Saturday, 10 August 2013

What You Need to Know If You’re Sectioned


So, you’ve been detained under the Mental Health Act 1983, and you’re in hospital. It’s most likely you’ve been detained under either Section 2 or Section 3.

Section 2

A Sec.2 lasts for up to 28 days. The purpose of detention under Sec.2 is to assess you to decide if you have a mental disorder.
 
There are two grounds for a Sec.2:
“(a) he is suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and
(b) he ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons.”

Two doctors will have assessed you and will have decided that, in their opinion, you have a mental disorder. An Approved Mental Health Professional will have “interviewed you in a suitable manner” and would have had to satisfy themselves that detention in a hospital “is in all the circumstances of the case the most appropriate way of providing the care and medical treatment of which the patient stands in need”.

The primary purpose of detention under Sec.2 is to assess you to see if you do, in fact, have a mental disorder or not. Although the detention is for assessment, you can be given treatment as well.

Section 3

A Sec.3 lasts for up to 6 months, although it is fairly unusual for someone to be detained as long as this. The purpose of detaining under Sec.3 is in order to give you the treatment it is thought you need for a mental disorder.

There are three grounds for a Sec.3:
“(a) he is suffering from mental disorder of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital; and
(b) it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and it cannot be provided unless he is detained under this section; and
(c) appropriate medical treatment is available for him.”

Again, you will have been assessed by an Approved Mental Health Professional and two doctors.

The sort of treatment you will receive is primarily at the discretion of the hospital psychiatrist. However, Electro Convulsive Therapy (ECT) cannot be given to a detained patient unless they consent and are deemed to have the capacity to consent. See this post for more details about ECT.

A Sec.2 cannot be extended beyond 28 days. However, a Sec.3 can be extended for another 6 months. It can be extended beyond that, in which case the renewal would then last for 1 year.

“Mental disorder”

Both sections depend on establishing whether or not you have a mental disorder. The definition of “mental disorder” in the Act is very wide, being “any disorder or disability of the mind”.

The Code of Practice does however suggest a range of conditions which could be considered to be mental disorders. These include the following, although this is not an exhaustive list:

  • affective disorders, such as depression and bipolar disorder
  • schizophrenia and delusional disorders
  • neurotic, stress-related and somatoform disorders, such as anxiety, phobic disorders, obsessive compulsive disorders, post-traumatic stress disorder and hypochondriacal disorders
  • organic mental disorders such as dementia and delirium
  • personality and behavioural changes caused by brain injury or damage
  • personality disorders
  • mental and behavioural disorders caused by psychoactive substance use
  • eating disorders, non-organic sleep disorders and non-organic sexual disorders
  • autistic spectrum disorders (including Asperger’s syndrome)
  • behavioural and emotional disorders of children and adolescents     
As a rule, you cannot be detained under the Mental Health Act purely on the grounds that you have a learning disability, unless it is associated with “abnormally aggressive or seriously irresponsible conduct”.

Dependence of alcohol or drugs is not in itself considered to be a mental disorder.

What you can do

Everyone detained under Sec.2 and Sec.3 has the right to appeal.

If you’re appealing against a Sec.2, you will have to do this within the first 14 days of your detention. An independent Tribunal will then hear your appeal within a week.

If you’re appealing against a Sec.3, you can appeal at any time during the 6 months of the detention, and after that during any renewal.

An appeal against a Sec.3 can be considered by a panel of hospital managers. These are not staff of the hospital, but lay people who have an interest in mental health issues and who also have the time to devote to these duties. They would hear your appeal within a couple of weeks. If they do not discharge you from the section, then a Tribunal would hear your appeal within a month or two.

A Tribunal consists of a panel of three – the judge, who is a lawyer, the medical member, who is a psychiatrist, and specialist lay member, who is generally a lay person with a particular interest and experience in working with people with mental health problems, such as an AMHP, a nurse, or someone with extensive experience in the voluntary sector. Tribunals are part of the Judiciary, and are in effect a court of law, although they are much more informal than a normal court hearing.

For both a Managers’ Hearing and a Tribunal you are entitled to have a legal representative to present your case. These are solicitors with particular training and knowledge of mental disorder. You will not have to pay for this representative. Alternatively, you can appoint any other person to represent you, apart from people who are themselves detained under the MHA or who are inpatients in the hospital.

You will be allowed to attend the hearing, and will also be allowed to take part and have your say. The other people present at these hearings will be your representative, your Consultant Psychiatrist or one of his junior doctors, a hospital nurse involved with your care, and someone from the community mental health team, who could be a social worker, a community mental health nurse or an occupational therapist. Your nearest relative can also attend if you want them to. There will also be a clerk.

Both a Managers Hearing and a Tribunal Hearing will have access to three reports: a medical report compiled by the patient’s psychiatrist, a nursing report, and a social circumstances report written by someone from the community team.

Both Tribunals and Managers have to be satisfied that you are “suffering from mental disorder of a nature or degree which makes it appropriate for the patient to be liable to be detained in hospital” for either assessment or treatment. For a Sec.2 they also have to be satisfied that the patient’s detention “is justified in the interests of the patient’s own health or safety or with a view to the protection of others”, while for a Sec.3 they also have to be convinced that “it is necessary for the health or safety of the patient or for the protection of others that the patient should receive such treatment”. For Sec.3 they also have to be satisfied that the appropriate medical treatment is available.

In order to satisfy themselves of these factors, they will use the reports supplied, but will also hear verbal evidence presented by those present. This gives a chance for you and your representative to cross examine the other people present and to give your side. They can then decide one of three things: not to discharge you, to discharge you with immediate effect, or to direct that you be discharged at a future date.

