Dr Alan McLeod
The Mental Health Act (1983) is the legislation dealing with the legal aspects of mental health. It outlines the circumstances that must be fulfilled for a person to be admitted and possibly treated against their will. It also set out the rights that these patients have and the responsibilities of those caring for them. It was updated by the Mental Health Act 2007.
As with most legislation, the act is long and complex - for medical finals the below summary table should be more than sufficient.
|
Section |
Applies to |
Used by |
Used For |
Duration |
|
2** |
Patient in community, with a suspected but undiagnosed mental disorder* |
AMHP*** + 2 doctors. One must be section 12.2 approved and the other should ideally know the patient. Nearest relative must be informed in section 3 admissions where practicable. The nearest relative can choose to block admission under section 3 but not under section 2. |
Assessment and treatment |
Up to 28 days - may be converted to section 3 |
|
3** |
Patient in the community, with a diagnosed mental disorder* |
Treatment for up to six months with further treatment allowed with patient consent or after consultation with an independent psychiatrist. |
Up to 6 months - this period may be reviewed and extended if needed. A vital difference between S2 and S3 is that section three makes legal provision for aftercare under section 117 of the act. |
|
|
A non-admitted patient, with suspected or known mental disorder* e.g. in A&E or Outpatients dept. This is an EMERGENCY power. |
Single doctor - initial application can come from a patients nearest relative or an AMPH*** |
Detaining a patient who wishes to leave until formal assessment under section 2 or 3. No treatment can be given without consent except that permitted under the mental capacity act. |
72 hours |
|
|
An admitted patient in a general or psychiatric hospital with suspected or known mental disorder* e.g. a voluntary patient |
Doctor in charge of the patients care or another doctor designated by them. |
72 hours |
||
|
An admitted patient into a psyciatric hospital |
Nurse with mental health training |
6 hours |
||
|
Person in a private dwelling |
Police with a magistrates order |
Removal of person to a 'place of safety' to await formal assessment under section 2 or 3. No treatment can be given without consent. |
72 hours |
|
|
Person in a place to which the public have access |
Police |
72 hours |
* causing such severe problems that they are a risk to their own health or the health and safety of others.
** There is a right to appeal against sections 2 and 3, usually taking 1-2 weeks or 4-5 weeks respectively to resolve by tribunal.
*** The role of AMHP (Approved Mental Health Practitioner) has replaced the old role of the social worker in the 1983 Act. At present most AMHPs are social workers but they do not have to be - some are mental health nurses or other qualified and approved persons. Likewise not all social workers are AMHPs.
Other important sections
Section 12: Sets out which people may conduct examinations under the act and introduces the concept of 'special experience' in the diagnosis or treatment of mental disorder.
Section 12 (2) states that "Of the medical recommendations given for the purposes of any such application, one shall be given by a practitioner approved for the purposes of this section by the Secretary of State as having special experience in the diagnosis or treatment of mental disorder; and unless that practitioner has previous acquaintance with the patient, the other such recommendation shall, if practicable, be given by a registered medical practitioner who has such previous acquaintance."
Put simply, this means that one of the doctors must be registered as having special experience (most often a psychiatrist) and one of the doctors should ideally have prior knowledge of the patient. One doctor can fulfil both of the criteria,
Section 17: Sets out the conditions for leave of abscence for patients admitted under sections 2 or 3 of the act. It is needed for e.g. patients to get weekend leave when their treatment has progressed far enough for this to be beneficial.
Section 117: Sets out provisions for aftercare that must be made for people detained under Section 3 (or some other sections relating to transfer from prison or similar). Basically, It is be the duty of the Primary Care Trust and of the local social services authority to provide after-care services until the person concerned is no longer in need of such services. This may potentially be lifelong and can extend to the provision of suitable housing and other social needs.
The Mental Capacity Act (2005)
Note that this deals with patients who lack capacity for certain decisions - it is not primarily an act concerned with those suffering mental illness but it can be used in some situations with this patient group.
A quick guide can be found [here]
