When can I be detained in hospital?

The Mental Health Act sets out the circumstances in which you can be admitted to hospital and detained there.

Admission for assessment (Section 2 of the Mental Health Act 1983)

This is used if the doctors and the approved social worker think you need a period of assessment in hospital. For example, you can be detained for this reason if this is the first time you have been in contact with mental health services.

You can be admitted to hospital and detained there only if the approved social worker and the doctors believe that:

• your mental disorder is of a nature or degree that means you need to be detained in hospital for assessment or for
• assessment followed by medical treatment; and
• you should be detained in hospital in the interests of your health or safety, or for the protection of others.

A Section 2 detention lasts up to 28 days and cannot be renewed. However, if your doctor thinks you should stay longer in hospital but you don’t want to, they will arrange an assessment to decide whether you should be detained for admission for treatment under Section 3 of the Mental Health Act 1983

Admission for treatment’ ( Section 3 of the Mental Health Act 1983)

The conditions for being admitted to hospital and detained there under Section 3 are stricter than for Section 2.

You can be detained under section 3 only if all the following conditions are met:

• You have a specific form of mental disorder or disability of mind.
• Your mental disorder is of a ‘nature or degree’ that means the treatment you need should be given to you in hospital.
• You need treatment for your health or safety, or to protect other people, treatment can be given only if you are detained under section 3.

You can be detained in hospital for up to six months to begin with, but the detention can be renewed for six months and then each year after that, as long as your doctor thinks you need to stay in hospital and receive treatment for your mental disorder.

What powers does my family have?

Under the Mental Health Act 1983, as amended by the Mental Health Act 2007, you have a nearest relative who will be involved in decisions about whether you will be detained. You can choose your nearest relative – he or she is a person who is related to you or someone you live with, as described in the Mental Health Act 1983. Different people may become your nearest relative as your situation changes. For example, if you are married, your husband or wife will be your nearest relative. However, if you divorce or separate permanently, someone else will become your nearest relative. This could be the older of your parents or your eldest child if he/she is over 18. Also civil partners and same sex couples can be nearest relatives and if you feel that the nearest relative has become unsuitable you can ask for that person to be displaced.

What if my nearest relative doesn’t want to take on this role?

If your nearest relative doesn’t want to take on this role, they can write to a doctor or other people responsible for your care, such as a Hospital Administrator, naming another person to act as your nearest relative. Your nearest relative can also change their mind at any time about whether someone else should take on this role, but they need to make their instruction clear in writing.

What Rights do my nearest relative have?

Your nearest relative has several rights, powers and responsibilities:

• They can apply for you to be admitted to hospital.
• They should be consulted if the Approved Mental Health Practitioner (AMHP) has applied or is applying for you to be detained under the Mental Health Act 1983.
• They must be told if the AMHP has plans for you to be detained under Section 3 of the Mental Health Act 1983,
• unless it is not practical to do so or it would cause an unreasonable delay. They can also object to any application
• to detain you but the AMHP can ask the court to appoint someone else as your nearest relative if he or she thinks the objection is unreasonable.

When deciding if it is practicable to contact your nearest relative about an application to detain you under Section 2 or Section 3, the AMHP can consider factors such as whether you object to involving the nearest relative, but there would need to be a good reason for excluding the nearest relative.

Admission for assessment in cases of emergency (Section 4 of the Mental Health Act 1983)

This is used if you need to be detained in hospital urgently, and there is no time for a second doctor to see you. However, the same conditions as for Section 2 detention must be met, but in this case, you can be detained in hospital on one doctor’s recommendation for up to 72 hours. If during that time a second doctor examines you and recommends that you are detained under Section 2, the Section 4 admission will become a Section 2 admission.

What happens if I agree to go into hospital?

If you agree to go into hospital and get the treatment the doctors think you need, you can be admitted on an informal basis. You will then be free to leave hospital whenever you want.

However, the doctor in charge of your treatment has the power to stop you from leaving if they think you need to stay in hospital. This is called a doctor’s holding power and can last for up to 72 hours. A qualified nurse can also detain you on the ward for up to six hours if they thought you should be prevented from leaving hospital. These holding powers are meant to give the doctors and the AMHP time to decide whether you need to be detained in hospitalWhen can I be given compulsory treatment?

If you are detained under Section 2 or 3 of the Mental Health Act 1983, compulsory treatment will apply. This means your Responsible Clinician (RC) can treat you without your permission, but these compulsory treatment powers do not apply if you are:

• detained as an emergency admission, but can be given medication if necessary.
• detained under a doctor’s or nurse’s holding power; or
• being detained in a ‘place of safety’

Compulsory treatment powers under the Mental Health Act 1983 are only for treating a mental disorder. They are not for any other problem you may have. If doctors want to treat you for something not covered by the Mental Health Act 1983, they can do so only if:

• you agree to it; or
• you are unable to agree to it, you didn’t previously refuse it, and the treatment is ‘in your best interests.

Should I ask about the type of treatment I am getting?

You should always ask about any treatment, whether or not you are detained under the Mental Health Act. Doctors and anyone else who is treating you should always first ask you whether you agree to a treatment, even if they have the power to treat you without your permission.

How can I decide whether to agree to have a treatment?

