UKMLA Psychiatry + Mental Health Act: Legal-Clinical Guide

Psychiatry is the UKMLA specialty where the clinical content and the legal framework are tested together, and where candidates most often underprepare because they studied them separately. An AKT stem will rarely ask "what are the symptoms of depression?" in isolation — it will ask "this depressed patient refusing treatment lacks capacity; under which legal framework would you detain them for treatment?" The answer requires mood disorder knowledge, Mental Health Act familiarity, and an understanding of where the MHA and the Mental Capacity Act intersect. Miss any one of those and the whole stem is lost.

Roughly 15–20% of AKT questions touch psychiatry, and about a third of those test the legal frameworks (MHA sections, MCA, DoLS). For UK medical students this content is absorbed across psychiatry rotations and ethics teaching; for IMGs it is often a significant gap because the legal frameworks are genuinely UK-specific and don't appear in non-UK psychiatry curricula. The UKMLA examines both cohorts against the same standard, so closing the legal-framework gap is essential regardless of your training background.

This masterclass walks through the seven clinical psychiatry topic clusters the UKMLA tests aggressively, then builds in the Mental Health Act sections, the Mental Capacity Act 2005, DoLS, and the safeguarding triggers that thread through every psychiatric stem. Aligned to 2026 NICE guidance, the current MHA (pending reform), and the GMC content map.

Table of contents

1. Why psychiatry carries legal weight
2. Mood disorders — depression and bipolar
3. Psychotic disorders — schizophrenia and acute psychosis
4. Anxiety disorders
5. Substance misuse and alcohol withdrawal (CIWA-Ar)
6. Delirium vs dementia
7. Eating disorders
8. Personality disorders
9. Mental Health Act — the key sections
10. Mental Capacity Act 2005
11. DoLS — Deprivation of Liberty Safeguards
12. Common AKT legal-clinical stems
13. Safeguarding triggers
14. Common AKT question patterns
15. FAQ

1. Why psychiatry carries legal weight

The GMC content map names "self-harm", "suicidal ideation", "mental capacity", "consent", "mood disturbance", "psychosis", "eating disorders", "substance misuse", and "confusion" as core presentations. Between them they drive 25–40 stems on a typical AKT paper. What makes them distinct from other specialties is that a third of psychiatric stems test legal reasoning on top of the clinical diagnosis — capacity assessment, MHA sectioning, DoLS decisions, safeguarding escalation.

Candidates lose psychiatry marks most often through four errors: confusing MHA sections (especially 2 vs 3 vs 5(2)), missing serotonin syndrome or neuroleptic malignant syndrome in pharmacology stems, under-recognising eating disorder red flags, and failing to separate delirium from dementia. Each is preventable with targeted drilling.

Your target: 75%+ subscore on psychiatry Q-bank filters. Pair this post with the emergency presentations masterclass for acute overdose management and the NICE guidelines post for antidepressant and antipsychotic prescribing.

2. Mood disorders — depression and bipolar

Depression. NICE NG222 classifies by severity using PHQ-9 or clinical judgement:

• Less severe (PHQ-9 <16, previously "mild-moderate"): offer psychological therapy first-line (guided self-help, group CBT, behavioural activation). Antidepressant only if patient preference or previously responded.
• More severe (PHQ-9 ≥16, previously "moderate-severe"): combined antidepressant + psychological therapy.

First-line antidepressants. SSRI — sertraline or citalopram (UK cost-preferred). Escitalopram and fluoxetine also acceptable. Paroxetine has the highest discontinuation-syndrome risk and is less favoured.

Duration. At least 6 months after symptom remission; 2 years if recurrent. Taper over 4+ weeks to avoid discontinuation syndrome.

