Sectioning-does anyone know what the proceedure is to have a family member sectioned for their own safety?

Question

I've heard that there are three stages of sectioning.I need to know where to begin.He has been in this deep depression now for weeks,this is the worst it's ever been.Now he has told all of us not to phone not to visit,he is changing his telephone number and to leave him alone.
He says he contemplates suicide every day,and he has always said that if his life was no better by the time he was 30 then there was no point in being here.I've never seen him this bad,he won't accept there is any help out there for him,although he has agreed that he is a manic depressive.We've all been there for him over the last l5 years and supported him in every way we could and we tell him all the time how much he is loved.I have kept this thought to the back of my mind hoping that he would pull through once again,but this time things are different,he is different,and I truly feel that if I don't do something drastic,he will kill himself and I will live with the thought that I didn't try hard enough.help.

Answer 1

Being sectioned in the UK (from www.thesite.org)

Being sectioned means you are detained, under the Mental Health Act, for hospital treatment.

The law, in a nutshell

The Mental Health Act 1983, is divided into 10 parts - each one covering a specific area. It is a complex piece of legislation, and some critics argue that reform is needed, especially for the rules outlining the compulsory admission to hospital and treatment of the patient without their consent.

Under what circumstances could I be detained for hospital treatment?

Initially, an approved social worker, or your nearest relative, can make an application to have you detained for assessment, based on two medical recommendations (i.e. your doctor). The grounds for the application are set out under different sections of the Mental Health Act 1983.

Section Two is most often called upon to secure a hospital assessment. To qualify, it must be agreed that you're suffering from a mental disorder to a degree that warrants medical care and attention. Under Section Two, you can be detained for up to 28 days.

If a longer stay is deemed necessary for treatment, (initially for six months) an application under Section Three of the Mental Health Act 1983 will be required. Under this section, the mental disorder that you're suffering from must be specified, as well as any treatment proposed. Section Four covers emergency cases, and enables one doctor to order you to 'rest' in hospital for 72 hours.

Can they force medication on me?

Yes, under Sections Two, Three and Four, you may have to accept any medical advice or treatment that your doctor deems necessary. If they're talking about electro convulsive therapy (ECT) and you're unhappy with that, your doctor must first ask another GP from outside the hospital to assess you. If the second doctor says you should have the treatment you are legally obliged to do so.

How do I get out?

You are free to leave once your doctor is satisfied that you have made a recovery, or if the section order comes to an end. If you feel ready to face the world before that time, you can be discharged in several ways. Either you or your nearest relative can apply to the hospital managers, or your case may be referred to a Mental Health Tribunal. It should be pointed out that many patients remain in hospital voluntarily after a section order has come to an end, in order to complete any recommended treatment.

Do I have any rights?

Yes, although they vary by section. Under the terms of the Mental Health Act, you are legally entitled to a leaflet outlining your rights according to the section you've been detained under. A range of leaflets are available, each one detailing the care you can expect to receive under the terms of the section order, plus contacts if you have any questions or wish to appeal at any time. Other leaflets are available that explain issues such as Guardianship, supervised discharge and hospital orders with restrictions (if you're serving a prison sentence at the time, for example.)

Key to abbreviations

ASW: Approved Social Worker
DoH: Department of Health
MHRT: Mental Health Review Tribunal (an independent body that decides whether a formal patient should be discharghed)
RMO: Responsible Medical Officer (the doctor in charge of a formal patient's treatment)



The vast majority of the people receiving treatment in a mental hospital or psychiatric unit are informal patients, which means they are in hospital on a voluntary basis and have exactly the same rights as a person being treated for a physical illness.

Formal patients, who constitute about 15 per cent of the mental hospital population, are compulsorily detained under a section of the Mental Health Act 1983 and lose some of the rights enjoyed by informal patients.

This guide gives an outline guide to the main provisions of the Mental Health Act 1983 as they affect formal patients and their relatives. Numbers of the relevant section or part of the 1983 Act are indicated in brackets.



Definitions (Section 1)
Mental disorder is defined as ‘mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind’.
Four categories of mental disorder are specified as follows:

Mental illness: not defined.

Severe mental impairment: ‘a state of arrested or incomplete development of mind, which includes severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned’.

Mental impairment: defined in the same way as severe mental impairment except that the phrase ‘severe impairment’ is replaced by ‘significant impairment’.

