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22nd April 2009
Mental Health Act 1983
Practical Application
e-Learning
Introduction
The Mental Health Act (MHA) provides the authority to detain
and treat people with a mental disorder in hospital.
The ‘Act’ is arranged like a book and is divided into chapters
called parts. Each part contains numbered paragraphs called
sections. Altogether there are 149 sections.
MHA Powers
The Powers of the ‘Act’ are Considerable as They Override Two
Basic Rights.

Usually a person can only be detained if they have committed
an offence. Under this legislation however, a person is
detained not because of a crime but because they have a
mental disorder that needs hospital treatment.

The other basic right is that an adult with mental capacity to
consent can only be given treatment with their consent. Again
the Act overrides this and makes psychiatry unique in the
medical profession for authorising treatment that can override
the refusal of consent by an adult with capacity. (With a few
exclusions – e.g. ECT, Advance Directives).
Part II
Powers to Admit and Treat People in Hospital
Over 20 different sections provide the powers to detain a
person for assessment and/or treatment of a mental
disorder. Each section differs in relation to a number of
matters, including the maximum detention period allowed,
the professionals required, the appeal procedures and the
treatment regulations.
In this e-learning we will concentrate on the Hospital
Sections – Section 4, 5(4), 5(2), 2 and 3. We will also
outline Section 63/58, Section 17 and Section
132/133/23a.
Section 4
Admission for Assessment in Cases of Emergency
The Power to forcibly admit and detain a person in hospital for up to
72 hours. It may be applied when staff want to place a person under
Section 2 but are unable to get two doctors as required by Section 2
and the person needs urgent hospital admission.
- Detention – Power to admit someone forcibly from the community to
hospital and detain them for 72 hours.
- Treatment – Can only be given if the person has capacity and
consents. If they lack capacity, the Mental Capacity Act can be used
- Absconding – They can be forcibly returned to hospital by any
authorised member of the hospital staff or by the police
- Forms – A10, A11, H3 and 132 rights
Section 5(4)/5(2)
Sections 5(2) and 5(4) are short term emergency powers
that are designed to prevent a voluntary in-patient
discharging themselves. The duration of these section
allows time for the longer term powers of Section 2 or
Section 3 to be applied.
Section 5(4)
Nursing Power
The power for a nurse to detain a voluntary in patient for up to six hours.
The person has to indicate they wish to leave hospital and there has to
be an immediate need to prevent this where a doctor is not available to
complete a Section 5(2) instead.
- Detention – The power to detain for up to six hours.
- Treatment – The power to treat a person forcibly under the Act does not
apply to this section. Treatment can only be given if the person has
capacity to consent. If they lack capacity to consent, powers of the
Mental Capacity Act can be used. (Section 5 MCA)
- Absconding – If the person absconds they can be forcibly returned to
hospital by any authorised member of hospital staff or by the police.
- Forms – H2, H3 and 132 rights form.
Section 5(2)
The power for a doctor to detain a voluntary in-patient for up to 72
hours. It is designed to provide the time required to complete an
application for Section 2 or 3.
- Detention – The power to detain a person who is already in hospital for
up to 72 hours.
- Treatment – The power to treat a person forcibly under the act does not
apply to this section. Again Section 5 MCA can be used if the person
lacks the capacity to consent.
- Absconding – If the person absconds, they can be forcibly returned to
hospital by any authorised member of hospital staff or by the police.
- Forms – H1, H3 and 132 rights form
Note – Once assessment has taken place, the S5(2) ends.
Section 2/3



