Being sectioned (in England and Wales)

If you have, or are thought to have:

1. a mental illness which needs assessment or treatment which is sufficiently serious that it is necessary for
   a. your health or safety, or
   b. for the protection of other people
2. you need to be in hospital to have the assessment or treatment
3. 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.

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.

In an emergency

In an emergency, things are slightly different - 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.

• 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 annually).
• 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.

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.

Yes. You would normally be taken to hospital by ambulance, although the police will be asked to help if necessary.

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 keep.

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 patient?

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.

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 or SOAD).

No, you can't be forced to have Electroconvulsive Therapy (ECT) (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.

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.

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:

• 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.
• 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.
• 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.

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.

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).

In Scotland:

• There is a range of useful topic guides on various aspects of compulsory treatment. These can be found at on the Scottish Government's website.
• Mental Health Tribunal for Scotland

In England, Wales and Northern Ireland:

• Mental Health Act Code of Practice: The Code of Practice provides guidance on how the Mental Health Act 1983 should be applied
• Care Quality Commission: Mental Health Act leaflets available where patients are detained.
• Mental Health Tribunals for England
• Mental Health Review Tribunals for Wales
• Mental Health Review Tribunal in Northern Ireland
• MIND: provides information on the Mental Health Act

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.