New podcast: Being
sectioned under the Mental Health Act: Claire Greaves recalls
her experiences of the mental health services system, in
conversation with Raj Persaud.
Being sectioned (in England and Wales)
Being sectioned means being admitted to
hospital whether or not you agree to it. The legal authority for
your admission to hospital comes from the Mental Health Act rather
than from your consent. This is usually because you are unable or
unwilling to consent.
The term ‘sectioned’ just means using a
‘section’ or paragraph from the Mental Health Act as the authority
for your detention. A better word is 'detained'. You are detained
under the Mental Health Act. The paragraph or ‘section’ number is
often used so a patient may be told they are on a section 2 or
How often does this happen?
The Mental Health Act is used about 50,000
times a year in England and Wales. This isn’t 50,000 people because
some people may be detained several times within a year.
Why may I be detained?
If you have, or are thought to have;
1. a mental illness which needs
assessment or treatment which is
2. sufficiently serious that it is
a. your health or safety, or
b. for the protection of other
3. and you need to be in hospital to
have the assessment or treatment. And
4. you are unable or unwilling to
agree to admission.
If you are on a section 3, that is for
treatment, then the treatment you need must be available at the
hospital in which you’re detained.
Who decides I need detaining?
The process usually starts because your GP, a
family member, a police officer or psychiatrist is worried about
your mental health. The decision is usually made (other than in an
emergency) by two doctors and an Approved Mental Health
Professional (AMHP). One of the doctors must be specially certified
as having particular experience in the assessment or treatment of
mental illness. If possible, one of the doctors will already know
you. The AMHP is usually a social worker, but could be a mental
health nurse, psychologist or occupational therapist.
Who decides in an emergency?
It depends on where you are.
- If you are in a public place, then a police
officer can detain you and take you to a place of safety (usually a
hospital or police station).
- If you are already in hospital, then the
clinician (usually a doctor) in charge of your care or treatment
can detain you.
- If you are in your own home, and refuse to
let a doctor or AMHP in to see you, then a magistrate can give
permission for your home to be entered without your permission and
for you to be taken to a place of safety.
How long does the section last?
- The assessment section (section 2) lasts up
to 28 days.
- The treatment section (section 3) lasts up to
6 months and can be renewed (for a further 6 months, then
- The emergency sections last up to 72 hours
during which time arrangements must be made to assess if a section
2 or section 3 is necessary.
Does my family have a role?
One member of your family is known as your
‘Nearest Relative’. Who fulfils this role is decided from a list in
the Mental Health Act. It is not the necessarily the same as your
next-of-kin. Your husband/wife/civil partner is the first choice.
If you don’t have one then, in order, it is the oldest of your
children, or parents, or brothers or sisters and so on.
The person who acts as your nearest relative
can only be changed by that person themselves or by a court. You
can apply to the court to change your nearest relative if you don’t
think the person at the top of the list is suitable.
Your nearest relative has a number of powers,
including stopping you being placed on a section 3 and applying for
your discharge from detention. Under certain circumstances, the
powers of your nearest relative can be overridden.
Can I be forced to go to hospital?
Yes. You would normally be taken to hospital
by ambulance, although the police will be asked to help if
What happens when I get to hospital?
You will meet members of the clinical team,
particularly the nursing and medical staff, who are
responsible for your care and treatment. Most of your care will be
the same as you would expect if you had agreed to admission. But,
in addition, you will have your rights as a detained patient
explained to you and be given a copy of these rights to
You should also be offered the assistance of
an Independent Mental Health Advocate. You will be placed under the
care of a person who is called your Responsible Clinician. This is
usually a consultant psychiatrist, although it could be a senior
nurse, psychologist, occupational therapist or social worker.
What power does the hospital have over me when I am a detained
You can be held in the hospital, including
being kept on a locked ward if necessary (because, for example, you
keep trying to run away or behave in a way which suggests you need
more staff to keep you, and other people, safe). You can also be
required to take medication for your mental illness.
Can I have medication forced on me if I refuse to take it?
Yes. The choice of medication should be
discussed with you, unless you are unable or unwilling to discuss
it. But you can be forced to take it if your Responsible Clinician
thinks it is necessary.
