You hear it on the news, on soaps, and in magazines. Another celebrity has been sectioned, or that criminal who committed that crime was sectioned when he was younger, or that character is being sectioned against their will because they’re crazy…
The term “sectioned” has been totally demonised by society and the media, when in actual fact for some people being sectioned is the best thing that could have happened to them. If someone is being, or has been, sectioned then they have been through enough without people being scared of them because of them ‘being sectioned’. It’s really not as scary as it seems. Since working as a support worker in a CAMHS (children and adolescent mental health service) low secure hospital, primarily on the PICU (psychiatric intensive care unit) ward, I’ve learnt that not many people understand the work I do, or the reason behind why I need to do it and why my patients are where they are. I also realise that not many people understand the mental health system – this needs to change.
As I’ve stressed in many of my previous blog posts, mental health can affect anyone at anytime, and for many people it’s just not as simple as popping to the GP and getting themselves put on some prozac for a few weeks. In some cases, individuals need to be sectioned for their own health, their own safety, and also for the safety of others. Believe it or not, it doesn’t just involve throwing that individual into a hospital surrounded by high fences until they ‘get better’.
Laws surround these individuals for their own safety, and the main law involved in this is the Mental Health Act (1983/2001), and in this blog post I will be briefly explaining the main sections of the MHA and why they are needed.
The Mental Health Act (MHA) was brought about in 1983, and was revised again in 2007. It sets out when an individual can be detained or admitted to hospital against their wishes for their own safety or the safety of others- this is what being ‘sectioned’ is. It’s called being ‘sectioned’ because different individuals are detained for different reasons, and these reasons are outlined in the different sections of the mental health act. See, I bet that the word ‘sectioned’ sounds less scary already, doesn’t it?
An individual is sectioned when their mental disorder is causing them so much disruption in their lives that they are putting themselves or others at risk. People who work with patients who have been sectioned see violence, aggression, drug withdrawal symptoms, self harming and suicidal behaviours, attempts and ideation on a daily basis – that’s the reason those patients were sectioned.
Patients can have a variety of mental disorders which results in them being sectioned:
- Bipolar Disorder
- Anxiety Disorder
- Eating Disorders
- Personality Disorders
- Brain Injury that results in a change in behaviour/mental state
- Drug induced mental disorder
- Autistic Spectrum disorder
- Can include individuals with a learning disability, but only where it is associated with abnormally aggressive or socially irresponsible behaviour.
Three different people have to agree that someone needs to be detained in hospital in order for it to happen.
1. An approved mental health professional (AMHP) – this can be social workers, psychologists, occupational therapists or nurses. This person would give a non-medical view of why the person needs to be detained. They will look at the social side of an individuals life – living conditions, family life, friends, occupation, etc.
2. A section 12 approved doctor – This is a doctor who is specialised in assessing mental health in relation to the MHA.
3. A registered medical practioner – This can be the individuals own GP. The two doctors must agree if the individual has a mental disorder and whether they need to be detained.
The individual who is under assumption for detention will be interviewed by these above people to see what their mental state is like, why their mental state is the way it is, and if being sectioned will be the safest option for them and others around them and whether it can help their recovery.
As mentioned earlier, there are different sections of the MHA. These sections describe in detail the laws surrounding mental health patients, whilst in hospital, when they’re not yet detained, once they are discharged from hospital, what are their rights, and how this differs between under 18s and adults. Today I will go over the 4 most common sections of the mental health act, and how they are used in order to detain patients in hospital.
Section 2 of the MHA
A patient can be detained in hospital under section 2 of the Mental Health Act. Patients who are under section 2 can be kept in hospital for up to 28 days, and their section is used so their mental health can be assessed and so they can receive any treatment they may immediately need.
Patients under section 2 usually have not been detained before, which is why the assessment is needed, or they have not been assessed for a long time.
Once the 28 days are up, the section cannot be renewed. The individual has to be discharged from hospital, or their section has to be transferred to a section 3 (which will be explained later.)
Patients under a section 2 cannot refuse treatment, so they can be treated against their will. For example, if they are distressed and refuse to take medication orally they may be forced to take the medication via an intramuscular injection.
Patients under a section 2 may not have to stay in hospital for the full 28 days. They can be discharged early if it is seen as unfit to keep them detained, and that they would be better off and safer not being in hospital. They can be discharged by the responsible clinician at the hospital (the professional responsible for their car, a tribal, or by their nearest relative – however this last one can be overruled by the responsible clinician.)
