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What the Act means to individuals and families The Mental Health Act 1983 (Revised 2007)
ensure that an application is necessary and that no ‘less restrictive’ form of intervention can be used. They will consider making an application for detention if it is felt that you may cause harm to yourself or others and if it is felt that you may not necessarily be aware enough to access The Mental Health Act (MHA) the proper medical care required. It lays down what says what legal powers doctors and Approved doctors and Approved Mental Health Professionals Mental Health Professionals can and can’t do and what (AMHPs) have to detain you rights you and your relatives in a hospital against your have. An application will be will. The doctors involved made on the basis of nature will be approved under (for example a diagnosis Section 12 of the Mental of mental disorder or past Health Act or they may history) or the degree (which know you (such as your GP). is the level or intensity) at The role of the doctors is which your mental disorder to make recommendations is affecting you and the risks for an application and the role of the Approved Mental for you and for others. Health Professionals is to The Mental Health Act 1983 was amended recently by the Mental Health Act 2007. It is an Act of Parliament which sets out how you can be treated if you have a mental disorder. It is the law used to admit, detain and treat adults, children and young people.
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leaflets available on the various sections for your information at www.surreycc.gov.uk/ mentalhealthact.
The Mental Health Act is very complex and covers compulsory admission to hospital, consent to treatment and your rights of appeal. There is a separate code of practice that gives a guide to implementing the Act. The Mental Health Act sets out: • when you can be taken into hospital against your will • when you can be given treatment against your will • what your rights are, and • what safeguards there are to make sure your rights are protected. This leaflet gives a summary of the main sections and professionals involved in your assessment. There are more detailed 2
What is an assessment under the Mental Health Act? has extra training under the Mental Health Act.
Some people can experience severe mental health problems that require admission to hospital for assessment and treatment.
During an assessment you will be asked questions about how things have been going for you. A Mental Health Act assessment will enable the doctors and Approved Mental Health Professionals to pay attention to: • how well you feel emotionally • your behavioural history • your medication history • how well you are able to think • how you are able to reason • how you are able to remember • cultural issues or factors, and • significant events in your life.
When you are detained in hospital, there are usually three people involved in the assessment and deciding that you need treatment in hospital. These three people in most cases will consist of an Approved Mental Health Professional (or nearest relative specified by Section 26 of the Act), a Section 12 approved doctor and a registered medical practitioner in a hospital or in the community who knows you. If a doctor who knows you is not available, you will see a second Section 12 approved doctor. A Section 12 doctor
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detained in the interest of your own health, your own safety or with a view to the protection of other people.
Following the assessment the two doctors decide whether to make medical recommendations (they can make these jointly or separately), that you are suffering from a mental disorder of a nature or degree which warrants your detention in a hospital for assessment or treatment and that you ought to be
The recommendation must include a statement about why an assessment or treatment is necessary and why other methods are not appropriate.
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Main sections of the Mental Health Act? with ‘abnormally aggressive’ or ‘seriously irresponsible’ conduct. Dependence on drugs or alcohol is not in itself considered to be a disorder or disability of the mind.
The Act is divided up into Sections, which is why people detained are sometimes referred to as having been ‘sectioned’. The section you are detained under gives guidance as to how long you will be detained, what your rights are and what should happen. Section 1 – Section 1 is about the definition of mental disorder. To be assessed for compulsory admission to hospital or a care home you must be suffering from a mental disorder (any disorder or disability of mind). In terms of mental disorder, a person with a learning disability is not considered having a learning disability (to meet the criteria for detention under the Mental Health Act) unless it is associated
This definition includes conditions such as schizophrenia, depression, bipolar disorder, anxiety disorder, obsessivecompulsive disorder, personality disorders, eating disorders, dementia, brain injury and mental disorders due to alcohol or drug use.