If, after 3 months, you are still detained and
don’t want the medication, or are too ill to consent to it but your
responsible clinician still thinks it’s necessary, then you will
see an independent consultant psychiatrist sent by the Care Quality Commission. You can
then only be forced to take the medication agreed to by the
independent psychiatrist (called a Second Opinion Appointed Doctor
Can I be forced to have ElectroconvulsiveTherapy (ECT)?
No (unless it is an emergency to save your
life or prevent a serious deterioration in your health). You can
have ECT if you consent. If you
are too ill to be able to make a decision, then you can have ECT if
it is agreed by a SOAD.
Can I leave the hospital at all whilst I’m detained?
Yes, but only with the permission of your
Responsible Clinician. Conditions may be put on your leave, such as
how long you can be away for, where you can go and whether or not
you are accompanied.
If I disagree with being in hospital what can I do about
The first thing to do is to discuss it with
your responsible clinician or other members of the team looking
after you. It is important to remember that they would like to be
able to discharge you home as much as you wish to go home.
The moment your Responsible Clinician thinks
it is safe to do so, they will discharge you. However, if your
Responsible Clinician thinks you still need to be detained, but you
disagree you can seek discharge in three other ways:
1. The Mental Health
Tribunal. This is a body totally independent from the
hospital. A three person team - a judge, a psychiatrist
and a person with a social care background - will organise a
hearing. They will require written reports from your Responsible
Clinician, a nurse on your ward and a professional who can write
about your social circumstances. You will receive copies of the
reports written about you. Information can be withheld from you
under certain circumstances, but this decision is made by the
Tribunal, not by those writing the reports. You are entitled to
have a solicitor to represent you, at no cost to you.
At the hearing, the
Tribunal will listen to the staff and to you. You will be asked
questions by the Tribunal members. The staff will also be asked
questions by the Tribunal members. The staff can also be asked
questions by your solicitor. It is for the staff to ‘prove’ you
need to be detained, not for you to prove you don’t.
If you are on a section 2 and wish
to appeal, you must do so within the first 14 days. You can then
appeal each time your detention is renewed.
2. The hospital
managers. Three hospital managers, usually with a
background of clinical or social expertise, can organise a
‘hearing’ which is very similar to the Tribunal hearing.
3. You can also ask your
Nearest Relative to discharge you, although, even
if they agree, this can be overridden by your Responsible Clinician
if they think you may be a danger to yourself or somebody else.
What are community treatment orders (CTO)?
They are sections of the Mental Health Act
which mean you can leave the hospital, but with certain conditions.
You can be put on a CTO if you are detained on a section 3 (but not
if you are on a section 2). The decision is made by your
Responsible Clinician and an AMHP. It is initially for 6 months but
can be renewed. You have the same rights of appeal as when you were
detained. You can be recalled to the hospital if your Responsible
Clinician thinks it necessary.
What sort of conditions?
All patients on a CTO must agree to see their
Responsible Clinician and, if required, a SOAD. Other conditions
will be decided by your Responsible Clinician and AMHP. The most
common is that you agree to take your medication.
Other conditions may include such things as
places you mustn’t go or things you mustn’t do. The conditions must
be necessary for your health or safety, or to protect other people
or to ensure you receive the treatment you need. You will normally
only be placed on a CTO if you agree to the conditions.
Can I be forced to take medication when I’m on a CTO?
Generally no, not while you are in the
community. The only time you can be forced to take medication is if
you lack the capacity to decide whether or not to take the
medication, and it is an emergency. If your Responsible Clinician
wishes to insist you take medication which you refuse, then they
must recall you to hospital.
What happens if I break the conditions?
Your Responsible Clinician may recall you to
hospital to discuss the difficulties. If your Responsible Clinician
and an AMHP think it necessary, your CTO may be revoked and you
will again be a detained patient.
Is there anyone else I can turn to for help?
The staff, particularly your Responsible
Clinician, should be able to help with most questions. In addition,
you are entitled to legal advice from a solicitor and assistance
from an Independent Mental Health Advocate. You can also request to
see a Mental Health Act Commissioner from the Care Quality
Commission (an independent healthcare regulator).
Sources for help
In England, Wales and Northern Ireland:
Expert review: Dr Tony Zigmond.
Series Editor: Dr Philip Timms
User and Carer input: members of the RCPsych Service User
Recovery Forum and Carers Forum.
© August 2013. Due for review: August 2015. Royal
College of Psychiatrists. This leaflet may be downloaded,
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