Sectioning

What is sectioning?

For a small minority of people with mental health problems, the impact that the condition has on their lives can be overwhelming. This can lead to them having difficulty making decisions about their treatment and finding themselves in situations that are unsafe for them and those around them.

Approximately 100 in every 1,000 (ten per cent) people will experience some form of mental health problem at any time ). Only about six in every 1,000 will need to be admitted to hospital, and not all of these will be admitted using one of the sections of the Mental Health Act.

An admission using a section is only used as a last resort, as the Act makes it clear only the minimum amount of restriction can be used to ensure safety and effective treatment. Being treated under a section of the Mental Health Act doesn’t mean the person cannot take decisions about other areas of their life; this is covered by the Mental Capacity Act 2005.

Who has the power to section?

The act was originally passed in 1959, rewritten in 1983, with amendments in 2007. In the 2007 amendments, while doctors are still needed for some decisions, the scope has been widened for other mental health professionals to be in charge of a person’s care or to take decisions about the use of a section. It’s now possible for a ‘responsible clinician’, who has roughly the role of a consultant psychiatrist, to be an experienced practitioner who has had additional training, for example:

• Clinical psychologists
• Occupational therapists
• Social workers
• Nurses

Similarly, the role of the social worker in taking decisions about the use of a section can be fulfilled by an ’approved mental health professional’, an experienced mental health practitioner who can be from a number of backgrounds and who has also had additional training.

The amount of time a person can be held in hospital and what can be done without their consent, varies between sections. But for most sections, there is a right of appeal. The person placed under section can ask for a hearing by the hospital managers and also to the Mental Health Review Tribunal.

What do the sections mean?

The sections of the Mental Health Act that can be used to detain and/or treat people are:

Section 2

This lasts for up to 28 days and is used to assess a person, although that can include assessing their response to treatment so they can be required to take medication. It can only be applied if the person has been assessed by two doctors and an approved mental health professional. The doctors must be specially trained psychiatrists (although one of them can be replaced by a doctor who knows the patient, such as their GP). They must all agree on the need for the section. When it’s finished, the person must either be discharged, consent to treatment or placed on section 3.

Section 3

This last six months at first, but can renewed for up to a year. It’s used to give someone longer-term treatment. It requires the agreement of two doctors (as for section 2) and an approved mental health professional. The nearest relative also has to agree to the section being implemented. In addition, if a person on section 3 doesn’t consent to treatment after three months, another doctor has to give a second opinion that treatment is necessary. There are also special safeguards around the use of electro-convulsive therapy (ECT) for people under section 3.

Section 4

Last for 72 hours for emergency admissions where one doctor and an approved mental health professional agrees on an admission but a second doctor cannot be found. Most doctors and approved mental health professionals try to avoid its use.

Section 5

There are two versions of this: section 5(2) and 5(4). Sometimes when a person agrees to go to hospital, they change their mind after they have been admitted. This section allows a doctor to hold a person for up to 72 hours, or a nurse to hold them for up to six hours. This is to allow time for the person to be assessed for section 2 or 3.

Section 7 and 8

These are called guardianship orders. They can require a person who has been discharged from hospital to live in a certain place and attend outpatient appointments. It doesn’t require them to comply with any actual treatment.

Section 17A

This is known as a community treatment order and allows for a person to be returned to hospital if they don’t comply with their treatment after discharge.

Section 135/6

These are used by magistrates to allow the police to either enter a person’s home or transfer them from a public space to a safe place where they can be assessed for section 2 or 3.

The person cannot be required to take medication under sections 4, 5, 135 or 136. They cannot be required to take medication in the community either under sections 7, 8 and 17A. However, they can be required to be monitored by their team and returned to hospital quickly if they refuse medication.

Being on a section of the Mental Health Act usually happens to a person at a time of serious distress and the process can feel as though things are being made worse not better. The 2007 amendments also established Independent mental health advocates to work with people who are on a section to ensure that:

• People who are on a section have their voices heard
• The minimum of restrictions are being imposed
• The maximum amount of choice is being made available to the person involved

Find out about the role of independent mental health advocates.

With thanks to Mrs Judith Richardson, Mental Health Act Administrator for Oxleas NHS Foundation Trust.

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