SSRI side effects to know:

• GI upset, nausea (weeks 1–2)
• Sexual dysfunction
• Increased bleeding risk (especially with NSAID co-prescription)
• Hyponatraemia (SIADH)
• Serotonin syndrome (see below)
• Initial worsening anxiety/suicidal ideation in under-25s — close review weekly for first month

Serotonin syndrome. Triad: autonomic hyperactivity (tachycardia, hypertension, diaphoresis, hyperthermia) + neuromuscular (clonus, hyperreflexia, tremor) + mental state (agitation, confusion). Usually from SSRI + MAOI, SSRI + tramadol, SSRI + ondansetron, SSRI + triptan. Management: stop causative drugs, supportive care, benzodiazepines, cyproheptadine for severe.

Bipolar disorder. Alternating manic/hypomanic and depressive episodes.

• Mania: ≥1 week of elevated/irritable mood + increased energy + DIGFAST (distractibility, impulsivity, grandiosity, flight of ideas, activity increase, sleep decrease, talkative). Psychotic features in severe.
• Hypomania: ≥4 days of similar features without marked impairment or psychosis.
• Bipolar depression: depressive episodes with bipolar history.

Management:

• Acute mania: oral antipsychotic (olanzapine, quetiapine, risperidone, haloperidol). Stop antidepressants. Add lithium or valproate if antipsychotic alone insufficient.
• Long-term prophylaxis: lithium first-line. Valproate alternative (NOT in women of childbearing potential).
• Bipolar depression: quetiapine, lamotrigine, or olanzapine ± fluoxetine. Avoid antidepressant monotherapy (risk of switch to mania).

Lithium monitoring:

• Levels 12 hours post-dose, target 0.4–1.0 mmol/L.
• Check levels weekly until stable, then every 3 months.
• TFTs and U&Es every 6 months (lithium nephrotoxic and affects thyroid).
• Toxicity features (level >1.5): coarse tremor, ataxia, confusion, seizures, renal impairment.
• Precipitants of toxicity: dehydration, NSAIDs, ACEi/ARBs, diuretics.

AKT question pattern. Patient on lithium develops coarse tremor, ataxia, confusion. Level 2.1. First action? Stop lithium, IV fluids, consider haemodialysis if severe.

3. Psychotic disorders — schizophrenia and acute psychosis

Schizophrenia diagnostic criteria. ≥2 of the following for ≥1 month:

• Delusions
• Hallucinations
• Disorganised speech
• Grossly disorganised/catatonic behaviour
• Negative symptoms (flattened affect, avolition, alogia)

At least one must be one of the first three.

Schneider's first-rank symptoms (suggestive but not diagnostic): auditory hallucinations (running commentary, third-person), thought insertion/withdrawal/broadcasting, somatic passivity, delusional perception.

First-episode psychosis. Early Intervention in Psychosis teams — refer within 14 days of suspicion. CBT + family intervention + antipsychotic.

Antipsychotic choice:

• First-line: any oral atypical (olanzapine, risperidone, quetiapine, aripiprazole) based on side-effect profile and patient preference.
• Treatment-resistant (failed 2 adequate trials): clozapine — requires FBC monitoring (agranulocytosis).

Antipsychotic side effects:

• Extrapyramidal (EPS): acute dystonia (treat with procyclidine), akathisia, parkinsonism, tardive dyskinesia. Worse with typicals (haloperidol, chlorpromazine).
• Metabolic: weight gain, diabetes, dyslipidaemia. Worst with olanzapine and clozapine.
• Prolactinaemia: worst with risperidone; causes galactorrhoea, amenorrhoea, sexual dysfunction.
• QT prolongation: quetiapine and haloperidol — baseline ECG.
• Anticholinergic: chlorpromazine, clozapine — dry mouth, constipation, urinary retention.
• Clozapine-specific: agranulocytosis (weekly FBC for 18 weeks then fortnightly then monthly), myocarditis, constipation (can be fatal), hypersalivation, seizures.

Neuroleptic malignant syndrome (NMS). Within days-weeks of antipsychotic start or dose change. Triad: fever + rigidity + autonomic dysfunction + raised CK (often >1000). Altered consciousness. Management: stop antipsychotic, supportive care (cooling, IV fluids), dantrolene or bromocriptine in severe cases, ICU.