Psychopathic disorder: ‘a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) that results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned’.

Note: some forms of mental disorder fall outside the scope of these four categories; for example, a state of arrested or incomplete development of mind, which includes severe or significant impairment of intelligence and social functioning, but is not associated with abnormally aggressive or seriously irresponsible conduct.

Some sections of the Act apply to people suffering from mental disorder, while others apply only to people suffering from one of the four specified categories of mental disorder.

The term ‘nearest relative’ is defined in section 26.



Compulsory admission to hospital or guardianship for patients not involved in criminal proceedings (part II)

Admission for assessment (Section 2)

Duration of detention: 28 days maximum.

Application for admission: by an ASW or the patient’s nearest relative.
The applicant must have seen the patient within the previous 14 days.

Procedure: two doctors must confirm that
(a) the patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment (or assessment followed by medical treatment) for at least a limited period; and
(b) she or he ought to be detained in the interests of her or his own health or safety, or with a view to the protection of others.

Discharge: by any of the following

RMO

hospital managers

the nearest relative, who must give 72 hours notice. The RMO can prevent her or him discharging a patient by making a report to the hospital managers

MHRT. The patient can apply to a tribunal within the first 14 days of detention.



Admission for assessment in cases of emergency (section 4)

Duration of detention: 72 hours maximum.

Application for admission: by an ASW or the nearest relative. The applicant must have seen the patient within the previous 24 hours.

Procedure: one doctor must confirm that
(a) it is of ‘urgent necessity’ for the patient to be admitted and detained under section 2; and
(b) waiting for a second doctor to confirm the need for an admission under section 2 would cause ‘undesirable delay’.

Note: the patient must be admitted within 24 hours of the medical examination or application, whichever is the earlier, or the application under section 4 is null and void.



Admission for treatment (Section 3)

Duration of detention: up to six months, renewable for a further six months, then for one year at a time.

Application for admission: by nearest relative, or ASW in cases where the nearest relative does not object, or is displaced by County Court, or it is not ‘reasonably practicable’ to consult her or him.

Procedure: two doctors must confirm that
(a) the patient is suffering from one of the four specified categories of mental disorder (see Definitions above) of a nature or degree that makes it appropriate for her or him to receive medical treatment in hospital; and
(b) if the patient is suffering from a psychopathic disorder or mental impairment, such treatment is likely to ‘alleviate or prevent a deterioration’ of her or his condition; and
(c) it is necessary for her or his own health or safety, or for the protection of others that she or he receives such treatment and it cannot be provided unless she or he is detained under this section.

Renewal: under section 20, the RMO can renew a section 3 detention if the original criteria still apply and treatment is likely to ‘alleviate or prevent a deterioration’ of the patient’s condition. In cases where the patient is suffering from mental illness or severe mental impairment, but treatment is not likely to alleviate or prevent a deterioration of her or his condition, detention may still be renewed, if she or he is unlikely to be able to care for her or himself, to obtain the care she or he needs or to guard her or himself against serious exploitation.

Discharge: by any of the following

RMO

hospital managers

the nearest relative, who must give 72 hours notice. If the RMO prevents the nearest relative discharging the patient, by making a report to the hospital managers, the nearest relative can apply to a MHRT within 28 days

MHRT. A patient can apply to a tribunal once during the first six months of his detention, once during the second six months and then once during each period of one year.

If the patient does not apply in the first six months of detention, her or his case will be referred, automatically, to the MHRT. After that, the case is automatically referred when a period of three years has passed since a tribunal last considered it (one year, if the patient is under 16).



Compulsory detention of informal patients already in hospital (Section 5)

A doctor in charge of an informal patient’s treatment, or one other doctor designated by her or him, can detain a patient for up to 72 hours by reporting to hospital managers that an application for compulsory admission ‘ought to be made’.

A nurse of the prescribed class (a nurse trained to work with mental illness or learning disabilities) can detain an informal patient who is receiving treatment for mental disorder for up to six hours, or until a doctor with authority to detain her or him arrives, whichever is earlier.




Guardianship (Sections 7-10)

Duration of guardianship order: up to six months, renewable for a further six months, then for one year at a time.

Application for reception into guardianship: by an ASW or nearest relative.

Procedure: two doctors must confirm that
(a) the patient is suffering from one of the four specified categories of mental disorder (see p. 3) of a nature or degree that warrants reception into guardianship; and
(b) it is necessary in the interests of the patient’s welfare or for the protection of others.

