The Mental Health Act (1983)
The Mental Health Act (MHA) 1983 (updated in 2007) is the law in England and Wales which guides the compulsory treatment and care of people with mental health problems.
If you are in hospital under a section of the Mental Health Act, this is commonly known as being “sectioned”. In hospital, you will receive a leaflet explaining your rights and what the section means.
One of your rights is access to free and confidential support from an independent mental health advocate who can help you understand your rights under the Mental Health Act. You should always know which section you are under and if you’re unsure, a nurse will help you with your questions.
The main sections of the Mental Health Act that are used to keep people in hospital are below.
Emergency section – Section 4
An approved mental health professional can use section 4 when they are very concerned about your mental health and need to act quickly in an emergency. This section is used to help keep you, or others, safe.
Section 4 requires only one doctor and lasts up to 72 hours. It might be followed by a section 2 or section 3.
Assessment and treatment section – Section 2
Under section 2, professionals are given time to assess your mental health and decide what treatment might help.
Section 2 lasts for up to 28 days and requires the agreement of two doctors and an approved mental health professional.
Treatment section - Section 3
Under section 3, up to six months of time is given for treatment to improve your mental health. This section requires the agreement of two doctors and an approved mental health professional and lasts for up to six months. This can be extended up to another six months and any further extensions last up to a year.
Independent doctors will check that your treatment is appropriate and ensure your views and wishes have been considered.
Holding sections – Sections 5(2) and 5(4)
You might be kept in hospital if you’re a voluntary or informal patient and there are serious concerns about your safety. A voluntary/informal patient means you have agreed to come into hospital voluntarily and you are not detained under the Mental Health Act.
A doctor can use section 5(2) to keep you in hospital for up to 72 hours. This allows time to assess you for a section 2 or 3.
In the absence of a doctor, a nurse can use section 5(4) to keep you in hospital for up to six hours which ends when a doctor sees you.
Section 136 can be used by a police officer if you’re in a public place and there are concerns about your mental health. You will be taken into hospital for an assessment.
Time off the ward – section 17
Section 17 allows time off the ward if you are in hospital under section. This needs to be agreed by your responsible clinician who will tell you how much time you can be given off the ward. If you do not return by an agreed time, the police may be involved to bring you back to hospital for your safety.
If you are sectioned under the Mental Health Act, a mental health assessment will be carried out to decide whether you should stay in hospital to receive care and treatment. The assessment usually involves two doctors and an approved mental health professional.
To make decisions under the Mental Health Act, professionals will consider the following principles from the Code of Practice:
- Least restrictive option and maximising independence. Patients should be treated safely and lawfully with minimum restrictions imposed on their liberty.
- Empowerment and involvement. Patients should be involved in decisions about their care, support and treatment.
- Respect and dignity. Patients and their families and carers should be treated with respect, dignity, and be listened to by professionals.
- Purpose and effectiveness. Decisions about care and treatment should be appropriate to the patient, have clear therapeutic aims and promote their recovery.
- Efficiency and equity. This refers to the most appropriate use of resources to meet the needs of patients.
Based on these principles, every effort is made to consider ways to support you in the community or to admit you to hospital informally before detention becomes an acceptable option. Informally means you give valid consent (agreement) to be taken into hospital and can leave if you wish.
Mental Health Act assessments take place in different ways:
- Sometimes they happen in your own home. You will either give valid consent for this assessment to take place, or you live with someone else who can give consent for you.
- Sometimes the assessment team cannot gain access and the local authority applies to the magistrate to obtain a section 135 warrant, which allows the police to gain entry to the premises and potentially take you to a place of safety for assessment.
- If the police find you in a public place and you appear to be “suffering from a mental disorder” and “in immediate need of care and control”, they can use section 136 to take you to a place of safety. AWP manages two health-based places of safety, called Mason and Bluebell. You can be looked after in a place of safety for 24 hours for a mental health assessment.
- Sometimes they take place in a range of managed settings, including acute hospitals, prisons, custody, and care homes.
If you’re an informal patient (you have agreed voluntarily to come into hospital) and plan to leave hospital, a nurse or doctor can use a holding power if there are concerns about your mental state. This means you cannot leave the ward until a Mental Health Act assessment is carried out.
The Mental Health Act provides protections around treating you without your consent, known as consent to treatment rules. These rules must be followed by a responsible clinician who has overall responsibility for your care and treatment.
In some situations, a doctor is consulted to provide a second opinion to agree whether or not the treatment should be given.
There are other legal protections if you are detained in hospital:
- You have the right to appeal to a mental health tribunal and directly to the hospital managers. In AWP, this is carried out by the mental health associates.
- Your nearest relative has certain rights. They can object to a section 3 detention for treatment and can also write to hospital managers giving three days’ notice for your discharge.
- You have the right to an independent mental health advocate who can support you with your rights.
When the responsible clinician decides that the criteria for detention are no longer met, the detention must be rescinded. This means it is withdrawn and you become an informal patient.
If you are involved in criminal proceedings, it is possible to be detained in a secure hospital by a court process as outlined in part 3 of the Mental Health Act. You can be detained under the following sections:
SECTION 35: Remand to hospital direct from court for a report to be written.
SECTION 36: Remand to hospital direct from court for treatment.
SECTION 37: This provides a hospital order, with admission to hospital direct from court.
SECTION 38: This is similar to section 37 and provides an interim hospital order.
SECTION 47: Convicted prisoners are transferred to hospital.
SECTION 48: A prisoner on remand can be transferred from prison to hospital.
The Ministry of Justice can create a section 41 restriction order which is attached to section 37 and becomes a section 37/41. This means that if you have spent some time in a secure hospital and are discharged into the community, you are subject to certain restrictions and monitored by a social supervisor and a clinical supervisor. You can be recalled to hospital by the Ministry of Justice if necessary.
While the Mental Health Act guides your compulsory admission and treatment, the Mental Capacity Act 2005 is different. It protects and empowers people who may lack the mental capacity to make their own decisions about their care and treatment.
It covers decisions about day-to-day things, like what to wear or what to buy for the weekly shop. It also covers more serious life-changing decisions, like whether to move into a care home or have major surgery.
Five principles are central to this legislation:
Assume a person has capacity unless proved otherwise.
Do not treat as unable to make a decision unless all practical steps have been tried to help them.
A person should not be treated as incapable of making a decision because their decision may seem unwise.
Always do things or take decisions for people without capacity in their best interests.
Before doing something to someone or making a decision on their behalf, consider whether the outcome could be achieved in a less restrictive way.
A capacity assessment can be carried out to determine whether someone is able to make a specific decision based on their ability to understand, retain, weigh-up and communicate. If they are assessed as having no capacity for a specific decision, a decision on their best interests is made which allows staff to use proportionate restraint. For example, if a person with dementia on a ward is refusing to leave and does not have capacity to decide about their care and support, proportionate restraint can be used to remove them from the ward and take them to the care home.
Deprivation of Liberty Safeguards (DoLS)
Patients with no capacity to decide about their care and support can be admitted to a psychiatric hospital in their best interests under the Mental Capacity Act. However, the Act cannot authorise a deprivation of liberty, which means they are not free to leave and are under continuous supervision and control. In these situations, AWP can contact the local authority to consider initiating Deprivation of Liberty Safeguards (DoLS).
DoLS was introduced to provide some protections for people who did not have the mental capacity to decide about their hospital admission, and sometimes stayed in hospital for long periods without formal review of their deprivation of liberty.