Dr Ruth YatesGP ST2 in Psychiatry

Aims and ObjectivesTo learn about the Mental Health Act 1983

and different sections of itTo learn how to detain people under the act,

who is involved and how

OverviewIntroductionTerminologyWho’s whoDefinition of mental disorderSections of the MHA

(including 2, 3, 4, 5, 135, 136)SummaryQuiz

Introduction• Informal patients

– In hospital voluntarily– Same rights as those being treated for physical

illness

• Formal patients– 25% of mental hospital inpatients– Compulsorily detained under a section of MHA

1983– Lose some rights available to informal patients

Some TerminologyCommunity Treatment Order (CTO)

Legal order that allows patient to be discharged from formal detention onto supervised community treatment

Supervised Community Treatment (SCT)Patient is discharged from detention under

MHARequired to comply with conditions set out in a

CTOIf fail to do so, may be recalled to hospital for

tx

Who’s whoApproved mental health professional (AMHP)

Social workers, nurses, OTs or psychologistsApproved by local services authorityCarry out certain functions under MHA 1983 to

give them power to make an application for admission to hospital under a section of the Act where necessary and proper.

Must interview patient to check detention appropriate

Who’s whoApproved clinician

Mental health professional who has been approved, for the purposes of the MHA, by the Secretary of State (England) or Welsh Ministers (Wales).

Doctors, psychologists, nurses, occupational therapists, social workers

Who’s whoResponsible clinician

Approved clinician with overall responsibility for patient’s care and treatment

Are only ones who can make certain decisions E.g. Placing detained patient on SCT

All responsible clinicians must be approved clinicians

Who’s whoA person’s nearest relative can apply for their

relative to be formally detained under a section of the Act

Who’s whoMental Health Tribunal (MHT)

Independent panels that decide whether a formal patient should be discharged or not

Definition of mental disorderAny disorder or disability of mindNote

A person with a learning disability is not considered to be suffering from a mental disorder for most purposes under the Act; or to require treatment in hospital, unless that disability is associated with abnormally aggressive or seriously irresponsible conduct.

Section 2Compulsory admission to hospital or

guardianship for patients not involved in criminal proceedings

Admission for assessment28 days maximumApplication by AMHP or patient’s nearest

relative

Section 2 cont...Procedure: 2 doctors must confirm that....

a) patient has mental disorder of a nature/degree that warrants detention in hospital for assessment (or assessment followed by medical treatment) for at least a limited period; AND

Patient ought to be detained in interests of his/her own safety, or with a view to the protection of others

Section 2 cont...Discharge by

Responsible clinicianHospital managersNearest relative, who must give 72 hours’

notice The responsible clinician can prevent him/her

discharging a patient by making a report to the hospital managers

MHT – the patient can apply to a tribunal within the first 14 days of detention

Section 3Admission for treatmentDuriation:

Up to 6/12Renewable for a further 6/12Then renewable for one year at a time

Application for admission:By nearest relative or AMHP

Section 3 cont...• Procedure: 2 doctors must confirm that...

– a) the patient is suffering from a mental disorder of a nature/degree that makes it appropriate for him/her to receive medical tx in hospital; AND

– b) appropriate medical tx is available for him/her; AND

– c) it is necessary for his or her own health or safety, or for protection of others that he/she receives such treatment and it cannot be provided unless he/she is detained under this section

Section 3 cont...Renewal: under section 20

Responsible clinician can renew section 3 if: Original criteria still apply Appropriate medical treatment is available for

patient’s conditionResponsible clinician must consult another

person of a different profession who has been professionally concerned with the patient’s treatment.

Section 3 cont...• Discharge by:

– Responsible clinician– Hospital managers– Nearest relative (must give 72 hours’ notice). If

the responsible clinician prevents this, by making a report to the hospital managers, the nearest relative can apply to an MHT within 28 days

– MHT . A patient can apply to a tribunal:• Once during first 6 months of detention• Once during 2nd 6 months of detention• Then once during each period of one year

Section 4• Admission for assessment in cases of

emergency• Duration of detention: 72 hours max• Application by AMHP or nearest relative

– Applicant must have seen patient within the previous 24 hours

• Procedure: 1 doctor must confirm that:– a) urgent necessity for admission and

detainment under section 2– b) waiting for 2nd doctor to confirm the need for

an admission under section 2 would cause ‘undesirable delay’

Section 5• Compulsory detention of informal patients

already in hospital• A doctor or other approved clinician in charge of

informal patient’s treatment (inc. physica problem) can detain a patient for up to 72 hours by reporting to hospital managers that an application for compulsory admission ‘ought to be made’

• A nurse working in mental illness or learning disabilities can detain an informal patient who is receiving treatment for a mental disorder for up to 6 hours until a doctor/clinican can detain them

Section 135• Warrant to search for and remove patients• Duration: 72 hours max• Procedure: if there is reasonable cause to

suspect a person suffering from mental disorder AND– a) is being ill-treated/neglected/not kept under

proper control– b) is unable to care for themselves and lives alone

• ....a magistrate can issue a warrant authorising a police officer (with a doctor and AMHP) to enter any premises where person is believed to be and remove them to place of safety

Section 136• Mentally disordered persons found in public• Duration: 72 hours max.• Procedure:

– Person suffering from mental disorder – Is in immediate need of care or control– Police officer can take to ‘place of safety’• Hospital or police station

– Person then examined by a doctor and interviewed by an AMHP and ‘any necessary arrangements’ made of their treatment or care

Summary• Many sections of MHA 1983• Section 2 – assessment• Section 3 – treatment• Section 4 – emergency detainment while awaiting

2nd doctor for section 2• Section 5 – detainment of patients in hospital

informally• Section 135 – search premises and remove person

to place of safety• Section 136 – remove person from public place to

place of safety

Quiz

Any Questions?