The Mental Health Act (sectioning)

Question 1

Definitions - patient:

Answer 1

A person who is or appears to be suffering from a mental disorder

Question 2

Definitions - Nearest Relative:

Answer 2

Patients do not necessarily have a nearest relative. When legislation requires people to consult, inform or notify nearest relatives it typically refers to “the person (if any) who appears to be the nearest relative. The patient may request who they wish to be classed as their nearest relative”

Question 3

Definitions - Mental Disorder:

Answer 3

Any disorder or disability of the mind. (Neurosis, Psychosis, Organic, Personality Disorders, Behavioural change due to brain damage, Mental and behavioural disorder due to psychoactive substance abuse and other delusional disorders, Depression, Bi-polar, Phobias, OCD, PTSD, Hypochondriacal, Eating disorder, Non-organic sleep or sexual disorder, Antisocial personality disorder, Learning disabilities, Autism)

Question 4

Mental Disorder Exclusions - dependence

Answer 4

Alcohol or drug dependence are excluded from the definition of mental disorder.

A person cannot be detained simply because they are dependent.

Dependant patients may develop mental illness due to dependency, this however can be treated.

Question 5

Mental Disorder Exclusions - Substance abuse caused MD

Answer 5

Any disorder due to prolonged abuse i.e. withdrawal state delirium or mental disorders associated with prolonged abuse of drugs or alcohol.

Severe acute intoxication may justify use of the powers in the act, provided all relevant criteria are met.

Question 6

Compulsory Detention (time period) - section 2

Answer 6

Up to 28 days for assessment (non renewable)

Question 7

Compulsory Detention (time period) - section 3

Answer 7

Up to 6 months for treatment (renewable)

Question 8

Compulsory Detention (time period) - section 4

Answer 8

72 hours for emergency assessment

Question 9

Section 131

Answer 9

Informal admission (no time limit, patient can change mind at any time)

Question 10

Section 135

Answer 10

Assessment in private premises (admission for 72 hours)

Question 11

Section 136

Answer 11

Detained in a public place (by police). (admission for 72 hours)

Question 12

Section 2 - details

Answer 12

A mental disorder which warrants detention in hospital (for 28 days) to allow the assessment of, followed by medical treatment; A patient who needs to be detained for their own health or safety, or for that of others.

Question 13

Section 2 - criteria for use

Answer 13

The diagnosis and prognosis of a patients condition is unclear.

There is a need to carry out an in-patient assessment in order to formulate a treatment plan

A judgement has to be made as to whether a particular treatment proposal, which can only be administered to the patient using the powers in part 4 of the act, is likely to be effective.

The condition of a patient who has already been assessed, and who has previously been compulsory admitted under the Act, is judges to have changed since the previous admission, or it is uncertain whether it has changed, and further assessment is needed.

The patient has not previously been admitted to hospital either compulsorily or informally and has not been in regular contact with the specialist mental health services and it has not been possible to formulate a treatment plan.

Question 14

Application for Section 2 admission can be by either:

Answer 14

Nearest Relative
or
AMHP who must have interviewed the patient and be satisfied that the detention is appropriate.

Question 15

Recommendations for admission is made by?

Answer 15

two doctors, one of whom must be an approved doctor. The patient must be examined by both doctors, singly or together, within 5 days of each other.

Question 16

Section 3 - details

Answer 16

Admission for 6 months, renewable for a further 6 months and then for a period of up to a year at a time, for the treatment of:
Severe mental illness
Severe mental impairment
Disorder of a nature or degree which makes medical treatment in hospital appropriate.

Question 17

Section 3 - pointers for use

Answer 17

The patient is detained under section 2 and assessment indicates a need for treatment under the Act for a period beyond the 28 day detention under section 2.

The patient is considered to need compulsory admission for the treatment of a mental disorder which is already known to their clinical team, and has been assessed in the recent past by that team. In these circumstances it may be right to use section 3 even where the patient has not previously been admitted as an in-patient.

Question 18

Application for Section 3

Answer 18

Is the same as section 2, but the AMHP cannot make an application if the nearest relative objects.

Question 19

Recommendation for Section 3

Answer 19

Recommendation for admission is the same as for section 2.

Made by two doctors, one of whom must be an approved doctor. The patient must be examined by both doctors, singly or together, within 5 days of each other.

Question 20

Section 4 - details

Answer 20

Admission for a period of 72 hours for urgent admission.

The patient can be placed under section 2 or 4 after examination.

Question 21

Application for Section 4

Answer 21

Application for admission can only be made by the nearest relative or AMHP so long as they have seen the patient within the preceding 24 hours.

Question 22

Recommendation for Section 4

Answer 22

Recommendation for admission can be made by 1 doctor, preferably with previous knowledge of the patient.

Question 23

Section 131 - details

Answer 23

Voluntary admission

The patient voluntarily agrees to be admitted but can change their mind at any time.

There is no time limit.

Question 24

Section 135 - details

Answer 24

Admission period of 72 hours.

A person suffering from a mental illness can be removed from a private dwelling to a place of safety (hospital) by a police officer or an approved social worker.

A magistrates warrant is required.

Question 25

Section 136 - details

Answer 25

Admission for a period of 72 hours.

A person suffering form mental illness can be removed form a public place to a place of safety (hospital) by a police officer or AMHP.

Question 26

Patients under section procedure

Answer 26

Documents must be signed by nearest relative or AMHP and one or two doctors (depending on which section is being used)

Compulsory removal can be carried out by the applicant or authorised persons, i.e. ambulance staff.

Police may be called is a violent incident occurs or is likely to occur (to prevent a breach of the peace).