Admission and treatment under the MHA

The decisions that need to be made when considering the use of the MHA are shown in Figure 1. It will be seen from this that people can only be admitted and treated against their will if they have a ‘mental disorder’, which is defined in the MHA 2007 as ‘any disorder or disability of the mind’. Detention should only be authorised if it is in the interests of the person’s health or safety, or for the protection of others, and if there is no less restrictive way available to deal safely and effectively with their problems. Detention under the MHA should not be prolonged longer than is absolutely necessary, so the detained person should be regraded to informal status by the responsible clinician (i.e. taken off section and treated on a voluntary basis) if they regain insight and agree to receive the treatment required, or if treatment is no longer needed.

Fig. 1 Deciding when to use the Mental Health Act.

Section 2 is used to assess the nature and severity of the detained person’s condition. It cannot be renewed but can if necessary be converted to Section 3. Section 3 is used when the nature of a person’s mental disorder has been established and compulsory treatment is needed. People can only be detained under Section 3 if the doctors recommending detention in hospital believe there will be appropriate treatment available for them there. For example, it might be in the interests of a person’s health to detain them in a general adult psychiatric unit for treatment of residual schizophrenia with antipsychotic medication, but it might not be appropriate if past experience suggested they would be highly distressed by hospital admission and would only improve to a limited extent. It might though be appropriate to detain them in a specialised psychiatric rehabilitation unit. Section 3 can be renewed, initially for six months and subsequently for periods of one year.

Sections 2 and 3 both require written recommendations from two doctors. One doctor must be approved by the Secretary of State as having expertise in the assessment and treatment of mental disorder, as described in section 12 of the MHA. This will usually be a psychiatrist. The other doctor should, if possible, have previous knowledge of the patient and ideally will be their general practitioner. Once these medical recommendations have been made, an application is made to the managers of the hospital by an Approved Mental Health Practitioner (AMHP), who will be a qualified practitioner, such as a social worker, nurse or occupational therapist, who has experience in the mental health field and has gone on to complete special training for the role. The AMHP will form their own opinion about whether use of the MHA is appropriate and will also consult with the person’s nearest relative. The application can also be made by the nearest relative, although this is unusual.

All this means that, before being placed on Section 2 or 3, the patient is assessed by a doctor who knows them and by a psychiatrist and another mental health practitioner with extensive experience, and in addition their nearest relative is consulted. This process is designed to safeguard the rights of people assessed under the MHA and ensure that these compulsory powers are not used inappropriately. In light of this, either Section 2 or Section 3 should be used whenever possible if compulsory admission is required. However, it can take time to assemble the AMHP and two doctors required for these sections and, if it is not safe to wait, then there are other sections that can be used to detain the person in hospital until an assessment for Section 2 or Section 3 can take place. Section 4 and Section 136 can be used to admit people from the community and Sections 5(2) and 5(4) to detain informal inpatients who want to leave the ward; details of these powers are shown in Table 1.