Compulsory Admission

Mental Health Act 1983

 Mental Disorder
• Mental illness
– undefined, clinical judgment, includes anorexia
nervosa
• (Severe) Mental impairment
– a state of arrested or incomplete development
of mind which includes significant impairment
of intelligence and social functioning
– associated with abnormally aggressive or
seriously irresponsible conduct
 Mental Disorder
• Psychopathic disorder
– persistent disorder or disability resulting in
abnormally aggressive or seriously
irresponsible conduct
 Mental Disorder
• Exclusions
– promiscuity
– other immoral conduct
– sexual deviance
– alcohol or drug dependence
 Criteria for Admission
• Suffering from mental disorder

AND

• In the interests of his/her own health, or

• In the interests of his/her own safety, or
• For the protection of other people
 Admission for Assessment
(Section 2)
• Pointers:
– diagnosis/prognosis unclear
– in-patient assessment to formulate treatment plan
– to judge whether patient will accept treatment on
voluntary basis following admission
– to judge whether a proposed treatment which can
only be given under Part IV is likely to be
effective
 Admission for Assessment
(Section 2)
– condition has changed and further assessment is
needed
– patient not previously admitted and not in
regular contact with psychiatric services
 Admission for Assessment
(Section 2)
• Application by Approved Social Worker (ASW)
or nearest relative
• Recommendation by two medical practitioners,
one with prior knowledge of patient, one “Section
12(2) approved” (special experience in treatment
and diagnosis of mental disorder)
• Only one recommendation from practitioner on
staff of hospital to which patient is to be admitted
 Admission for Assessment
(Section 2)
• Recommendations to be made within 5 days of
each other
• Power of detention lapses if patient not admitted
within 14 days
• For assessment or assessment followed by
treatment
• 28 days maximum duration
 Admission for Treatment
(Section 3)
• Pointers:
– patient’s disorder already known to clinical
team and recently assessed
– detained under Section 2 and assessment
indicates need for treatment beyond 28 days
 Admission for Treatment
(Section 3)
• Application and recommendations as for Section 2
• Mental disorder of a degree or nature necessitating
medical treatment in hospital
• In psychopathic disorder and mental impairment,
treatment should alleviate or prevent a
deterioration in patient’s condition
• 6 months maximum duration
• Nearest relative may object
 Admission for Emergency Assessment
(Section 4)
• Criteria for Section 2 met
• Emergency when those involved cannot cope with
mental state or behaviour of the patient. Evidence of:
– immediate and significant risk of mental or physical
harm to patient or to others, and/or
– danger of serious harm to property, and/or
– need for physical restraint
• Not enough time to obtain second medical
recommendation
 Admission for Emergency Assessment
(Section 4)
• Application by ASW or nearest relative
• One medical recommendation, preferably with
prior knowledge of patient, with guidance from
local psychiatric services
• Both should have seen patient within previous 24
hours
• Second Section 12 approved recommendation
within 72 hours, then treat as for Section 2
 Police Powers
(Section 136)
• Police powers to remove to a place of safety
anyone in a public place who is judged to be
suffering a mental disorder and is in immediate
need of care and control
• Policy determined locally by social services,
health authority and trust, chief constable
 Police Powers
(Section 136)
• Places of Safety
– Residential accommodation (Part III National
Assistance Act 1948)
– hospital
– police station
– mental nursing home
– residential home for mentally disordered people
– any other suitable place where occupier is willing to
receive patient temporarily
• Cannot transfer between places of safety
 Police Powers
(Section 136)
• Assessment by ASW and doctor (preferably
Section 12 approved) as soon as possible
• Police officers should remain in attendance where
the patient’s health or safety or the protection of
others so require
• Patient has right of access to legal advice
• 72 hours maximum duration
• If required, informal admission or detain under
Section 2 or 3
 Police Powers
(Section 135)
• Power of entry to gain access to a mentally
disordered person who is not in a public
place and, if necessary, remove him or her
to a place of safety
• Must be accompanied by a doctor and ASW
 Doctor’s Holding Power
(Section 5(2))
• Informal in-patient requiring detention but not
possible or safe to use Sections 2,3 or 4
• Not applicable to out-patients or A&E attenders
• Invoked by consultant in charge of case or
nominated deputy
• Immediately after assessment of patient
• Immediate consultant psychiatric involvement
• 72 hours maximum duration
 Nurse’s Holding Power
(Section 5(4))
• Informal in-patient already being treated for
mental disorder
• Doctor not immediately available
• Nurse qualified to nurse patients suffering
from mental illness or learning disabilities
• Maximum duration 6 hours
 Summary
• Compulsory admission should be achieved under
the guidance of local psychiatric services
• In A&E, Section 4 can be applied
• Sections 2 and 3 require approved medical
recommendations
• Police powers defined locally, ideally Section 12
approved doctors should be involved