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The Mental Health Act: Understanding Compulsory Admissions

The Mental Health Act 1983 (which was further updated in 2007) provides a critical, legal framework that outlines various rights relating to people with mental health conditions and how they may receive treatment. One of the fundamental aims of the Act is to protect individuals who may not have the capacity to make informed decisions about their treatment options. 

The Mental Health Act covers:

  • Assessment and treatment in hospital
  • Treatment in the community
  • Pathways to hospital

People who are receiving treatment in psychiatric wards are there as either informal patients or formal patients.

  • Informal patients – are receiving treatment of their own accord and have agreed to be in hospital on a voluntary basis.
  • Formal patients – are in the hospital without their agreement and have been sectioned under the Mental Health Act.

Formal patients do not have the right to leave the hospital of their own free will and the Mental Health Act is an important piece of legislation that outlines exactly what the rights of such patients are. 

The Mental Health Act contains key information about when a person can be detained, who can make these decisions, why a compulsory admission to hospital may be necessary and what a patient’s rights are if they find themselves in this situation.

The Act is vital to support patient safety, inform people of their rights and to provide a framework for clinicians and other professionals to ensure they uphold patient rights and maintain their dignity. 

The mental health act

Criteria for Compulsory Admissions

People are usually only detained under the Mental Health Act if they are considered to be a danger to themselves or others and are experiencing ‘a mental disorder of a nature or degree which warrants the detention of the patient…for at least a limited period’. 

For the purpose of the Act, a mental health disorder is defined as ‘any disorder or disability of the mind’. Examples of clinically recognised conditions that could fall under this definition include:

Simply having a mental disorder is never sufficient grounds to be detained under the Act and various admission criteria need to be met:

  • A person must have a mental disorder and be assessed to be a risk
  • They must undergo an assessment by a qualified clinician
  • Compulsory admissions should be used as a last resort option
  • Each admission must be ‘legally justified’ under the Mental Health Act
  • Evidence and documentation must be kept that proves that all of the criteria have been met and that the sectioning is justified and in the best interest of the patient
  • Patient rights and autonomy must be protected

The length of time patients can be detained

This depends on various factors, including the type of mental health condition they have and their circumstances at the point of admission. 

Patients may be detained for:

  • Up to 28 days under Section 2 of the Mental Health Act
  • Up to 6 months under Section 3 of the Mental Health Act, with further renewals

A compulsory admission may happen due to emergency or non-emergency reasons.

In an emergency situation

  • Someone is at serious risk or harming themselves or someone else.
  • Police have the right to enter a person’s home (including by force) under a Section 135 warrant and to detain them in a ‘safe place’ until they can be assessed.
  • If a patient is found in a public place (i.e. not in their home) and is showing signs of severe mental health distress and requires urgent care or control, police can detain them and take them to a safe place (usually the police station or hospital) and detain them under Section 136.
  • Once a patient is in a safe place, they can be kept for up to 24 hours while an assessment by a mental health professional is made (the duration can extend to 36 hours if needed).
  • In hospital, some nurses can stop a patient from leaving under Section 5(4) until the appointed doctor in charge can make a decision about whether to detain them under Section 5(2).
  • Under Section 5(2), doctors can detain someone in hospital for up to 72 hours while an assessment is made as to whether further detention under the Mental Health Act is necessary.

In a non-emergency situation

In a non-emergency case, someone will express concerns about an individual’s mental health, for example:

  • A friend or family member
  • A GP
  • A carer
  • A social worker

In most circumstances a patient will be able to engage with these concerns and will be able to see a doctor or psychiatrist to discuss their options. In extreme situations, such as a person is having visual hallucinations or is experiencing mania due to bipolar, someone will ask for an assessment to be made under the Mental Health Act process. This process can also be enacted by the court or when prison officials decide to move a prisoner into psychiatric care. 

  • As part of the formal process, patients need to be assessed by doctors
  • At least one of the doctors involved needs to be specially trained to deal with mental health and psychiatric care
  • These people will then make decisions about whether or not a person requires compulsory detainment and what treatment they should receive moving forward

Community Order (CTO)

A community order is made by a clinician who is responsible for a mental health patient. The order allows a patient to be treated in the community, under supervision, rather than remaining in hospital. Under the Mental Health Act, a patient who is on a CTO is known as a community patient. 

A CTO comes with certain conditions that must be met. If a patient fails to adhere to their conditions or relapses, they can be recalled to hospital for treatment.

Whilst a person is under a CTO, they have to be supervised by:

  • A responsible clinician (often called a community RC) who is the person responsible for the CTO
  • A care coordinator who acts as a main point of contact
Compulsary admissions

Not all patients are suitable for a CTO. A responsible clinician can only recommend a CTO if a patient is in hospital under certain sections of the Mental Health Act:

  • Section 3
  • Section 37 hospital order
  • Unrestricted transfer direction under Section 47 (Notional Section 37)

A patient cannot be put on a CTO if:

  • They are under Sections 2, 4 or 5
  • They have already been discharged from their section

When patients are detained under the Mental Health Act, this is commonly referred to as sectioning. The different sections that they are held under determine certain criteria and conditions. The main sections used are Section 2, Section 3, Section 5(2) and Section 5(4).