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Section 2 – allows for a person who meets the criteria to be compulsorily admitted to hospital for assessment (or assessment followed by treatment). They can be detained there for up to 28 days. Two doctors
team is the same as with Section 2. The criteria is also the same as Section 2, but there must also be appropriate treatment available to them and this place of treatment must be specified. This section is renewable.
and an Approved Mental Health Professional carry out an assessment. The doctors may be approved under Section 12 of the Mental Health Act, or they may know you, for which there are rules relating to this. The criteria is that the person is suffering from a mental disorder of a nature or degree which warrants detention in a hospital for assessment and that they need to be there in the interests of their own health or safety or with a view to the protection of other people. Section 3 – allows for a person who meets the criteria to be admitted to hospital and detained there for up to six months for treatment. The assessing
Section 4 – this is where there is an urgent or emergency situation and only one doctor is available (and waiting would involve unreasonable delay). Section 4 allows for the detention for up to 72 hours initially. It is converted into a Section 2 if a second doctor makes a recommendation within the 72 hour period.
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Section 5 – allows inpatients to be detained for short periods of time, for up to six or 72 hours.
Section 5.4 assessment – A nurse is able to detain a person who is already an inpatient for a short period of time (up to six hours) until a doctor or approved clinician can use their holding power under Section 5.2 or a Mental Health Act assessment can be arranged.
Section 5.2 assessment – The doctor or approved clinician in charge of the person’s treatment can detain an informal inpatient in a hospital for up to 72 hours when they think that an application needs to be made. This application would be for a Section 2 or 3.
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Section 7 - under Section 7 of the Mental Health Act a person who has a mental disorder can be given a Guardian to help them as part of their care plan. The Guardian will be either from the local Social Services Authority or somebody who is willing to be named as the Guardian. The Guardian may use their legal powers to tell you where you must live, to attend appointments for medical treatment, or to allow a doctor or named person to see you. Section 17a – this is a Community Treatment Order (CTO). This is an application under the Mental Health Act following treatment where you are well enough to leave hospital but you may benefit from a Community
Treatment Order. The Community Treatment Order should be part of your overall treatment plan and allows you to be brought back to hospital (recalled) if certain conditions are not kept. Section 117 – this gives guidance on aftercare for people who have been detained under Section 3 of the Mental Health Act (and other forensic sections).
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Section 135 (1) - this is a warrant from a Justice of the Peace which will allow a police officer to enter premises (by force if necessary) in order to search for the named person with a mental disorder to be taken to a place of safety for assessment. Once the person arrives at a place of
Section 136 – this section allows a police officer to remove a person who is in a place to which the public have access to a place of safety for the purpose of examination by a doctor and interview by an Approved Section 135 (2) – this Mental Health Professional warrant enables a police and to make, when needed, officer or another person arrangements for their care authorised by the hospital, and treatment. The person or an Approved Mental must be in immediate need Health Professional (or in of care and control, appear the case of a guardianship, to be suffering from a any person authorised by mental disorder and it is in the local authority) to enter the interests of the person premises to return a person or to protect other people who has been detained to remove them to a place under the Mental Health Act, of safety. to hospital. safety (usually a hospital) there will be 72 hours to have an assessment. The police officer must be accompanied by an Approved Mental Health Professional and a doctor.
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Part 3 of the Mental Health Act
You may have been admitted to hospital under what is called a Part 3 or Forensic Section. These sections are placed on someone to bring them to hospital in one of two ways. The first way is from a court of law. The second way is from a prison (either where you were on remand or are serving a sentence).
If you are placed under this section it will be because it is felt by either the court of law or the prison authorities, who would have received advice from one or more doctors, that you would benefit from time spent in hospital to assess or treat your mental health problem. If you are admitted under this kind of section a nurse will have given you a leaflet explaining the section you are under and any rights of appeal you have. The leaflet will also explain what happens next (after the assessment or treatment has finished), as in some cases you will leave hospital and return to court or prison.