AKT question pattern. Patient started on haloperidol 3 days ago, now with fever, lead-pipe rigidity, autonomic instability, CK 5000. Diagnosis? NMS. Management? Stop haloperidol, ICU admission, supportive care.

4. Anxiety disorders

Generalised anxiety disorder (GAD). Persistent excessive worry, ≥6 months, multiple domains, physical symptoms (restlessness, fatigue, poor concentration, muscle tension, sleep disturbance).

Management (stepped care per NICE CG113):

1. Education, active monitoring.
2. Low-intensity psychological interventions (self-help, psychoeducational groups).
3. High-intensity psychological intervention (CBT) OR drug treatment (SSRI, usually sertraline).
4. Specialist input; add pregabalin, augment CBT, consider referral.

Panic disorder. Recurrent unexpected panic attacks + anticipatory anxiety. Management: CBT first-line, SSRI if meds needed (sertraline/citalopram). Benzodiazepines avoided beyond short-term crisis — dependence risk.

Specific phobia, social anxiety, PTSD, OCD — CBT-based (trauma-focused CBT and EMDR for PTSD; exposure and response prevention for OCD). SSRIs (sertraline, fluoxetine) for OCD at higher doses than depression.

AKT question pattern. Young adult with persistent worry about multiple life domains, 8 months, sleep disturbance, muscle tension. Diagnosis? GAD. First-line? Low-intensity CBT/guided self-help. If that fails? High-intensity CBT or SSRI (sertraline).

5. Substance misuse and alcohol withdrawal (CIWA-Ar)

Alcohol dependence features. CAGE/AUDIT screening. Consider dependence when: tolerance + withdrawal + loss of control + prioritisation over other activities + continuation despite harm.

Alcohol withdrawal symptoms:

• 6–12 hours: tremor, sweating, anxiety, tachycardia.
• 12–24 hours: visual/tactile hallucinations.
• 24–48 hours: seizures (generalised tonic-clonic).
• 48–72 hours: delirium tremens — confusion, severe autonomic instability, profound tremor, hallucinations. 5–15% mortality untreated.

CIWA-Ar scale quantifies severity (nausea, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbance, headache, orientation). Score ≥10 triggers pharmacological management.

Management:

• Chlordiazepoxide reducing regimen (long-acting benzodiazepine) — UK first-line. Lorazepam alternative in hepatic impairment.
• Pabrinex (IV B vitamins + C) — before glucose to prevent Wernicke's encephalopathy.
• Thiamine oral replacement for long-term use.
• Hydration, electrolytes.

Wernicke's encephalopathy. Triad: confusion + ataxia + ophthalmoplegia. Treat with high-dose IV Pabrinex. Untreated progresses to Korsakoff's (irreversible anterograde amnesia + confabulation).

Long-term alcohol management:

• Motivational interviewing + community detox + mutual aid (AA, SMART Recovery).
• Acamprosate (reduces craving) or naltrexone (reduces reward) for relapse prevention.
• Disulfiram (aversion) — patient preference, requires commitment.

Opioid dependence. Methadone or buprenorphine for maintenance. Naloxone reverses acute overdose. Community drug services for rehabilitation.

AKT question pattern. Alcoholic 36 hours into withdrawal, CIWA score 15. First action? IV Pabrinex + PO/IV chlordiazepoxide reducing regimen. Distractor: IV glucose first (wrong — risks Wernicke's).

6. Delirium vs dementia

This discrimination is on almost every AKT paper.

Delirium causes (PINCH ME):

• Pain
• Infection (UTI, pneumonia commonest)
• Nutrition (thiamine, B12)
• Constipation
• Hydration (dehydration or overload)
• Medication (anticholinergics, opiates, benzos)
• Environment (hospital admission itself, ICU)

Management:

• Treat underlying cause.
• Orient patient — clock, calendar, natural light, family present.
• Quiet single room if possible.
• Avoid restraints.
• Minimise iatrogenic precipitants (bladder catheters, unnecessary meds).
• Avoid benzodiazepines (worsen delirium) except for alcohol withdrawal.
• Haloperidol 0.5 mg PO/IM for severe agitation (avoid in Parkinson's/DLB — use lorazepam).

