Mental Health Act 1983: Encyclopedia II - Mental Health Act 1983 - Civil sections

Mental Health Act 1983 - Civil sections

The civil section of the Act applies to any mentally disordered person who is not subject to the Criminal Justice System. The vast majority of persons detained in psychiatric hospitals in the United Kingdom are detained under one of the civil sections of the Act.

These sections are implemented following an assessment of the person suspected to be suffering from a mental disorder. These assessments can be performed by various professional groups, depending upon the particular section of the Act being considered. These professional groups include ASWs (see above), Section 12 approved doctors (see above), any doctors, registered mental nurses (RMNs) and police officers. The civil sections are outlined below.

Mental Health Act 1983 - Section 2

Section 2 is an assessment order and lasts up to 28 days; it cannot be renewed. It can be instituted following a “Mental Health Act assessment” by two doctors and an ASW. At least one of these doctors must be a Section 12 approved doctor. The other must either have had previous acquaintance with the person under assessment, or be a Section 12 approved doctor him- or herself. This latter rule can be broken in an emergency situation where the person is not known to any available doctors and two Section 12 approved doctors cannot be found. In any case, the two doctors must not be employed in the same organisation; this is intended to prevent the situation in which one doctor is unduly influenced in his or her decision to recommend detention of a person in hospital by the other doctor, who, but for this restriction, could be, for instance, his or her line manager. Commonly, in order to satisfy this requirement, a psychiatrist will perform a joint assessment with a general practitioner (GP). A Mental Health Act assessment can take place anywhere, but commonly occurs in a hospital, at a police station, or in a person’s home.

If the two doctors agree that the person is suffering mental disorder, and that this is severe enough that, despite the person’s refusal to go to hospital, he or she ought to be detained in hospital in the interest of the person’s own health, the person’s own safety, and/or with a view to the protection of other persons, they complete a medical recommendation form and give this to the ASW. The doctors do not have to stipulate which subcategory of mental disorder the person is suffering from. If the ASW agrees that there are no other viable alternatives to detaining the person in hospital, he or she will then complete an application form requesting that the hospital managers detain the person. The person will then be transported to hospital and the period of assessment begins. Treatment, such as medication, can be given against the person’s wishes under Section 2, as observation of response to treatment constitutes part of the assessment process.

Mental Health Act 1983 - Section 3

Section 3 is a treatment order and can initially last up to six months; if renewed, the next order lasts up to six months and each subsequent order lasts up to one year. It is instituted in the same manner as Section 2, outlined above, following an assessment by two doctors and an ASW. One major difference, however, is that for Section 3, the doctors must state which subcategory of mental disorder the person is suffering from i.e. mental illness, mental impairment, severe mental impairment or psychopathic disorder (see above).

Most treatments for mental disorder can be given under Section 3, including injections of psychotropic medication such as antipsychotics. However, after three months of detention, either the person has to consent to their treatment or an independent doctor has to give a second opinion to confirm that the treatment begin given remains in the person’s best interests. A similar safeguard is used for electroconvulsive therapy (ECT), although the RMO can authorise two ECT treatments in an emergency situation for persons detained under Section 3.

Absence or “leave” from hospital can be granted by the RMO for patients detained under either Section 2 or Section 3. The RMO will also ultimately be responsible for discharging patients from either Section 2 or Section 3. After a Section 3, a formal discharge planning meeting must be held, as stipulated in Section 117 of the Act. This makes informal plans for after-care following discharge.

Mental Health Act 1983 - Sections 4 and 5

Section 4 is an emergency order that lasts up to 72 hours. It is implemented by just one doctor and an ASW, in an emergency situation in which there is not ample time to summon a second suitable doctor in order to implement a Section 2 or Section 3. Once in hospital, a further medical recommendation from a second doctor sees the order converted from a Section 4 to a Section 2. Section 4 is not commonly used.

Section 5(2) is a doctor’s holding power. It can only be used on persons who are informally (willingly) admitted to a hospital, but who then change their mind and wish to leave. It can be implemented following a (usually brief) assessment by the RMO or his deputy, which, in effect, means any hospital doctor, including psychiatrists but also those based on medical or surgical wards. It lasts up to 72 hours, during which time a further assessment may result in either discharge from the Section or detention under Section 2 or Section 3.

Section 5(4) is a similar holding power that can be used for the same group of persons as those that may be detained under Section 5(2) (see above). It is implemented by a registered mental nurse (RMN). It lasts up to 6 hours and is usually prompted converted to a Section 5(2) upon an assessment by a doctor.

Mental Health Act 1983 - Sections 135 and 136

Section 135 is a magistrates’ order. It can be applied for by an ASW in the best interests of a person who is thought to be mentally disordered, but who is refusing to allow mental health professionals into their residence for the purposes of a Mental Health Act assessment. Section 135 gives police officers the right to enter the property and to take the person to a “Place of Safety”, which is locally defined and is usually either a police station or a psychiatric hospital ward.

Section 136 is a similar order that allows a police officer to take a person whom they consider to be mentally disordered to a “Place of Safety” (see above). Once a person subject to Section 135 or Section 136 is at a Place of Safety, they are further assessed and, in some cases, a Section 2 or Section 3 implemented.

Adapted from the Wikipedia article "Civil sections", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki