Dr Ruth Yates
GP ST2 in Psychiatry
Aims and Objectives
 To learn about the Mental Health Act 1983 and
different sections of it
 To learn how to detain people under the act, who is
involved and how
Overview
 Introduction
 Terminology
 Who’s who
 Definition of mental disorder
 Sections of the MHA
 (including 2, 3, 4, 5, 135, 136)
 Summary
 Quiz
Introduction
• Informal patients
– In hospital voluntarily
– Same rights as those being treated for physical illness
• Formal patients
– 25% of mental hospital inpatients
– Compulsorily detained under a section of MHA 1983
– Lose some rights available to informal patients
Some Terminology
 Community Treatment Order (CTO)
 Legal order that allows patient to be discharged from
formal detention onto supervised community treatment
 Supervised Community Treatment (SCT)
 Patient is discharged from detention under MHA
 Required to comply with conditions set out in a CTO
 If fail to do so, may be recalled to hospital for tx
Who’s who
 Approved mental health professional (AMHP)
 Social workers, nurses, OTs or psychologists
 Approved by local services authority
 Carry out certain functions under MHA 1983 to give
them power to make an application for admission to
hospital under a section of the Act where necessary and
proper.
 Must interview patient to check detention appropriate
Who’s who
 Approved clinician
 Mental health professional who has been approved, for
the purposes of the MHA, by the Secretary of State
(England) or Welsh Ministers (Wales).
 Doctors, psychologists, nurses, occupational therapists,
social workers
Who’s who
 Responsible clinician
 Approved clinician with overall responsibility for
patient’s care and treatment
 Are only ones who can make certain decisions

E.g. Placing detained patient on SCT
 All responsible clinicians must be approved clinicians
Who’s who
 A person’s nearest relative can apply for their relative
to be formally detained under a section of the Act
Who’s who
 Mental Health Tribunal (MHT)
 Independent panels that decide whether a formal
patient should be discharged or not
Definition of mental disorder
 Any disorder or disability of mind
 Note
 A person with a learning disability is not considered to
be suffering from a mental disorder for most purposes
under the Act; or to require treatment in hospital, unless
that disability is associated with abnormally aggressive
or seriously irresponsible conduct.
Section 2
 Compulsory admission to hospital or guardianship for
patients not involved in criminal proceedings
 Admission for assessment
 28 days maximum
 Application by AMHP or patient’s nearest relative
Section 2 cont...
 Procedure: 2 doctors must confirm that....
 a) patient has mental disorder of a nature/degree that
warrants detention in hospital for assessment (or
assessment followed by medical treatment) for at least a
limited period; AND
 Patient ought to be detained in interests of his/her own
safety, or with a view to the protection of others
Section 2 cont...
 Discharge by
 Responsible clinician
 Hospital managers
 Nearest relative, who must give 72 hours’ notice

The responsible clinician can prevent him/her discharging a
patient by making a report to the hospital managers
 MHT – the patient can apply to a tribunal within the
first 14 days of detention
Section 3
 Admission for treatment
 Duriation:
 Up to 6/12
 Renewable for a further 6/12
 Then renewable for one year at a time
 Application for admission:
 By nearest relative or AMHP
Section 3 cont...
• Procedure: 2 doctors must confirm that...
– a) the patient is suffering from a mental disorder of a
nature/degree that makes it appropriate for him/her to
receive medical tx in hospital; AND
– b) appropriate medical tx is available for him/her; AND
– c) it is necessary for his or her own health or safety, or
for protection of others that he/she receives such
treatment and it cannot be provided unless he/she is
detained under this section
Section 3 cont...
 Renewal: under section 20
 Responsible clinician can renew section 3 if:


Original criteria still apply
Appropriate medical treatment is available for patient’s
condition
 Responsible clinician must consult another person of a
different profession who has been professionally
concerned with the patient’s treatment.
Section 3 cont...
• Discharge by:
– Responsible clinician
– Hospital managers
– Nearest relative (must give 72 hours’ notice). If the
responsible clinician prevents this, by making a report to
the hospital managers, the nearest relative can apply to
an MHT within 28 days
– MHT . A patient can apply to a tribunal:
•
•
•
Once during first 6 months of detention
Once during 2nd 6 months of detention
Then once during each period of one year
Section 4
• Admission for assessment in cases of emergency
• Duration of detention: 72 hours max
• Application by AMHP or nearest relative
– Applicant must have seen patient within the previous 24
hours
• Procedure: 1 doctor must confirm that:
– a) urgent necessity for admission and detainment under
section 2
– b) waiting for 2nd doctor to confirm the need for an
admission under section 2 would cause ‘undesirable
delay’
Section 5
• Compulsory detention of informal patients already in
hospital
• A doctor or other approved clinician in charge of
informal patient’s treatment (inc. physica problem)
can detain a patient for up to 72 hours by reporting to
hospital managers that an application for compulsory
admission ‘ought to be made’
• A nurse working in mental illness or learning
disabilities can detain an informal patient who is
receiving treatment for a mental disorder for up to 6
hours until a doctor/clinican can detain them
Section 135
• Warrant to search for and remove patients
• Duration: 72 hours max
• Procedure: if there is reasonable cause to suspect a
person suffering from mental disorder AND
– a) is being ill-treated/neglected/not kept under proper
control
– b) is unable to care for themselves and lives alone
• ....a magistrate can issue a warrant authorising a police
officer (with a doctor and AMHP) to enter any
premises where person is believed to be and remove
them to place of safety
Section 136
• Mentally disordered persons found in public
• Duration: 72 hours max.
• Procedure:
– Person suffering from mental disorder
– Is in immediate need of care or control
– Police officer can take to ‘place of safety’
•
Hospital or police station
– Person then examined by a doctor and interviewed by an
AMHP and ‘any necessary arrangements’ made of their
treatment or care
Summary
• Many sections of MHA 1983
• Section 2 – assessment
• Section 3 – treatment
• Section 4 – emergency detainment while awaiting 2nd
doctor for section 2
• Section 5 – detainment of patients in hospital informally
• Section 135 – search premises and remove person to place
of safety
• Section 136 – remove person from public place to place of
safety
Quiz
Any Questions?