Note: the patient must be over 16. The guardian must be a local social services authority, or person approved by the social services authority, for the area in which she or he (the guardian) lives.

Effect: under section 8, a guardian has the following powers

to require a patient to live at a place specified by the guardian

to require a patient to attend places specified by the guardian for occupation, training or medical treatment (although the guardian cannot force the patient to undergo treatment)

to ensure that a doctor, social worker or other person specified by the guardian can see the patient at home.

Discharge: by any of the following

RMO

local social services authority

nearest relative

MHRT. The patient can apply to a tribunal once during the first six months of guardianship, once during the second six months and then once during each period of one year.



Mentally disordered persons found in public places (Section 136)

Duration of detention: 72 hours maximum.

Procedure: if it appears to a police officer that a person in a public place is 'suffering from mental disorder’ and is ‘in immediate need of care or control’, she or he can take that person to a ‘place of safety’, which is usually a hospital, but can be a police station. Section 136 lasts for a maximum of 72 hours, so that the person can be examined by a doctor and interviewed by an ASW and ‘any necessary arrangements’ made for her or his treatment or care.



Warrent to search for and remove patients (Section 135)

Duration of detention: 72 hours maximum.

Procedure: if there is reasonable cause to suspect that a person is suffering from mental disorder and
(a) is being ill-treated or neglected or not kept under proper control; or
(b) is unable to care for her or himself and lives alone
a magistrate can issue a warrant authorising a police officer (with a doctor and ASW) to enter any premises where the person is believed to be and remove her or him to a place of safety.



Patients involved in criminal proceedings (part III)
Hospital order (Section 37)

Duration of order: up to six months, renewable for a further six months, then for one year at a time.

Procedure: a hospital order can be made by the Crown Court, or Magistrates’ Court in the case of an offender convicted of an offence that it could punish with a prison sentence (such offences include manslaughter but not murder).

The Magistrates’ Court can make a hospital order without recording a conviction, if an offender is suffering from mental illness or severe mental impairment, and magistrates are satisfied that she or he committed the act as charged.

The court can make a hospital order on evidence from two doctors that
(a) the offender is suffering from one of the four specified categories of mental disorder (see Definitions above) of a nature or degree that makes detention for medical treatment appropriate; and
(b) if the patient is suffering from a psychopathic disorder or mental impairment, such treatment is likely to ‘alleviate or prevent a deterioration’ of her or his condition; and
(c) taking into account all the relevant circumstances, including the past history and character of the offender and alternative methods of dealing with her or him, a hospital order is the most suitable option.

Discharge: by any of the following

RMO

hospital managers

MHRT. The patient can apply to a tribunal once in the period between six and 12 months after a hospital order is made, and then once during each period of one year. A patient’s case is automatically referred to a tribunal when a period of three years has passed since a tribunal last considered it (one year if the patient is under 16).



Restriction order (Section 41)

Duration of order: may be specified by the court or without limit of time.

Procedure: the Crown Court that has made a hospital order under section 37 can also impose a restriction order if
(a) this is necessary to protect the public from ‘serious harm’ and
(b) at least one of the doctors who made recommendations for the hospital order gave her or his evidence orally.

A Magistrates’ Court cannot make a restriction order, but can commit an offender to a Crown Court so that a section 41 order can be imposed.

Patients on restriction orders are usually known as restricted patients.

Discharge: by either

the Home Secretary or

MHRT. A patient can apply to a tribunal once in the period between six and 12 months after a restriction order is made, and then once during each period of one year. The patient’s case is automatically referred to a tribunal when a period of three years has passed since a tribunal last considered it (one year, if the patient is under 16).



Transfer to hospital from prison (Section 47)

Duration of detention: up to six months, renewable for a further six months, then for one year at a time. If the Home Secretary imposes a restriction direction (section 49), it continues in force until the earliest date on which the patient would have been released from prison with remission.

Procedure: the Home Secretary orders the transfer, if satisfied by evidence from two doctors that
(a) an offender has one of the four specified categories of mental disorder, of a nature or degree that makes detention for medical treatment appropriate; and
(b) if the patient has a psychopathic disorder or mental impairment, such treatment is likely to ‘alleviate or prevent a deterioration’ of this condition.