It’s worth appealing, because often a psychiatrist will decide to discharge you from your section before the appeal is heard, and even if they don’t, about 15% of people who appeal are discharged by the Tribunal.

12 comments:

  1. The stress of appealing at Tribunal is so great that it constitutes as major trauma. It is a court however you disguise it. And a court where your rights are significantly less than in criminal proceedings.

    I was take off a S2 an hour before the Tribunal. The hospital team had already objected to sharing some reports with me and my solicitor so unlike in a criminal trial I would not have known what the objections were. In my case it looks like they felt the paperwork wasn't in order and therefore detention may have been invalid. At least that's what the Judge told my solicitor.

    It was the first time I was hospitalised and the only time I had ever asked to be admitted.Despite this I was sectioned.. The outcome for me is that I made the decision NEVER to ask for help again and NEVER to appeal if sectioned. The actions and the system are deeply inhumane and more damaging than any voices or thoughts that I can stop trains, get energised by the 3rd rail or that I have to die.

    So, like ever other person that has been sectioned, I have a plan on what to do if this ever happens again. In my case a kit that will kill me in a ward situation so that I do not ever have to experience that level of cruelty again.Put together on the day I was discharged. Because the process meant I will never trust MH workers again

    So please dont tell us about 'rights'. Rights that cannot be enforced or only enforced by experiencing significant trauma are worthless.

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    1. This made me cry. I am so sorry that you had to go through this.

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    2. I agree.
      Im on section 3.
      Every door has a hatch so even if you even if the doors shut. They check on you via the hatch and it makes me feel like im in jail!
      I hate it....

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  2. I think people they want to lock up should think about escaping every single time. You are treated like a dog in most units and it os not treatment or assessment when the nurses sit in an office all day and dont come out yet get a say in whether you can even go out for 30 minutes. My solicitor says just play the game as this is what it is but a very sick game. So play the game and get out escorted and make sure you have secreted away a PAYG alternative phone and have some cash and jump on the bus/taxi/train and watch what the escort does lol! Then if on a S2 stay away until the section ends and the police cant take you back. This is a much easier way of getting out rather than face a Tribunal where staff who NEVER talk to you get a say and a Psych who sees you for 5 mins once a week and relys on the nurses reports get to decide if you ever get out. They dont have enough beds to get you back again after the section has expired.EVERYONE i know has an escape plan and back up but cant always manage it but the staff on the ward wont jump on the bus with you and most are too fat and unfit to run after you if you can run and even 1 day of freedom us better than nothing. I will never forgive those who lock people up and leave them there and think the tribunal system works. Better off kill yourself for some poeople and hope the next life will be better.

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  3. I was on section 2 ,was kept in there till the day it ran out. I was continually threatened with section 3 if I tried to " escape " . I was sectioned by the police and then subsequently by my psychiatrist, took them all of ten minutes to decide,wanted to appeal and was talked out of it with lies and manipulation of ward staff . I managed to jump the fence twice and got dragged back ( literally ) by the fuzz.
    so expect to be ignored, treated like crap,lied to, threatened.and spoken to like you have one brain cell. and that's just the staff!!

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  4. the whole system is based on threatening the weakeset members of society because it is easy for those employed on wards to get away with it. so many of those employed to work on wards have serious issues themselves and so abuse their power. most dont give a damn and most rarely leave the office they sit in. knock for help they shout through the door. get distressed and they have absolutely no communucation skills to support or de-escalate. even the useless cqc has heavily criticised lack of basic skills.

    i am so tired of trying to go the extra mile to explain myself to those who just want to intimidate and frighten. a system based on threat and violence and they know so little about the outside world. .

    i am so so tired of having to justify my existance to these people. better not to exist than to risk hospital ever again.. judge jury and executioners in my case. they were the trigger

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    Replies
    1. �� totally agree

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    2. I completely agree, they just don't listen, they don't allow you have an opinion in any area of your care, nurses writing notes about nothing, some of them I didn't even see throughout the day and they wrote reports on me, making them up, I attend an outpatient clinic and I wouldn't ring them for help if it was the last place on earth, to me they were judgemental and uncaring, I was feeling suicidal as a result of being sectioned and was told to just get over it or go to court! I can't see how thats in anyway helpful to assist in suicidal feelings, I thought it was just cruel and nasty, the system is very backwards and the patients have no input or say, I know for a fact if I ever felt depressed or suicidal again I'd stay away from the mental health system in ireland, their cruelty and judgement is enough to push you to suicide.At one point during the whole ordeal I prayed to god to let me die and have peace. The doctors and nurses are only interested in their paypackets at the end of the week. Not the welfare of the human beings under their care.

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  5. Mental health teams should also check that family members who are carers are not lying about that person. For e.g steals the person who they are looking afters property. Then use falsely use the mental health act and accuse their charge of self harm to justify theft. I even heard of someone who was hit by their carer who argued it was legal Because she had a mental health problem.

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  6. I meant cover up in my comment above

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  7. I would sooner die than let these scumbags take me, as such I have several plans for escape and evading the services. The mental health services are giving me grief after I was referred regardless of my refusal to be referred, and I've told them several times to leave me alone... I guess only time will tell whether they do go away, or whether I get 'sectioned' under this heavily loophole-ridden legislation. If I do get detained and there's no other way out, I wouldn't think twice about killing myself

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  8. I have been sent in with a infection by gp which has been ongoing for 6 months and because i got upset i am being detained made to stay on ward in side room so on my own all day which would make some one depressed

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