Lewy body dementia caveat. Visual hallucinations + fluctuating cognition + parkinsonism + REM sleep behaviour disorder. Severe antipsychotic sensitivity — use trazodone or quetiapine at very low dose if essential, not haloperidol.

AKT question pattern. Elderly post-op patient, acute confusion, fluctuating over 24 hours, visual hallucinations. Diagnosis? Delirium. First action? Identify cause (check for UTI, electrolytes, constipation, medications).

7. Eating disorders

Anorexia nervosa. Persistent restriction + significantly low body weight (BMI <17.5 in adults) + fear of weight gain + body image distortion.

Red flags (require urgent assessment):

• BMI <13
• Rapid weight loss (>1 kg/week)
• Bradycardia <40
• Hypotension
• Hypoglycaemia
• Hypokalaemia, hypophosphataemia
• Prolonged QT
• Severe electrolyte derangement
• Organ failure signs

Refeeding syndrome. Life-threatening complication when nutrition resumed in malnourished patient. Hypophosphataemia, hypokalaemia, hypomagnesaemia, thiamine deficiency, cardiac failure, arrhythmias. Management: slow refeeding (start 5–10 kcal/kg/day), correct electrolytes pre-emptively, IV thiamine, daily electrolyte monitoring.

Anorexia management:

• Psychological: CBT-ED (eating disorder focused), MANTRA, or SSCM.
• Medical: weight restoration, bone protection (vitamin D, calcium, consider bisphosphonates if prolonged amenorrhoea).
• Inpatient admission for severe (BMI <15, medical instability, no outpatient engagement).
• SSRIs ineffective for weight restoration; may help comorbid depression/OCD post-restoration.

Bulimia nervosa. Recurrent binge-eating + compensatory behaviours (vomiting, laxatives, excessive exercise) + usually normal/above-normal BMI.

Complications: electrolyte disturbance (hypokalaemia), parotid enlargement, dental erosion, Russell's sign (calluses on dorsum of hand), oesophageal tears (Mallory-Weiss, Boerhaave).

Management: CBT-ED, family therapy in younger patients, SSRI (fluoxetine 60 mg — only SSRI with evidence in bulimia).

Binge-eating disorder. Recurrent binges without compensation. CBT-ED, ± SSRI.

AKT question pattern. Teenage girl with BMI 13, bradycardia 38, hypokalaemia. Next step? Urgent medical admission for monitoring + controlled refeeding + electrolyte correction.

8. Personality disorders

Three clusters (DSM-5):

• Cluster A (odd/eccentric): paranoid, schizoid, schizotypal.
• Cluster B (dramatic): antisocial, borderline (emotionally unstable), histrionic, narcissistic.
• Cluster C (anxious): avoidant, dependent, obsessive-compulsive.

Emotionally unstable personality disorder (EUPD, borderline). Most examined. Unstable relationships, identity, affect; impulsivity, self-harm, suicidality, fear of abandonment, chronic emptiness. Dialectical behaviour therapy (DBT) first-line. Mentalisation-based therapy alternative. No drug is licensed for EUPD; pharmacotherapy targets comorbid depression/anxiety/psychosis only.

Key exam point. Short-term psychotropic prescribing in EUPD crisis should be avoided; self-harm management is supportive + crisis plan + urgent CMHT follow-up, not a new long-term drug.

9. Mental Health Act — the key sections

The MHA 1983 (as amended 2007) governs detention for assessment and treatment of mental disorder. The Reforming MHA bill (2024–) is in progress but not yet law — 2026 AKT tests current legislation.

Key sections:

Section 2 — admission for assessment.

