Introduction
The Mental Health Act 1983 is principally concerned with the grounds for detaining patients in hospital and in amending the 1959 Mental Health Act aims to improve patients’ rights and the protection of staff.
Most patients who need hospital care are admitted informally but a minority require compulsory admission and detention in their own interests and/or for the protection of others.
Section 1 – Definition of Mental Disorder
A patient must be suffering from mental disorder as defined by the Act before compulsory admission to hospital can be considered. This definition, however, is open to broad interpretation; ‘mental disorder1 means mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind. Nevertheless a person may not be regarded as suffering from mental disorder by reason only of promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs.
Section 2 – Admission for Assessment
This allows for admission for assessment (which may be followed by medical treatment) for up to 28 days. Application may be made by the nearest relative or an approved social worker (in practice it is usually the latter) and must be supported by two medical recommendations, at least one of which must be from a doctor approved under Section 12 as having special experience in the diagnosis or treatment of mental disorder.
The patient has the right to apply to a Mental Health Review Tribunal within 14 days of admission. The nearest relative, the managers or the responsible medical officer can discharge the patient although the RMO can bar discharge by the nearest relative.
Section 3 – Admission for Treatment
This Section provides for the admission of a patient to hospital and his detention for a maximum period of 6 months (unless the order is renewed). Application may be made by the nearest relative or an approved social worker supported by two medical recommendations, at least one of which must be from a doctor approved under Section 12.
The patient has a right to apply to a Mental Health Review Tribunal within the first 6 months and once during each subsequent period for which the detention is renewed.
Section 4 – Admission for Assessment in Cases of Emergency
An emergency application for admission for assessment may be made by the nearest relative or an approved social worker supported by one medical recommendation, preferably from a doctor acquainted with the patient. The application should state that it is of urgent necessity to admit the patient and that admission under Section 2 or 3 would involve undesirable delay. The order ceases to have effect after 72 hours unless the second medical recommendation under Section 2 is given and received by the managers within that period.
Section 5(2) – Application in Respect of a Patient already in Hospital
This Section allows the detention of a patient already receiving any form of inpatient treatment (i.e. not necessarily psychiatric treatment). The application must be made by the doctor in charge of the case or his nominated deputy. The Section provides that the patient may be detained for up to 72 hours (including any period during which a nurses holding power was used) unless further powers have been taken under Section 2 or 3.
Section 5(4) – Nurse’s Holding Power
Only applicable to patients already receiving treatment for mental disorder in hospital. Allows a registered mental nurse (or equivalent) to detain a patient for up to 6 hours from the time that the decision is recorded while a doctor is found.
Section 136 – Persons in Public Places
This Section authorises a police constable who finds a person who appears to suffer from mental disorder (in a place to which the public has access) to remove him to a place of safety (not necessarily a mental hospital) where he may be detained for up to 72 hours for further assessment. The constable must consider it necessary to detain the person in his interests or for the protection of others. If the police bring someone to hospital under this Section, they must be seen and assessed by a doctor, but admission does not have to follow if this is deemed unnecessary.