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Main professionals involved in your assessment The Approved Mental Health Professional - An Approved Mental Health Professional is the person responsible for organising and co-ordinating, and making the applications for detention under the Mental Health Act. They are there to ensure that the legal criteria is met and that an application must be the least restrictive option available to you. They may be social workers or other mental health professionals, who have undergone additional training and who have been approved by the local authority to carry out designated duties under the Mental Health Act. The Act gives them the power to make an application for admission
to a hospital (though some sections deal with other specified places, this is not so common) under a section of the Act. They will assess if detention in hospital or a specified place is the best way of providing care and medical treatment for your needs. When making that decision, “all the circumstances of the case” are required to be considered. That might include • the past history of your mental disorder • your present condition and the social, family and personal factors which may affect it • you and your relatives and carers’ wishes • the opinion of other professionals involved in 12
caring for you, and • the other options available for supporting you. They will fully explain the process and choices available to you. You have the right to see them alone if you wish to do so and they have a duty to ensure that they interview you in a suitable manner. The Section 12 approved doctor - Medical recommendations are to be made by the doctors, one of them being Section 12 approved. A Section 12 approved doctor is a medically qualified doctor who has expertise in mental disorder. The nearest relative People described in the
Mental Health Act as “Nearest Relatives” have various rights in relation to you as the patient under the Act. The Nearest Relative (NR) is important as he or she has the power to discharge you from some sections of the Act or object to an application being made for detention under Section 3 of the Mental Health Act. The role of the Nearest Relative is defined by the Mental Health Act. You can find a list of people who could be your Nearest Relative under Section 26 of the Mental Health Act. Quite often, it does not mean the same as your closest relative or your next of kin. When it requires people to consult, inform or notify nearest 13
relatives, the Act and the Regulations typically refer to “the person (if any) who appears to be the nearest relative�. The type of relationship a person has with you, plays a big role in determining if they are your Nearest Relative, i.e. husband,
wife or civil partner; son or daughter; father or mother; brother or sister; grandparent; grandchild; uncle or aunt; nephew or niece; or an unrelated person who resides with you. Your Nearest Relative does not have to act as your Nearest Relative. They can
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‘delegate’ their powers to another person. There are forms available to do this and an Approved Mental Health Professional or your care coordinator can help them to do this, it is not a complicated process. If you do not want your
Nearest Relative to be your Nearest Relative you can talk to your solicitor or an Approved Mental Health Professional about how you can change them. The County Court can change your Nearest Relative for you on certain grounds if you make an application.
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How do we hold your information? In Surrey, we work in integrated teams where health and social care professionals ensure that confidentiality is a basic principle in the relationship between social care, health professionals and patients. In general, information disclosed by you to your doctor or team is regarded as confidential. However, the information may be passed to someone else in cases of emergency.
to be shared with and we will put this on the forms held in your record. It is important that you should be made fully aware of what you are agreeing to.
There are two main exceptions to the duty of confidence. Firstly, public interest can override the duty. For example, a psychiatrist could pass on information about you to the police if it was felt that you would be a danger to other people. Secondly, There are clear processes disclosure of confidential regarding how your information may be information is kept and used in Surrey to ensure you permitted or required by statute or a court order. The receive the care you need. information sharing leaflets Your care team should give will fully explain information you these leaflets and you will be asked with whom you sharing to you. would like your information 16
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Advocacy
An advocate is someone who enables you to ‘find your voice’ and to express your views, for example, at a Tribunal Hearing. Advocacy is often about ensuring these views are acknowledged and taken seriously, when others may be unable or unwilling to give weight to them. The Mental Health Act states that you have the right to access an Independent Mental Health
Advocate (IMHA). It is the responsibility of Surrey County Council and Surrey and Borders Partnership NHS Foundation Trust to provide you with the independent advocacy service, if you reside within their area. The advocate cannot act independently of you, but rather will help you represent your wishes and feelings.
The following is a link to the Surrey and Borders Partnership NHS Foundation Trust website which gives a comprehensive list of local community teams and wards http://www.sabp.nhs.uk/services/adult/community
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Surrey County Council County Hall Kingston Upon Thames KT1 2DN
If you would like this information in large print, Braille, on tape or in another language please contact us on: Tel: 03456 009 009 Minicom: 020 8541 9698 Fax: 020 8541 9575 Email: contact.centre@surreycc.gov.uk
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