- assessment and treatment in hospital
- treatment in the community
- pathways into hospital, which can be civil or criminal
Many people who receive inpatient treatment on psychiatric wards have agreed to go into hospital as informal patients (also known as voluntary patients). However, many are in hospital without their agreement as formal patients. This is because they have been detained under the Mental Health Act (often called being sectioned).
The 1983 Mental Health Act has a range of responsibilities and duties, and can enforce a person with a mental disorder to be detained in a psychiatric hospital.
- Compulsory Admissions / Sections
- Who is involved?
- Patient rights
- Older people and the Mental Health Act
Compulsory Admissions / Sections
Compulsory admission under the Act may take place when the patient is:
- suffering from mental disorder and
- detention is necessary in the interests of his or her own health or safety or for the protection of others.
There are three admission procedures under the Act which result in compulsory detention:
- admission for assessment with or without treatment for up to 28 days, which is not renewable (Section 2)
- admission for treatment for up to six months, renewable for a further six months, and thereafter for periods of up to 12 months at a time (Section 3).
- emergency admission for assessment for up to 72 hours (Section 4)
A patient can only be admitted under section 3 if the necessary treatment cannot be provided without detention in hospital. Patients who are discharged from a Section 3 are automatically the subject of Section 117, which requires health and local authorities to arrange a package of ‘aftercare’ to assist with re-engaging with daily living.
Section 7 (2) explains that a person over 16 can have ‘their interests protected and be under some control’ of the local authority or a guardian appointed by the local authority. This is to make sure that a patient receives support and community care where it cannot be provided without compulsory powers.
Who is involved?
Approved social workers, GPs and doctors approved under Section 12 of the Act – either psychiatrists or others with specific training in mental health are involved in assessing sections. Each professional assesses the patient’s mental health and circumstances. If any of them believe there is insufficient evidence to warrant sectioning, the person cannot be detained under The Mental Health Act.
The patient’s ‘next of kin’ can also apply for their relative to be detained under the Act and has the power to formally request an assessment under the Act in certain circumstances. For more information about the rights of the nearest relative, visit our page here.
- They have to be informed as soon as practicable after admission of the reasons for their detention and rights of appeal.
- People who have been detained for more than a few days have the right to appeal against their detention to a Mental Health Act Review Tribunal, an independent committee which has the power to discharge patients in certain circumstances. Patients are entitled to free legal representation in these appeals.
- The Mental Health Act Commission is a government body which monitors the care of people who are detained, and to ensure that their rights are upheld. The commissioners make regular visits to all hospitals, and will also respond to individual requests for visits. Most hospitals also have an independent hospital managers’ committee to protect the rights of detained people.
- They have the right to an Independent Mental Health Advocate (IMHA) to support them.
These safeguards are not available to informal patients.
For more about the Mental Health Review Tribunal, see the MHRT website.
Older people and the Mental Health Act
The Mental Health Act is only appropriate in work with older people in certain circumstances.
For older people with a progressive mental illness (such as dementia) it is crucial to reassess their needs and capacity on a regular basis. Most older patients enter a psychiatric hospital on an informal basis, unless they actively object to admission. However, many older patients need supervision and may even need to be restrained from leaving hospital for their own safety. This is also the case for a significant number of older people with dementia in care homes.