These sections can be used in a number of ways
To forcibly admit a person from the community into hospital
To prevent a voluntary in-patient leaving the hospital
To detain a patient for a longer period if they are already on a short term
section such as Section 4, 5(2), 135(1), or 136.
Legal Criteria
The person is suffering from a mental disorder and it is of a nature or
degree to warrant detention in hospital for assessment or assessment
followed by treatment for a least a limited period, and the person ought to be
detained in the interests of their own health or safety or with a view to
protection of others. (Section 3 only) – and appropriate medical treatment is
available for them.
(Nature – Refers to the particular mental disorder from which the patient is
suffering, its chronicity, prognosis and the patients previous response to
receiving treatment for the disorder)
(Degree- Refers to the current manifestation of the patients disorder)
Section 2
Admission for Assessment
The power to detain and treat a person in hospital for up to 28 days. It is used
for the assessment and treatment of people who have, or are believed to have a
mental disorder. There must be an intention to assess the person for this power
to be used.
- Detention – The power to detain a person for up to 28 days in hospital (Although
section 2 itself cannot be renewed, a person can be detained for a further period
of time by the completion of a section 3 before the section 2 expires)
- Treatment – The person can be given treatment for mental disorder with or without
their consent (Section 63, excluding ECT)
- Absconding – If the person absconds, they can be forcibly returned to hospital by
any authorised member of the hospital staff or by the police
- Leave of Absence - The RC may grant (Section 17) leave.
- Forms – H3, A2, A3, A4, 132 rights and Scrutiny.
Section 3
Admission for Treatment
This section gives the power to detain and treat a person in hospital for
up to six months. The power is renewable for further periods of time if
required.
- Detention – The power to detain a person for up to 6 months initially.
- Treatment – The person can be given treatment for mental disorder with
or without their consent (Section 63/58. excluding ECT)
- Absconding – If the person absconds they can be forcibly returned to
hospital by any authorised member of hospital staff or by the police.
- Leave of Absence – The RC may grant (Section 17) leave.
- Forms – H3, A6, A7, A8, 132 Rights and Scrutiny
This section has been used 324 times during the last year (2.2.092.2.10)
Section 17 (Leave of Absence)
A detained patient may not leave hospital unless granted leave under
Section 17 of the Act. Leave can be granted for a specific period of time
such as weekend, or for a specific occasion such as a family
celebration. Leave needs to be reviewed every seven days in order to
consider SCT as an alternative.




Rules
A RC may grant leave to patients on Section 2,3,37,47 or 48.
The leave may be granted with or without conditions, as considered
appropriate by the RC, in the interests of the patient or for the
protections of others.
The RC can require the patient to be escorted by another person during
their leave for the protections of the patient or others. In this case, the
patient can be escorted by a member of hospital staff or another person
as authorised in writing by the RC.
A RC may NOT grant leave to restricted patients without the approval of
the MoJ.
Forms – Section 17 (Blue)
Section 132 rights




Nursing staff should take all practical steps to ensure the
patient understands their legal rights and provide this
information both orally and in writing.
This is documented on a Section 132 Rights Monitoring
Form, even if the patient does not understand. Further
attempts to be made until the patient is responsive. (e.g.
Elderly patients without capacity.
All rights leaflets are held on inpatient wards.
The MHA administrators also produce written confirmation
sent directly to the patient and nearest relative (if the
patient does not object) regarding rights upon detention
under the MHA 1983.
Section 133/23a
Section 133 – Duty of managers of hospitals to inform
nearest relative of discharge from section.
Section 23a – This section provides for the absolute
discharge of detained patients. The discharge must be
ordered, it cannot be effected by implication.
In this section, the term “discharge” mean discharge from
detention, not from hospital.
Section 58-63
The power to give treatment with or without consent is
contained in Part 4 of the Act (Consent to Treatment).
Sections 56 to 64 within Part 4, details the powers
available to treat people under the Act and the rules and
limitations that apply to these powers.
Section 63 – Provides the power to give treatment to
detained patients with or without their consent in the first
three months starting with the first time they are given
medication.
Section 58 – Comes into force after medication has been
given for three months. This provides a form of protection
for patients still being treated
Section 58 (Continued…)
If the patient has capacity and consents to treatment, the
RC must complete a Form T2 stating that the patient has
understood the nature, purpose and like effects of the
treatment and consented to it.
If the patient refuses treatment or does not have
capacity to consent to it, a second opinion appointed
doctor (SOAD) must be called. They will consult a nurse
who has been involved with the patient, another
professional (not a nurse or doctor), the RC and the
patient. Following these consultations, the SOAD can
authorise the treatment if they consider it as appropriate
for the treatment to be given. Form T3
Withdrawing Consent (S58)
A patient may initially consent to treatment and a form T2
is signed. However, consent is a continuing process and
the patient may later refuse treatment. This would
invalidate the form and the treatment must stop. A SOAD
should then be called in order to authorise the treatment. If
needed, during the interim period, emergency treatment
may be considered under Section 62.
Form T2 would also become invalid if the person lost their
capacity to consent to treatment or if the treatment
prescribed was different to that originally written on the
form. The reverse would also be true. If a person lacked
capacity at the beginning of the treatment and then
regained capacity during treatment, their consent must be
sought.
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