What to expect when you speak with Second Opinion Appointed Doctor (SOAD)

Page last updated: 5 April 2023

If a Second Opinion Appointed Doctor (SOAD) has been arranged, they will try to speak to you to consider your views about treatment.

You may meet the SOAD face-to-face, or speak to them over the phone or on a computer. It may not always be possible to arrange this in the way that you would prefer.

If you do not wish to speak to a SOAD, you can tell your care team. The SOAD will then decide whether to carry out their second opinion without speaking to you. They will still try to understand what you think about your treatment by speaking to people involved in your care and looking at your records.

Before you speak to the SOAD

Your care team will tell you when you will speak to the SOAD and who the SOAD is.

You may want to:

  • Arrange for an advocate, family member or carer to support you. Staff should help you do this.
  • Make some notes to bring to the meeting, or think about how you feel about your treatment, how it is affecting you and what has worked best for you in the past.
  • Have an interpreter or signer with you. If you need this, it will be arranged by the hospital.

When you speak to the SOAD

The SOAD will:

  • introduce themselves and their role and explain why they are speaking to you
  • treat you as an individual and explain things clearly
  • be polite and listen to your views
  • make sure that you can communicate with them effectively, for example through an interpreter
  • seek to understand your views on your treatment, including whether you agree to it or not, your reasons if you do not agree, and any previous experience you may have had with the treatment
  • consider your preferences and whether alternative treatments are more appropriate

The SOAD will speak to you in private where this is possible. You can ask the SOAD if you would like other people to be there to support you and the SOAD should consider this. For example, you could choose to have a family member, friend, peer support worker or IMHA at the meeting with you. The SOAD may ask other people to be present if they believe this is necessary. They may also ask other people to leave so they can speak to you alone. This is to make sure you can speak openly and they can see how your mental health is.

The SOAD may also speak to your family or carers if they believe this is appropriate.

A SOAD will not tell you what their decision is during your meeting. This is because they will not have decided on this yet.

After you speak to the SOAD

The SOAD must also speak to 2 people professionally involved in your care, such as a nurse and a social worker.

A SOAD will receive information about your care and treatment from your records and may also talk to your doctor to understand more about your treatment and the reasons for this.

The SOAD will decide whether some, all or none of your treatment is appropriate. If the SOAD approves your treatment to start or continue, they will fill in a certificate that says what treatment you can be given.

The SOAD will usually write why they have made their decision on their certificate although sometimes their explanation can be written separately. The SOAD will give their certificate to the hospital managers as soon as possible. They will also write down their reasons if they do not approve some or all of your treatments.

The SOAD is independent of the hospital, and they must make their own decision about what treatment is appropriate for you. If you do not agree with their decision, you cannot appeal to us about this.

Your doctor is personally responsible for telling you the outcome and what that means for you and your treatment. They may share the SOAD’s written reasons with you unless they think that doing so would be likely to cause serious harm to your physical or mental health or to that of others.

Once a SOAD has given a certificate, your doctor can, but does not have to, give you the treatment described on this. Your doctor is responsible for deciding what treatment you receive within the limits written down by the SOAD on their certificate. You should continue to talk to your doctor if you have any questions or concerns about your treatment.

Under the law of the Mental Health Act, the treatment on a SOADs certificate must be checked in the future. Your doctor must write a report about your treatment if your detention is renewed. This report must be sent to us. A different SOAD will check that report to see whether they agree that your treatment is still the best for you. If they do not agree, we will contact your doctor to ask for more information or to review your treatment.

What the SOAD can and cannot do

A SOAD can only make decisions on treatments to do with your mental health. They cannot make decisions on treatments for your physical health.

The SOAD will check whether the recommended treatment is clinically appropriate and that your views and rights have been considered.

A SOAD may make decisions on:

  • whether you are being given the right type and amount of medication
  • the use of electro-convulsive therapy (ECT) – including whether this type of treatment is appropriate for you in your circumstances.

A SOAD cannot:

  • help to discharge you or help you to appeal against your detention
  • authorise section 17 leave or help you with any leave requests

You should talk to your care team about these, and you can seek support from an IMHA.