You should always be told in plain language:

• what is the treatment;
• why you should have it;
• about any possible side effects;
• how it will help you;
• about any other types of treatment you could have instead; and
• what could happen if you don’t have the treatment.

Don’t be afraid to ask questions. Your doctor should ask you if you have any questions, and must answer them fully and honestly. You can also change your mind about agreeing to treatment if you want to, but bear in mind the Compulsory Treatment Orders if you are detained.

What treatment can I be given?

You can be given several types of treatment under the Mental Health Act 1983.

Medication

Your Responsible Clinician (RC) can give you medication (drugs) without your agreement for up to three months, starting from the day you are first given the treatment as a detained patient. If they want to continue giving you the medication they must either:

• get your permission; or
• get an independent doctor (known as a ‘Second Opinion Appointed Doctor’ or SOAD) to confirm that you should
• continue getting the treatment.

Electro-convulsive therapy (ECT)

Your RC can give you ECT only if:

• you give your permission; or
• the SOAD confirms that you should have it and that it will help you.
  

Types of treatment you can be given without your agreement

You can be given some treatments without your agreement or the SOAD’s permission, as long they are given by your RC or on their instructions. These treatments include:

• general nursing care;
• psychological treatments (which include behaviour therapy, counselling and psychotherapy); and
• treatment for a physical condition if it is directly connected with your mental health problems.

Treatments that cannot be given without your agreement

Some rarely used treatments, such as psycho-surgery (surgery on your brain), can be given only if:

• you agree to the treatment; and
• an independent doctor has confirmed separately that you should have the treatment and it will help you.

A panel of people appointed by the Mental Health Act Commission will make sure you understand what the treatment is and what it will do for you. This applies whether or not you are detained under the Mental Health Act 1983.

If you need urgent treatment

Sometimes you can be given treatment without the usual procedures being followed. For example, if you decide you no longer want to take medication that you had earlier agreed to, and your RC or an Approved Clinician (AC) believes there would be a serious problem if you stopped, they may be able to make you continue taking it. However, the Clinician should contact the Mental Health Act Commission immediately to arrange for a SOAD to consider whether you should continue taking the medication and that it will help you.

What does the Second Opinion Appointed Doctor (SOAD) do?

If you are unable or don’t want to agree to a treatment, a SOAD must make their own decision about whether you should be treated without your permission. The SOAD must discuss the treatment with:

• your responsible clinician;
• a nurse involved in caring for you; and
• another person who cares for you who is not a doctor or a nurse.

The SOAD must also talk to you about why you don’t want the treatment if this is so. If the SOAD decides you should be given the treatment, then they must give you the reasons for this decision in writing unless the information is likely to cause serious harm to your physical or mental health.

When could I be given treatment that is not covered by the Mental Health Act 1983?

If your doctor thinks you are unable to make decisions about treatment, it can be given to you in your ‘best interests’. However, some treatments, such as sterilisation that is to make you unable to have children, can be given only if a court allows it. ‘Best interests’ means that the doctors believe:

• you will die if you don’t have the treatment; or
• your condition will get worse if you don’t have the treatment; or the treatment will improve your physical or mental health.

If you are unable to make decisions, your doctor should also talk to any relatives or friends who care for you if you were able to decide. But the treatment must not be given if, at a time when you were able to make such decisions, you made and advance directive, sometimes called an advance refusal about your treatment.

When am I able to make a decision about treatment?

You are considered able to make decisions if you are 18 or over, unless there is evidence to show you can’t. If you are 16 or 17, you are considered able to make decisions (unless there is evidence to show you can’t) and to be able to consent to treatment. However, if you are unable to consent, or if you refuse the treatment, your parents may consent to the treatment
on your behalf. If your doctor thinks you may not be able to make a decision, they must
look at whether you can:

• understand and retain the information you have been given about the treatment (especially the information about weigh up the information to decide whether you want to have the treatment

What is an ‘advance directive’?

An example of an advance directive is when you make a statement saying you do not want to be given a particular treatment now or in the future, especially when you can no longer make such decisions. For example, someone with cancer may make an advance directive saying they do not want chemotherapy, even if at some point in the future they are unable to make decisions about their treatment. Advance directives may be included in a document called advance statements . These are statements that people make to describe how they would like to be cared for and treated in the future when they cannot make decisions of their own.

When you make an advance directive, it must be clear that you understand what will happen if you don’t have the treatment; for example, that if you do not have the treatment you may die. Advance directives do not need to be in writing, but it is better if they are. It
is also good practice to have a doctor write down that you made your statement when you were capable of making this decision. Advance directives can, however, be overridden by the compulsory treatment powers under the Mental Health Act.

Who can discharge me from hospital?

Hospital Managers

Your nearest relative

What if the hospital or doctor won’t discharge me?

If you are detained under Section 2 or 3 of the Mental Health Act 1983 and you want to be discharged from hospital, you can apply to a Mental Health Review Tribunal (MHRT). This is an independent panel made up of:

• a lawyer;
• a doctor (usually a psychiatrist); and
• a ‘lay person’ (for example, a social worker).

The Mental Health Act 1983 allows mental health review tribunals to discharge you straight away or at a later date.

14 Day Rule

If you are detained under Section 2, you must apply to a mental health review tribunal within 14 days of being detained.

If you are detained under Section 3, you can apply to a mental health review tribunal within six months of being detain

Further Help