• Up to 28 days.
• Requires: 2 doctors (one Section 12 approved) + AMHP (Approved Mental Health Professional).
• Grounds: mental disorder warranting hospital detention + risk to self/others.
• Purpose: assessment (can include treatment).

Section 3 — admission for treatment.

• Up to 6 months (renewable).
• Same application as Section 2: 2 doctors + AMHP.
• Grounds: mental disorder warranting hospital treatment + risk + appropriate treatment available.
• Treatment can be given without consent (within limits).

Section 4 — emergency admission.

• Up to 72 hours.
• Requires: 1 doctor + AMHP (rarely used; usually converted to Section 2).
• Grounds: urgent necessity.

Section 5(2) — doctor's holding power (inpatient only).

• Up to 72 hours.
• Applied to voluntary inpatient already admitted to any ward.
• By the doctor in charge of the patient's care (not just any doctor).
• Converts to Section 2 or 3 for ongoing detention.

Section 5(4) — nurse's holding power (inpatient only).

• Up to 6 hours.
• Applied by a registered mental health nurse.
• Psychiatric inpatient only.
• Bridge until doctor assesses for 5(2).

Section 136 — police powers (public place).

• Up to 24 hours (extendable to 36 hours).
• Police can detain person in public place appearing to have mental disorder and in immediate need of care.
• Must take to place of safety (usually A&E or psychiatric Place of Safety suite).

Section 135 — police warrant (private premises).

• Warrant to enter private premises + remove person to place of safety.
• Up to 24 hours.

What can/cannot be treated:

• Treatment for mental disorder can be given without consent under Section 3.
• Treatment for physical illness requires either capacity-based consent or MCA best-interests + possibly DoLS (see below).
• Example: schizophrenic patient with appendicitis — MHA cannot authorise appendicectomy; you use MCA best-interests if patient lacks capacity for that specific decision.

AKT question pattern. Inpatient in general medical ward attempting to leave against advice, thought to have mental disorder. Junior doctor assesses. Which section? Section 5(2), the doctor's holding power, by the responsible clinician or consultant. Convert to Section 2 via two-doctor + AMHP assessment.

10. Mental Capacity Act 2005

The MCA governs decisions for adults who lack capacity regardless of mental disorder. Applies to all healthcare and welfare decisions.

Five principles:

1. Presume capacity unless proven otherwise.
2. Support the person to make their own decision.
3. Unwise decisions don't equal lacking capacity.
4. Decisions for incapacitated people must be in their best interests.
5. Least restrictive option.

Two-stage capacity test (decision-specific and time-specific):

Stage 1 — Diagnostic test. Does the person have an impairment of mind or brain (temporary or permanent)?

Stage 2 — Functional test. Can they:

• Understand information relevant to the decision?
• Retain it long enough to decide?
• Weigh it as part of the decision?
• Communicate their decision (any means)?

All four must be intact for capacity. Failure of any one = lacks capacity for that decision at that time.

Best-interests decisions. Made by clinicians (or appropriate decision-maker) considering:

• The person's past and present wishes, beliefs, values.
• Views of carers and family.
• Whether capacity may return (delay reversible decisions).
• Avoiding discrimination.
• Least restrictive option.

Advance decisions (ADRT, living wills). Legally binding refusal of specific treatment (must be written, signed, witnessed if refusing life-sustaining treatment). Does not allow refusal of basic care (food, water by mouth).

Lasting Power of Attorney (LPA). Health and Welfare LPA can make healthcare decisions when donor lacks capacity. Finance LPA separate.

Independent Mental Capacity Advocate (IMCA). Appointed when incapacitated person has no family/friends and faces serious treatment or accommodation decisions.

Court of Protection. Ultimate decision-maker for serious disputes; DoLS appeals; complex best-interests.

AKT question pattern. 78-year-old dementia patient refusing cataract surgery that clinicians deem in her interest. She understands the consent form read to her at the time but cannot recall it 5 minutes later. Capacity? Lacks capacity (fails retention stage). Next step? Best-interests decision under MCA.

