The Mental Health Act (1983) (updated in 2007) provides a legal framework for keeping patients in hospital against their wish for assessment and treatment of a mental health disorder. This is called being detained or sectioned under the Mental Health Act.
When a patient with capacity agrees to be admitted to hospital voluntarily, this is called a voluntary or informal admission. An informal admission does not involve detention under the Mental Health Act. Section 131 of the MHA explains that patients can be admitted without involving the MHA.
People Involved
An Approved Mental Health Professional (AMHP) is a specially qualified professional (e.g., social worker or mental health nurse) that helps organise and contribute to Mental Health Act assessments.
A Section 12 doctor is a qualified and approved doctor (usually a psychiatrist) who can undertake Mental Health Act assessments.
The Responsible Clinician is the person with overall responsibility for the patient’s care (generally the consultant).
The Nearest Relative is someone close to the patient who is responsible for looking out for the patient’s interests. The Mental Health Act has an ordered list that dictates who fits this role.
An Independent Mental Health Advocate (IMHA) is an independent person allocated to a patient being detained under the Mental Health Act. Their role is to support the person, help them understand the situation, and express themselves.
Mental Health Act Assessment
A Mental Health Act assessment involves a detailed evaluation to determine whether to detain someone under the Mental Health Act.
The Approved Mental Health Professional (AMHP) is the primary person making the application and organising the admission. The Nearest Relative can also make the application.
The decision needs to be recommended by two registered medical practitioners (doctors):
- A Section 12 doctor
- Another doctor (e.g., their GP)
A Mental Health Act assessment can result in compulsory admission under Section 2 or Section 3.
Section 2
Section 2 involves compulsory admission for assessment following a Mental Health Act assessment, with a maximum period of 28 days.
It cannot be renewed. It ends in either discharge or further detention under Section 3.
Section 3
Section 3 involves compulsory admission for treatment. The maximum period is six months, after which the Responsible Clinician can arrange to renew it for further treatment.
Detention under Section 3 requires a Mental Health Act assessment. Patients that are well-known to mental health services may be detained under Section 3 straight from the community. Alternatively, patients may be detained under Section 3 following assessment under Section 2.
Section 4
Section 4 is used to detain patients for up to 72 hours in urgent scenarios where other procedures cannot be arranged in time. It requires an AMHP and one doctor. It is followed by a Mental Health Act assessment.
Section 5(2)
Section 5(2) is used in an emergency to detain patients who are already in hospital voluntarily. It lasts up to 72 hours and requires only one doctor. It is followed by a Mental Health Act assessment.
Section 5(4)
Section 5(4) is used in an emergency to detain patients who are already in hospital voluntarily. It lasts up to 6 hours and requires only one nurse. It is followed by a Mental Health Act assessment.
Section 136
Section 136 is used by the police to remove someone that appears to have a mental health disorder from a public place and take them to a place of safety where they can be assessed. It lasts up to 24 hours. It is followed by a Mental Health Act assessment.
Mental health hospitals often have 136 suites that act as a place of safety and are used for assessment.
Last updated June 2024
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