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Essential safeguards for use of covert medication

In Re AG District Judge Bellamy has given Important guidance on the use of covert medication to an adult lacking capacity to consent to care and treatment  detained under the `deprivation of libertty safeguards("DOLS").  AG's standard authorisation and the underlying assessments made no reference to the issue which only became apparent during the course of the challenge to the authorisation.  

Drawing attention to the requirement in the NICE guidance that a best interests meeting should be held before covert medication is administered to a person lacking capavity to consent to it, the judge gave the following guidance: 

- where there is a covert medication policy in place there must be full  consultation with the healthcare professionals and family

- the existence of the policy must be clearly identified in the assessments and authorisation

- if the authorisation exceeds 6 months there should be a clear provision for a review, possibly monthly, of the care and support plan, and reviews should involve family and healthcare professionals

-the RPR should be fully involved in the discussions;

a change in medication or treatment regime should trigger a review of the authorisation.

Supervisory bodies will no doubt wish to review whether any detained patients for whom they are responsible are receiving medication covertly other than in accordance with these safeguards.

DSC's Aswini Weereratne QC appeared for AG.

Covert medication is a serious interference with a person's autonomy and right to self-determination under Article 8. It is likely to be a contributory factor giving rise to the existing DOL. Safeguards by way of review are essential.


communitycare, community care & health