11. DoLS — Deprivation of Liberty Safeguards

DoLS authorise deprivation of liberty of people lacking capacity who are accommodated in hospitals or care homes.

Acid test (Cheshire West 2014): deprivation of liberty = continuous supervision and control + not free to leave, regardless of wishes.

Process:

1. Provider (care home/hospital) identifies possible deprivation.
2. Apply to Local Authority (in England; Local Health Board in Wales).
3. Six assessments: age, no refusal, mental capacity, mental health, eligibility, best interests.
4. Authorisation granted (up to 12 months, renewable).

Liberty Protection Safeguards (LPS). Intended to replace DoLS; legislation passed 2019 but implementation delayed multiple times. Not yet active in 2026 — DoLS remains the operating framework.

When DoLS does NOT apply:

• Detention under the MHA (MHA takes precedence for mental-disorder treatment).
• Person with capacity to consent to their care arrangements.
• Person not deprived of liberty (e.g. can leave freely).

AKT question pattern. Dementia patient in a locked care home, unable to consent to placement, requires close supervision. What authorises this? DoLS authorisation under the MCA.

12. Common AKT legal-clinical stems

Five hybrid stem templates mix clinical and legal reasoning.

Template 1 — Section which? Stem describes where the patient is (public place, inpatient ward, community, private home) and asks which section applies. Mistake: confusing 5(2) (inpatient doctor) vs 136 (public place police).

Template 2 — MHA or MCA? Clinical scenario with mental disorder AND physical illness. Task: identify which framework authorises which treatment. Mistake: applying MHA to authorise surgical treatment (wrong — MHA is for mental disorder only).

Template 3 — Capacity assessment. Stem describes specific patient decision and factors suggesting capacity concern. Task: apply four-stage functional test. Mistake: using "unwise decision" as evidence of incapacity (it's not).

Template 4 — Antipsychotic choice in elderly with DLB. Behavioural disturbance in Lewy body dementia. Mistake: picking haloperidol (dangerous neuroleptic sensitivity). Correct: non-pharmacological first, then low-dose quetiapine or trazodone if essential.

Template 5 — Recognition of NMS or serotonin syndrome. Stem describes fever + rigidity + CK raised on antipsychotic (NMS), or fever + clonus + hyperreflexia on SSRI combo (serotonin syndrome). Task: identify and stop offending agent.

MLA Prep tags every psychiatry question by both the clinical condition and the relevant MHA/MCA framework, so you drill both dimensions in the same session. Start the free diagnostic for a psychiatry-and-law split subscore in 20 minutes.

13. Safeguarding triggers

Safeguarding questions appear on every AKT paper. Three populations to know.

Child safeguarding (under 18). Escalate concerns via paediatric safeguarding lead and children's social care. Key triggers:

• Unexplained injuries or injuries inconsistent with developmental stage.
• Delayed presentation.
• Multiple injuries of different ages.
• Repeated attendance patterns.
• Sexualised behaviour or language inappropriate to age.
• Parental substance misuse, domestic violence, parental mental illness.
• Unexplained missed appointments/DNA.
• FGM disclosure (mandatory report to police in under-18s in England/Wales).

Vulnerable adult safeguarding (over 18 with care/support needs). Under Care Act 2014. Categories of abuse: physical, sexual, psychological/emotional, neglect, discriminatory, organisational, financial, modern slavery, domestic abuse, self-neglect.

Domestic abuse in pregnancy. Specific high-risk period. Routine enquiry recommended by NICE. DASH risk assessment. MARAC referral if high risk.

Mandatory reports:

• FGM in under-18s (England/Wales) — report to police.
• Suspected female genital mutilation recording duty for all healthcare professionals.
• Modern slavery/trafficking — report to National Referral Mechanism.
• Terrorism concerns (Prevent) — escalate via trust safeguarding lead.