Discharge: if no restriction direction has been imposed, the patient can be discharged by any of the following

RMO

hospital managers

MHRT. The patient can apply to a tribunal once during the first six months of transfer, once during the second six months, and then once during each period of one year. The Home Secretary must refer her or his case to a tribunal if the MHRT has not considered it in the previous three years (one year if the patient is under 16).

Until the end of her or his prison sentence (allowing for remission), a patient under a restriction direction can only be discharged by the Home Secretary. She or he can apply to a tribunal once during the first six months of transfer, once during the second six months and then once during each period of one year, but an MHRT can only recommend to the Home Secretary that the patient be discharged. She or he may order a return to prison instead. At the end of the prison sentence (allowing for remission), the restriction direction ceases to have effect and the above provisions apply.



Remand to hospital for medical report (Section 35)

Duration of remand: up to 28 days, renewable for further periods of 28 days to a maximum of 12 weeks in total.

Procedure: the Crown Court or Magistrates’ Court remands the accused person to hospital on evidence from one doctor that
(a) there is ‘reason to suspect’ that she or he is suffering from one of the four specified categories of mental disorder (see Definitions above); and
(b) it would be ‘impracticable’ for a report on her or his mental condition to be made if she or he were remanded on bail.



Remand to hospital for treatment (Section 36)

Duration of order: 12 weeks, renewable for 28 days at a time, to a maximum of six months in total.

Procedure: the Crown Court or Magistrates’ Court makes an interim hospital order on evidence from two doctors that
(a) a convicted offender is suffering from one of the four specified categories of mental disorder (see Definitions above); and
(b) there is reason to suppose that it is appropriate for the order to be made.

Note: a hospital order or prison sentence may subsequently be imposed on an offender who has been subject to an interim hospital order.



Interim hospital order (Section 38)

Duration of order: 12 weeks, renewable for 28 days at a time, to a maximum of six months in total.

Procedure: the Crown Court or Magistrates’ Court makes an interim hospital order on evidence from two doctors that
(a) a convicted offender is suffering from one of the four specified categories of mental disorder (see Definitions above); and
(b) there is reason to suppose that it is appropriate for the order to be made.

Note: a hospital order or prison sentence may subsequently be imposed on an offender who has been subject to an interim hospital order.



Hospital and limitation direction (Section 45a)

Duration of direction: the same as for a transfer direction under section 47, together with a restriction direction under section 49. The offender may be transferred to prison at any time during her or his sentence, by warrant of the Home Secretary, on the recommendation of her or his RMO or MHRT.

Procedure: if the Crown Court, having considered making a hospital order (section 37), instead imposes a fixed-term sentence of imprisonment, it may direct the immediate admission of the offender to hospital, if it is satisfied by evidence from two doctors that
(a) she or he suffers from a psychopathic disorder of a nature or degree that makes medical treatment appropriate; and
(b) such treatment is 'likely to alleviate or prevent a deterioration of his condition'.

Discharge: before the end of the prison sentence, the offender can only be discharged by the Home Secretary, on recommendation of the RMO or MHRT. She or he may order a return to prison instead.

At the end of the prison sentence (allowing for remission), the limitation direction ceases to have effect, and the offender is treated as if she or he were on a hospital order (section 37).



Consent to treatment (Part IV)

Part IV of the Mental Health Act applies to

treatments for mental disorder

all formal patients except those who are detained under sections 4, 5, 35, 135 and 136, subject to guardianship or conditionally discharged. These patients have the right to refuse treatment, as have informal patients, except in emergencies.

Part IV states that
(a) any treatment can be given without the patient’s consent, unless the Mental Health Act or DoH regulations specify otherwise
(b) under section 57, psychosurgery and treatments specified in DoH regulations as giving rise to special concern can only be given if
(i) the patient consents; and
(ii) a multidisciplinary panel appointed by the Mental Health Act Commission confirms that her or his consent is valid; and
(iii) the doctor on the multidisciplinary panel certifies that the treatment should be given. Before doing so, she or he must consult two people, one a nurse and the other neither a nurse nor a doctor, who have been concerned with the patient’s treatment.

Note: as the treatments specified in section 57 give rise to particular concern, this section applies to all formal and informal patients.

(c) under section 58, certain treatments can only be given if
(i) the patient consents; or
(ii) an independent doctor appointed by the Mental Health Act Commission confirms that treatment should be given. Before doing so, she or he must consult two people, one a nurse and the other neither a nurse nor a doctor, who have been concerned with the patient’s treatment.

