The Mental Health Act 1983

The majority of people admitted to a psychiatric hospital are informal, which means they can discharge themselves.  However The Mental Health Act 1983 governs the admission of people to psychiatric hospital against their will, their rights while detained, discharge from hospital, and aftercare. The Act applies in England and Wales.

The Mental Health Act 1983 is like any other Act of Parliament and is divided into Sections. This has coined the term "being sectioned" to mean being compulsorily admitted to hospital.

The most common sections include:

 

SECTION 2 - Admission For Assessment

This section is used to admit a person to hospital for assessment, or for assessment followed by medical treatment.  The criteria:

  1. The client is suffering from a mental disorder of a nature or degree which warrants the detention of the client in a hospital for assessment (or assessment followed by treatment) for at least a limited period; and

  2. That he/she ought to be detained in the interest of his/her own health or safety or with a view to the protection of other persons

The application is made by the nearest relative or Approved Social Worker (ASW).  The applicant must be seen within the previous 14 days.  The client must be admitted within 14 days of time when he/she was last medically examined.

Medical recommendations must be made by 2 doctors, one being approved under section 12 as having "special experience in the diagnosis or treatment of mental disorder."  They must examine the patient within 5 days of each other if they are unable to do a joint recommendation.

Application can be made in respect of a client already in hospital on an informal basis.

This section lasts for 28 days, beginning with the day of the admission.  it is not appropriate to make a fresh application immediately after the expiry of the previous one.

 

SECTION 3 - Admission For Treatment

This section is used for compulsory admission of a client for the treatment of his/her mental disorder.  The criteria:

  1. The client is suffering from mental disorder that makes it appropriate for him/her to receive medical treatment in hospital.

  2. In the case of psychopathic disorder or mental impairment, that such treatment is likely to alleviate or prevent a deterioration of his/her condition.

  3. It is necessary for the health or safety of the client, or for the protection of other persons, that he/she should receive such treatment and it cannot be provided unless he/she is detained under this section

The application is made by the nearest relative or Approved Social Worker.  The applicant must be seen within the previous 14 days.

Medical recommendations must be by 2 doctors, one being approved under section 12.  They must examine the patient within 5 days of each other if they are unable to do a joint recommendation.  The client must be admitted within 14 days of time when he/she was last medically examined.

This section lasts for 6 months, renewable for another period of 6 months, then at annual intervals.

 

SECTION 4 - Admission For Assessment In Cases Of Emergency

This section is used when there is an emergency application for admission for assessment from the community.  The criteria:

  1. It is of urgent necessity for the client to be admitted and detained in hospital under Section 4 and for reasons given under Section 2.

There must be evidence of:

  1. The existence of a significant risk of mental or physical harm to the client or to others; and/or

  2. The danger of serious harm to property; and/or

  3. The need for physical restraint of the client.

The application is made by the nearest relative or Approved Social Worker.  Either should heave seen the client within the past 24 hours.  This is to ensure that this section is only used in genuine emergencies and where there is no time to seek a second medical opinion.

Only one medical recommendation is required.  If possible this should be done by someone with knowledge of the client.  the doctor must confirm that:

  1. It is of urgent necessity for the client to be admitted and detained under Section 2; and

  2. Waiting for a second doctor to confirm the need for admission under Section 2 would cause undesirable delay.

The client must be admitted within 24 hours of the examination, or the application, whichever is earlier.

This section lasts for 72 hours from the time of admission

 

SECTION 5(2) - Doctors Holding Power

This section is used when the detention, where necessary, of a client already receiving treatment in hospital informally.  This prevents the client from discharging himself/herself from hospital before there is time to arrange for an application under Section 2 or 3.  The criteria:

  1. If it appears that an application for the clients compulsory admission to hospital should be made that it is for the health or safety of the client or other persons that he/she should be detained until such an application can be made.

The application is made by the doctor (Responsible Medical Officer) in charge of the clients treatment, or his nominated deputy.  The maximum period of detention is 72 hours commencing from the time the report is received on behalf of the managers or from the commencement of a nurses holding power.

 

SECTION 5(4) - Nurses Holding Power

This section is used to dented a client already receiving treatment in hospital informally.  If the doctor's presence cannot be immediately secured.  The holding power can be used if the client is indicating either verbally or otherwise that he/she wishes to leave hospital.  The criteria:

  1. The client is suffering from a mental disorder to such a degree that it is necessary for his/her health and safety, or for the protection of others for him/her to be immediately restrained from leaving hospital.

  2. The attendance of the Responsible Medical Officer (RMO) is not immediately possible.

  3. The client must be informal, admitted and within the hospital site.

The application is made by a registered mental nurse or a registered learning disability nurse.  This lasts for a maximum of 6 hours and is non-renewable.  The holding power starts when nurse has recorded his/her opinion on the correct forms.  The holding power lapses upon the arrival of the RMO or at the end of six hours.

 

SECTION 136 - Mentally Disordered Persons Found In Public Places

This section authorises a police constable who finds a person who appears to be suffering from mental disorder, in a place to which the public have access, to remove him to a place of safety.  The criteria:

  1. The constable thinks it is necessary to do so in the persons interest or for the protection of others.

  2. The person appears to be in immediate need of care and control. 

This section lasts for a maximum of 72 hours.  this is for the purpose of enabling the client to examined by a registered  medical practitioner and to interviewed by an ASW.  for the purpose of making any necessary arrangements for his treatment and care.

The section will lapse as soon as the client has been examined and interviewed and it is considered that no further arrangements need to be made for his/her treatment or care.

Definition of a place of safety:

  1. Police Station

  2. Hospital

 

For more information about the Mental Health Act click on the following link

Nigel Turner's Mental Health Act

Click below for the latest government white paper on reforming the Mental Health Act