for individuals who **lack capacity** to make decisions about their care or residence and are deprived of their liberty in their best interests. - The patient is stated to have **capacity** regarding accommodation, but his mental disorder is causing his refusal to stay, making the **Mental Health Act** the appropriate legal framework, not DoLS.
Question 118: In the Mental Capacity Act 2005, which of the following principles is NOT one of the five statutory principles?
- A. A person must be assumed to have capacity unless it is established that they lack capacity
- B. A person is not to be treated as unable to make a decision merely because they make an unwise decision
- C. Before determining that a person lacks capacity, all practicable steps must be taken to help them make the decision
- D. Any act done for a person who lacks capacity must be done in their best interests
- E. Any decision made on behalf of a person who lacks capacity must be approved by the Court of Protection (Correct Answer)
Explanation: ***Any decision made on behalf of a person who lacks capacity must be approved by the Court of Protection*** - While the **Court of Protection** deals with serious or disputed cases, there is no statutory principle requiring every decision to be court-approved; most are made daily by clinicians and carers. - The actual fifth principle is the **Least Restrictive Option**, which states that any action should be the least restrictive of the person's rights and freedoms. *A person must be assumed to have capacity unless it is established that they lack capacity* - This is the **presumption of capacity**, the foundational first principle of the **Mental Capacity Act 2005**. - It ensures that healthcare professionals do not assume incapacity based on age, appearance, or a specific medical diagnosis. *A person is not to be treated as unable to make a decision merely because they make an unwise decision* - Known as the **right to make unwise decisions**, this principle protects an individual's **autonomy** even if others find their choice eccentric or irrational. - Lack of capacity must be based on a **functional deficit** in decision-making, not the outcome of the decision itself. *Before determining that a person lacks capacity, all practicable steps must be taken to help them make the decision* - This is the principle of **supported decision-making**, requiring clinicians to provide information in accessible formats (e.g., simple language or visual aids). - Capacity cannot be formally questioned until every **practicable effort** has been made to facilitate the patient's understanding. *Any act done for a person who lacks capacity must be done in their best interests* - The **Best Interests** principle requires decision-makers to consider the person's past wishes, feelings, and beliefs, as well as consult with relevant family or carers. - It is a mandatory framework for making choices on behalf of anyone who has been formally assessed as **lacking capacity**.
Question 119: A 54-year-old man with motor neurone disease and full cognitive capacity is assessed regarding future care planning. He states he wishes to refuse all life-sustaining treatment including ventilation when his respiratory function deteriorates. What is the most appropriate legal mechanism to document this decision?
- A. Verbal communication to his family members
- B. An advance decision to refuse treatment (ADRT) (Correct Answer)
- C. A Lasting Power of Attorney for health and welfare
- D. A DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) order
- E. A written statement in his medical records
Explanation: ***An advance decision to refuse treatment (ADRT)***- An **ADRT** (or 'living will') is a legally binding document that allows a person with **capacity** to specify which treatments they do not wish to receive in the future.- To refuse **life-sustaining treatment** like ventilation, the ADRT must be **written, signed, witnessed**, and state clearly that it applies even if life is at risk.*Verbal communication to his family members*- Verbal statements are often not considered **legally binding** or sufficiently robust when specifically refusing life-sustaining interventions.- It leaves room for **ambiguity** and legal challenges that can be avoided with a formal written document.*A Lasting Power of Attorney for health and welfare*- An **LPA** delegates decision-making power to a third party (the **attorney**) rather than documenting the patient's own direct refusal of specific treatments.- While an attorney can make decisions once capacity is lost, the **ADRT** is the primary mechanism for a patient to assert their own autonomy regarding treatment refusals.*A DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) order*- A **DNACPR** order is a narrow clinical instruction specifically regarding the administration of **CPR** in the event of cardiac or respiratory arrest.- It does not legally cover the refusal of other **life-sustaining treatments** such as long-term mechanical ventilation or artificial nutrition.*A written statement in his medical records*- While a statement in records is helpful for clinicians to understand a patient's **preferences**, it may lack the formal **legal validity** of an ADRT for life-sustaining decisions.- Without being **witnessed** and containing specific mandatory wording, it does not meet the statutory requirements of the **Mental Capacity Act**.
Question 120: A 40-year-old woman with emotionally unstable personality disorder is assessed following superficial self-cutting to her forearms. She reports chronic suicidal ideation but denies current intent to end her life. She has had 15 similar presentations in the past year. What is the most appropriate approach to assessing her suicide risk in this presentation?
- A. Her repeated presentations indicate low risk as she is attention-seeking rather than genuinely suicidal
- B. Each presentation should be assessed individually as risk can escalate and repeated self-harm increases suicide risk (Correct Answer)
- C. She should be referred for dialectical behaviour therapy and discharged without detailed risk assessment
- D. A standardized suicide risk assessment tool should be used to guide management
- E. She requires detention under the Mental Health Act given her frequency of presentations
Explanation: ***Each presentation should be assessed individually as risk can escalate and repeated self-harm increases suicide risk*** - Every episode of self-harm in patients with **Emotionally Unstable Personality Disorder (EUPD)** must be evaluated independently because **previous self-harm** is one of the strongest predictors of future completed suicide. - Risk is dynamic and can fluctuate; assuming a "habitual" pattern remains low-risk is a clinical error that overlooks the potentially **cumulative effect** of frequent crises. *Her repeated presentations indicate low risk as she is attention-seeking rather than genuinely suicidal* - Labeling patients as **attention-seeking** is stigmatizing and dangerous, as individuals with EUPD have a **lifetime suicide risk** of approximately 8-10%. - Frequent attendance does not equate to safety; it often reflects severe **emotional dysregulation** and high levels of psychological distress. *She should be referred for dialectical behaviour therapy and discharged without detailed risk assessment* - While **Dialectical Behaviour Therapy (DBT)** is the gold-standard long-term treatment for EUPD, it does not replace the need for an **acute risk assessment** during a crisis. - Discharging a patient without a thorough assessment of their current **suicidal intent** and social support is a breach of clinical safety standards. *A standardized suicide risk assessment tool should be used to guide management* - **NICE guidelines** advise against using risk assessment tools or scales to predict future suicide or determine management, as they have poor **predictive value**. - Assessment should instead focus on a comprehensive clinical interview exploring the **intent, context, and psychosocial factors** of the presentation. *She requires detention under the Mental Health Act given her frequency of presentations* - Detention under the **Mental Health Act (MHA)** requires evidence of a mental disorder that warrants detention for health or safety, which is not met by **frequency of attendance** alone. - For patients with EUPD, prolonged **compulsory admission** can often be counter-productive, leading to increased regression and loss of autonomy.
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