AKT question pattern. 3-year-old presents with bruises of different ages and malnutrition. First action? Refer to local children's social care under safeguarding procedures; inform paediatric safeguarding lead; document findings; do not challenge carers aggressively.

14. Common AKT question patterns

Seven psychiatry stem templates recur on AKT papers.

Template 1 — Antidepressant choice and duration. Patient with new depression; pick first-line and counsel on duration/side effects.

Template 2 — Bipolar management in pregnancy. Avoid valproate; lithium risk-benefit; lamotrigine preferred.

Template 3 — Acute psychosis management. Newly psychotic patient; oral atypical first-line; escalate if refused or non-compliant → MHA if needed.

Template 4 — Alcohol withdrawal. Pabrinex before glucose; chlordiazepoxide reducing regimen; CIWA-Ar scoring.

Template 5 — Delirium vs dementia discrimination. Stem packs both acute and chronic features; pick the correct diagnosis and first investigation.

Template 6 — Eating disorder red flags. BMI, bradycardia, electrolytes, QT — which triggers admission.

Template 7 — MHA section selection. Match the clinical scenario to the correct section (2/3/5(2)/136).

15. FAQ

How many AKT marks come from psychiatry? Approximately 25–40 stems on a 200-question paper touch psychiatric content, with one-third testing legal framework in some form.

Can a patient with capacity refuse life-saving treatment? Yes. Capacity + informed decision = respected, regardless of clinician disagreement. This is a hard principle to enforce emotionally but it is firmly examined.

What if a patient with capacity to consent for treatment today later loses capacity? Their earlier capacity-based decision stands unless they made an advance decision or LPA. For new decisions arising after capacity loss, best-interests under MCA.

Is Section 5(2) available outside psychiatric wards? Yes — any inpatient on any ward (medical, surgical, obstetric) can be detained under 5(2) by the doctor in charge of their care. It's a common AKT trap.

What happens after Section 2 expires? Either patient discharged, continues voluntarily, or converted to Section 3 (treatment, 6 months).

Is a suicidal patient in A&E who refuses admission detainable? If they have mental disorder + risk to self, yes — via Section 2 (or Section 4 in emergency). Pathway: AMHP + two doctors. Section 136 only applies if they are in a public place and police brought them in.

Can I section a patient for an overdose alone? Overdose itself is not a mental disorder. You need evidence of an underlying mental disorder + risk. In practice, most overdose-related detentions invoke Section 2 for assessment of presumed mental disorder.

Do I need to memorise MHA section numbers word for word? Yes — Section 2, Section 3, Section 5(2), Section 136 in particular. These are the most-tested sections. Section 5(4) and Section 135 less often.

What about capacity in 16–17 year olds? MCA applies from age 16. Under-16s are assessed under Gillick competence for healthcare decisions. Parental consent can override a competent 16–17 year old's refusal of life-saving treatment (specifically refusal) — this is a nuanced area the AKT occasionally tests.

Does the Liberty Protection Safeguards (LPS) scheme apply in 2026? No — still deferred. DoLS remains current. Check for updates closer to your exam.

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Psychiatry is the specialty where clinical knowledge and legal framework fuse. Seven clinical clusters, four legal frameworks (MHA, MCA, DoLS, safeguarding), and seven question templates. Drill the MHA sections verbatim, the MCA capacity test in four parts, and the delirium/dementia discrimination — those three alone cover 60% of psychiatry stems.

Pair this masterclass with the NICE guidelines post for antidepressant and antipsychotic prescribing, the CPSA strategy post for communication station framing (capacity, consent, breaking bad news), and the emergency presentations post for overdose and acute psychiatric emergencies. The 12-week plan slots psychiatry alongside ethics/law in weeks 5–6.

MLA Prep's psychiatry module covers all seven clinical clusters + the MHA/MCA legal framework with scenario-based SBAs, capacity-assessment drills, and section-selection stems. Start the free diagnostic to benchmark your psychiatry and law subscore, or compare plans for full access.