The Mental Health Act (England and Wales)
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This was passed in 1983, and amended in 2007. . It is rather long and detailed. It allows for the compulsory admission of those who are mentally ill.  In practical circumstances, doctors and social workers will try to persuade patients to be admitted voluntarily, but in some circumstances, you may have to ‘section’ them to allow treatment against their will. The most important parts are 2,3,4,5 & 135 and 136.

Section 2

Section 2 aka an Assessment Orderallows a patient to be sectioned for up to 28 days. Must be signed by 2 doctors and an ASW. these professionals must agree that the patient is mentally unwell, and they require a full assessment in a psychiatric setting. The patient must have been examined by the two doctors within 5 days of eachother. The two doctors cannot be employed by the same organisation. One of the doctors has to have previously known the patient. It allows patients to be treated against their will, as they are seen to be mentally unstable.
  • Cannot be renewed
  • Commonly the doctors involved are the patient’s  GP, and a psychiatrist.
  • Type of mental disorder that the patient is thought to be suffering from does not have to be disclosed
  • Treatment can be given against the patient’s will – as this is considered part of the assessment process.
  • ASW – approved social worker

Section 3

Section 3 aka treatment orderssame as section 2, but for 6 months. The ASW must seek the consent of the nearest relative, and the patient cannot be detained if this relative objects.  Can be renewed for 6 months or even sometimes for a year
  • The doctor has to state the category of mental illness the patient is thought to be suffering from (e.g. mental illness, psychosis, mental impairment)
  • The majority of ‘sectionings’ are treatment orders
  • Treatment can be given – but after 3 months, either:
    • The patient has to consent to treatment
    • A third doctor has to review the patient and give their consent for treatment to be given
  • To be discharged from sections 2 & 3, the patient has to be discharged by one of:
    • The RMO (registered medical officer)
    • Hospital managers
    • The nearest relative can ask for discharge; however in practice it is unlikely that patients will be discharged before the sectioning is over.
  • Appeal – patient may appeal to mental health review tribunal
    • Section 2 appeal – must be made within 14 days
    • Section 3 appeal – must been made within 6 months

Section 4

Section 4 aka emergency orderadmission for emergency treatment. Lasts up to 72 hours. Must be signed by a doctor and ASW. Not commonly used. Can also be ‘converted’ to a section 2 when in hospital and approved by another doctor. cannot treat against the patient’s will with this order – just used for assessment – you get them in quickly; often used by GP

Section 5

Section 5 compulsory detention of patient who has come to hospital voluntarily (‘informal patient’). Patients who attempt to leave hospital are then detained under section 5.

Section 135

Section 135 – a police constable may enter the patient’s premises and remove a person to a ‘place of safety’ for up to 72 hours. Can use force if need be. Can only be used if a social worker has obtained a warrant. Cannot treat against the patient’s will.

Section 136

Section 136– same as above but for public place. Don’t need a warrant beforehand. Cannot treat. Basically done if the police believe the person is mentally unwell.

Important amendments in the 2007 Mental Health Act

  • Cannot detain unless specific suitable treatment is available
  • Integrates supervised community treatment
  • ECT cannot be given against the patient’s will. May still be given if the patient is unable to consent, provided there is no prior advance directive or intention not to have this treatment


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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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