So Section 2 = assessment, 28 days, can be discharged or transferred to a section 3
Section 3 of the MHA
This is where an individual is detained in hospital for treatment. They have either been on a section 2 and it has been decided they need a longer stay in hospital, or they are very well known to the mental health services so do not need the 28 day assessment period.
An individual under section 3 can be detained for 6 months. After 6 months, it can be renewed for another 6 months. After this year, it can be renewed after another year. However once every 6 months the individual can appeal against their detention, if they don’t believe they should be under section anymore.
The individuals under section 3 also have the right to access an independent mental health advocate. This is someone who can help them understand their rights, the law surrounding their section and can represent them during tribunals or professionals meetings if they feel unable to represent themselves. However, individuals under section 3, like section 2, are unable to refuse treatment in the first 3 months of their section. After 3 months, a second opinion appointed doctor can assess the situation and see if the individual has the capacity, or if it is appropriate, for them to be able to refuse their treatment.
Individuals under section 3 are discharged by the same people as those under section 2, the difference being that individuals who have been detained under section 3 are entitled to free aftercare once they are out of hospital – I will be going into detail about this aftercare in another blog post but for future reference it is called section 117 aftercare.
Section 3 = treatment, renewable every 6 then 12 months, entitled to aftercare, can’t initially refuse treatment.
Section 2 and 3 are the patients I deal with in my hospital. However there are two more common sections used to detain individuals, and these are usually used in emergency situations.
Section 4 of the MHA
Section 4 can be used to detain individuals in hospital for assessments in emergency situations. Due to the situation being an emergency, it only needs the recommendation of one doctor. The individual can also only be detained for up to 72 hours – 3 days.
Individuals are detained under section 4 if an assessment or treatment is needed as an emergency, in the interest of the individuals own health and safety and to protect others, but also if being detained under section 2 would involve a delay which is undesirable and would create an unsafe situation.
When under section 4 patients can refuse they treatment, unlike those under 2 and 3. However this is only if they have the capacity, and the treatment is not life-saving.
Those under section 4 are unlikely to be discharged back home, because of the emergency situation they were in, they are usually admitted as a voluntary patient if they agree, or they are detained under section 2 or 3 of the MHA.
Section 4 = emergency, 3 days, usually admitted at the end of the section.
Section 5 of the MHA
Section 5 is another emergency situation solution. A doctor or nurse can stop an individual from leaving either a mental health hospital, or even a general hospital as an informal patient. For example, if someone is in a general hospital receiving treatment for a physical condition and display symptoms that are suspected to be of a mental disorder and they are causing harm to themselves or others, a doctor or nurse can hold them under Section 5.
Section 5(2) is where a doctor can hold them, and they write a report explaining why the individual needs to be detained. The individual can be held for up to 72 hours and this is not renewable. Therefore, the situation must be addressed by the appropriate individuals (AMHP and 2 doctors) as soon as possible for possible admission under the MHA. A Section 5(4) is where a nurse can hold them because they must be immediately stopped and it is not possible for a doctor to attend immediately. However under a nurses holding power they can only be held for 6 hours and the power ends once a doctor has attended the patient and it can then be transferred to a section 5(2), section 2 or section 3.
Due to the nature of the section, and the individual having not been assessed, just like in section 4 the individual can refuse treatment.
section 5 = emergency, doctors and nurses can hold them but have different powers – 72 hours/6 hours
Hopefully this has helped you to see that being ‘sectioned’ isn’t as simple, or as scary, as it seems on the TV. Being sectioned isn’t something that doctors or patients take lightly, as there is no denying that it is a serious situation to be in, but that doesn’t necessarily mean it is a bad situation to be in.
With the patients I work with, and I’m sure other hospital staff will agree, of course I wish that none of them had to be sectioned, but they need help, and the fact that they have been sectioned just means that they have thankfully been caught in the system to receive that help to control their mental disorder, instead of ending up hurting someone, in prison as adults, or hurting themselves too severely and ending up dead.
Obviously a lot of patients don’t see it the way us staff do – none of them want to be in hospital, and a lot of the patients do just want to be dead or do just want to commit acts which will wind them up in prison – in their eyes that’s what they want to do with their life and that’s what they think they should be allowed to do. But from the staffs point of view that is just their mental disorder and it is out job to help them through this patch of life and get them on the road to being discharged as a healthier person than they were than when they first got sectioned, and hopefully help them avoid being sectioned again.
I will be doing further blog posts on the laws surrounding mental health, including further information about the Mental Health Act, the different type of hospitals there are, and also something interesting called the Mental Capacity Act. Watch this space!