 Under section 57 of the Act, which applies to both detained and informal patients, a panel of three people appointed by the Mental Health Act Commission has to establish that the patient is consenting.Then the psychiatrist on the panel authorises the operation if it is likely to alleviate or prevent deterioration in the patient's condition.In Scotland, under section 234 of the Mental Health (Care and Treatment) (Scotland) Act 2003, psychosurgery can only be carried out on consenting patients if a panel from the Mental Welfare Commission confirms that the patient's consent is valid and that the operation is in their best interests.