Table 5 Emergent factors from the Exploratory Factor Analysis

Factor 1: Support for the powers of the Mental Health Act to protect from harm

A7. Vignette item: 'If Mandy were 25 years old rather than 16 years old, her treatment team should be less willing to override her treatment refusal.' – reversed

B10. 'The Mental Health Act should not be used to enforce admission to hospital for mental disorders.' – reversed

B11. 'The Mental Health Act is used too often in the treatment of mental disorders.' – reversed

C12. 'The Mental Health Act should not be used when patients clearly believe that the advantages of anorexia nervosa for them outweigh the disadvantages.'- reversed

C13. 'It is appropriate that the Mental Health Act enables compulsory re-feeding of patients with anorexia nervosa.'

C14. 'The Mental Health Act is used too often in the treatment of anorexia nervosa.' – reversed

C15. 'The Mental Health Act should not be used to enforce admission to hospital for anorexia nervosa.' – reversed

C16. 'The Mental Health Act should be used more frequently to protect the health and safety of patients with anorexia nervosa.'

E32. Consideration of use of the Mental Health Act if: 'The patient's physical health is at risk.'

Factor 2: Primacy of best interests

A2. 'Since the Mental Health Act permits compulsory treatment in this case, it should be used as she is at substantial risk.'

A3. 'Since Mandy is young she should be treated in her best interests against her will.'

A4. 'In the end the parents' decision should prevail over Mandy's treatment refusal as she is only 16 years old.'

A5. 'Although Mandy is intellectually able to understand the risks, the fact that she has anorexia nervosa means that her competence to refuse treatment is almost certainly compromised.'

C18. 'Treatment of anorexia nervosa against a patient's will is justified if it is likely that the patient will recover and have a good outcome after treatment.'

C19. 'Treatment of anorexia nervosa against a patient's will is justified if it is likely that the patient will subsequently say he or she is glad that treatment was enforced.'

C20. 'Treatment refusal by patients is due to the influence of the anorexia nervosa and therefore does not fully reflect their true wishes or personality.'

Consideration of the use of the Mental Health Act if:

E34. 'The patient is unable to recognise what is in her own best interests.'

E35. 'The patient is not making choices consistent with her pre-morbid personality or wishes.'

E36. 'The patient's family is unable to support her in the treatment.'

E37. 'The patient's family is keen to support use of compulsory treatment.'

Factor 3: Autonomy viewed as being preserved in anorexia nervosa

A1. 'Since Mandy understands the risks, her refusal of treatment should ultimately be respected.'

A2. 'Since the Mental Health Act permits compulsory treatment in this case, it should be used as she is at substantial risk.' – reversed

D22. 'Patients with anorexia nervosa choose to engage in weight loss behaviours – mild anorexia nervosa'

D23. 'Patients with anorexia nervosa choose to engage in weight loss behaviours – severe anorexia nervosa'

D24. 'Patients with anorexia nervosa are able to control their own dieting, exercise and purging behaviours – mild anorexia nervosa'

D25. 'Patients with anorexia nervosa are able to control their own dieting, exercise and purging behaviours – severe anorexia nervosa'

D28. 'Patients with anorexia nervosa are generally able to reason properly about treatment – mild anorexia nervosa'