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Compulsory Admission to Hospital
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In the UK only about 5% of psychiatric patients are detained, 95% are "informal" so the vast majority of psychiatric treatment (including inpatient treatment) is not done under the auspices of the Mental Health Act. There are 8 procedures usually known by the Section of the Act in which they are found (hence the verb "to section"). Application forms for the compulsory admission or treatment of a patient must be completed by nearest relative or more commonly an "approved" Social Worker (ASW - appointed by the local authority). Recommendation forms must be completed by medical practitioner(s) and must state two grounds for compulsion.
- Patient is suffering from a mental disorder of appropriate severity.
- And compulsion is needed for this patient’s health, safety or for the protection of other persons.
When two recommendations are needed at least one doctor should be:
- "approved" by the regional health authority as having special experience in mental disorder (usually a consultant or specialist registrar in psychiatry).
- at least one doctor (often their GP) should have previously known patient (this is not always possible).
- at least one doctor should be independent of the admitting hospital.
Patients have the right to appeal to Mental Health Review Tribunals on Sections lasting over 72 hours. Patients also have the right to appeal to the Hospital Managers, a misleading term for members of the Trust Board and associate members appointed for the purpose of reviewing compulsory detention. They may appeal at any time. Patients detained under Section 3 of the Mental Health Act may only appeal to the Mental Health Review Tribunal on one occasion during any period of detention. There is no limit set by statute on the number of appeals which may be made to the Hospital Managers. The Managers should conduct a review when asked by the patient unless they have done so recently and there is no evidence of change.
The Sections
Section
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Grounds
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Requires
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Duration
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Mental disorder "warranting admission" and patient requiring detention for "own health or safety or protection of others"
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1 application and 2 medical recommendations. | Up to 28 days. | |
| As Section 2 but applies only to mental illness, severe mental impairment, mental impairment or psychopathic disorder. For the latter two, treatment must be likely to help. | 1 application and 2 medical recommendations. | Up to 6 months (third consecutive detention lasts up to one year). | |
| As Section 2 but need for emergency admission before an assessment for Section 2 or 3 could be completed. | 1 application and 1 medical recommendation. | Up to 72 hours if a Section 2 is being arranged. | |
| A patient previously admitted informally demands to leave and grounds for Section 2 apply. | Report by the responsible consultant (or nominated deputy) on an inpatient (includes general medical patients). | Up to 72 hours while further section is arranged. | |
"5(4)" Nurses' Holding Power |
As section 5(2) but no doctor is available. | A report from qualified psychiatric nurse. | Up to 6 hours. |
Guardianship ("7 & 8") |
Mental illness, mental impairment, severe mental impairment or psychopathic disorder. Guardianship is necessary for welfare of patient or protection of others. |
1 application, 2 recommendations and a named guardian. |
Up to 6 months. The Guardian can require a patient to live at a specified place and to attend for treatment (but can't force them to take treatment). |
There is reason to believe a person with mental disorder is suffering neglect or ill treatment in private premises. |
Warrant from magistrate. |
Police accompanied by a doctor and ASW may enter the premises by force. The person may be removed to a "place of safety" (hospital or police station) for up to 72 hours. |
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Person in a public place appears to Police to be suffering from mental disorder and in immediate need of care and control. |
Removal to "place of safety" for up to 72 hours. |
patients concerned in criminal proceedings...>>