Section 2 – Patients can be sectioned under Section 2 if:

  • They have a mental disorder
  • They require short-term detainment for treatment or assessment
  • It is necessary for the safety of the patient or the safety of others

Under Section 2 patients can be detained for 28 days; however, they may be assessed during this time and deemed to need sectioning under Section 3.

Section 3 – Applies to patients if:

  • They have a mental disorder
  • They require short-term detainment for treatment or assessment
  • Treatment cannot be given unless they are detained in hospital

Additionally, doctors must agree that treatment is available for a patient to be detained under Section 3. 

Under Section 3, patients can be kept for up to six months, although a responsible clinician can extend this:

  • For six months the first and second time
  • From the third time onwards in 12-month periods for an indefinite number of renewals

Patients can also be discharged early if they show improvements and their clinician agrees.

Section 5(2) – Applies to patients who are already in hospital (for a mental or physical reason). Under this section a doctor needs to report that an order to detain you in hospital ‘ought to be made’.

Patients can be detained for up to 72 hours under Section 5(2).

Section 5(4) – Applies to patients who are in hospital already (voluntarily) for a mental disorder. A mental health nurse can detain a patient under Section 5(4) if they believe their mental disorder is so serious that:

  • They need to be kept in the hospital to protect themselves or others from harm
  • It is so urgent that there isn’t sufficient time to get a doctor to provide a report to the hospital managers

A patient can only be kept under this section for up to 6 hours or until a doctor who has the authority to authorise further detainment arrives, whichever is sooner.

Rights of Individuals Under the Mental Health Act

To be treated for medical issues, a patient usually has to consent to their treatment – this is known as giving informed consent. Generally, under UK law, we use patient-centred care that values the individual and upholds their rights and autonomy. Under certain sections of the Mental Health Act, patients do not have all of these same rights, although they should always be treated with dignity and respect.

  • If you are sectioned under certain sections of the Mental Health Act (including Sections 2, 3 and 37) and you require treatment for a mental health problem that is prescribed by the clinician responsible for your care, it can legally be given to you, even if you refuse or resist.
  • If you are sectioned under Sections 4, 5, 35, 135 and 136, or you are under Mental Health Act guardianship or conditional discharge, you have the right to refuse treatment for your mental health problem; however, treatment can still be given in an emergency situation.

Under the Department of Health Code of Practice, people who are making decisions under the Mental Health Act must respect the needs, values and individual circumstances of patients, including any protected characteristics under the Equality Act, which are:

  • Age
  • Disability
  • Gender reassignment
  • Marriage and civil partnership
  • Pregnancy and maternity
  • Race
  • Religion or belief
  • Sex
  • Sexual orientation

Key rights of patients while detained include:

  • Patients should be given information about their rights under the Mental Health Act.
  • Information should be provided to a patient about why they have been detained and they should be given the opportunity to participate in discussions about their care and treatment.
  • While a patient is detained, they should be regularly assessed to decide if it is safe to discharge them, whether further treatment in hospital is needed or whether a CTO could be an option.
  • Patients have the right to a representative or advocate, such as an individual mental health advocate (IMHA). An IMHA is usually assigned to someone once they have been sectioned.
  • IMHAs are able to help patients who are sectioned to understand their rights, how to get discharged from hospital and how they may go about getting the section lifted.
  • Patients are also able to appeal and challenge their section to the Mental Health Tribunal.
  • Some telephone calls should be allowed as well as visits from friends or relatives and correspondence with any legal representatives or advocates.
  • Unless patients are in a psychiatric ward because they were sent there from prison or by a criminal court, they still have the right to vote in local and general elections.
  • A family member, referred to as a patient’s nearest relative, has certain legal rights, e.g. they can tell an approved mental health professional (AMHP) about their concerns which leads to an assessment and have certain medical notes and information shared with them.
  • The nearest relative may also have the right to appeal against someone being sectioned under Section 3 (but not Section 2).
  • Patients detained under the Mental Health Act still have the same rights to privacy as other patients; this includes the sharing of information, and accessing, updating and keeping records.
Rights of individuals

Conclusion 

The Mental Health Act outlines the main rights of people who are being detained in hospital for their own safety or the safety of others due to a mental disorder. A clear understanding of the Act is necessary in order for patients and their families to understand their rights and for medical and legal professionals to act respectfully, lawfully and with compliance.

You can read the Mental Health Act in full here.

If you or a loved one are struggling with mental health, you may find the charity Mind has a range of helpful resources. If you require advocacy services, Mind’s legal line is 0300 466 6463.

The First-Tier Tribunal (Mental Health) deals with cases in England relating to the Mental Health Act 1983, and if your case is in Wales, you can find services here.

If you require legal representation, consider contacting the Citizen’s Advice Bureau which may be able to provide a list of reputable solicitors or you can search the Law Society’s database

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About the author

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Vicky Miller

Vicky has a BA Hons Degree in Professional Writing. She has spent several years creating B2B content and writing informative articles and online guides for clients within the fields of sustainability, corporate social responsibility, recruitment, education and training. Outside of work she enjoys yoga, world cinema and listening to fiction podcasts.