Section 58 applies to treatments named in DoH regulations (including electroconvulsive therapy). Medication can be given without the patient’s consent for three months. After that, it is subject to the safeguards laid down in section 58.

Note: under section 62, any treatment for mental disorder can be given without consent in specific emergencies, subject to restrictions when a treatment is irreversible or hazardous.



Mental Health Act Commission

A special health authority authorised to keep under review all aspects of the care of formal patients. It can investigate complaints, appoint panels to give a second opinion on consent to treatment, and draw up codes of practice for mental health workers. It comprises approximately 170 part-time commissioners, mainly lawyers and mental health professionals, but also some service users.



Approved social workers

Approved social workers (qualified social workers who have proved their knowledge of mental health and the law) can apply to have people formally detained in hospital under a section of the Mental Health Act 1983. An ASW can make an application for admission where necessary and proper. Before doing so, the ASW must interview the patient and satisfy her or himself that detention in hospital is, in all the circumstances, the most appropriate way of providing the care and medical treatment the patient needs.



Voting

Informal patients have the right to vote, if they enter on the electoral register their last non-hospital address, or an address where they would be if not in hospital. Most formal patients can vote, if they are registered, either at the hospital or at a recent home address. However, those who have been sent to hospital by a criminal court, or transferred from prison, cannot vote.



Information

Under section 132, the hospital managers (usually the non-executive directors of the NHS Trusts) have a legal duty to give a formal patient information on:

the section she or he is detained under
her or his right to apply to a MHRT
her or his right to be discharged by the RMO, hospital managers and, if applicable, her or his nearest relative
consent to treatment rules
correspondence rules
the Mental Health Act Commission, including its responsibility to protect formal patients, and its codes of practice.
Managers must also tell the nearest relative when the patient is due to be discharged, unless the nearest relative or patient has instructed that this information should not be disclosed.



After-care

Under section 117, Health Authorities and local social services have a legal duty to provide after-care for patients who have been on sections 3, 37, 47 or 48, but who have left hospital. There is no power to charge for section 117 aftercare.

Answer 2

Your first point of contact should be with the GP. Although the Gp cannot disscuss confidential information, he/ she will be able to point you in the right direction, or set the ball rolling through his/ her own contacts. It may just be your relative needs some antidepressant to lift his mood to a level where he can start to help himself.

As for sectioning somebody. If it came to a point where he nedded to be sectioned, he will most likely be detained under section 2 of the Mental Health Act 1983. This is for admission for assessment and treatment if neccessary. An application by the nearest relative (known as form 1) can be submitted if the relative has seen the patient within the last 14 days. This can only be signed once a recommendation by two medical officers/ doctors has taken place. One doctor must be approved to reccomend sectioning and the second doctor must have had previous aquaintaces with the patient, eg the GP.

The procedure for getting the ball rolling to get someone sectioned is different in different trusts. As i said your best option would be to see the GP. Even better would be your relative to go and see the GP himself. Your relative is feeling massive helplessness and hopelessness. He says if things do not get better he will attempt suicide. It could be an option to sit and talk to him about his feelings. Explain to him that things will not improve unless he tries to help himself. From the extent of the depression you have described, it is obvious that he does need help. This does not always mean he must be sectioned. Your relative may willingly go in to hosptial/ take medication/ accept help from outside agencies, and carry on from there.

You sound like you have been very supportive of your relative over the years, and have tried very hard to help him see ways out of his darkness. In many cases of depression the person can only see the world through their own distorted way of thinking. If he does do something dratic before help is put in place, you cannot blame your self. You have done as much as you can. Talk to people at Mind or Saneline (i'm sorry i don't have the numbers for you), who will be able to support you and give you advice of what to do. I know you want help for your relative, but you need support as well. Hope this all helps and its not just a load of babble.

Answer 3

I'm so sorry to hear of his troubles, you said he's been suffering on and off for 15 years, hopefully his dr is aware of this and will be able to help with a referral to an asw or Approved Social Worker, it really is the only thing you as a family member can do.
Sectioning is possible but only if the patient can be proved to be a danger to themself or others, also the police are unable to help section a person against their will if the patient is conscious and in his own home.
I'm sure you know this but the only person who can start him on the road to recovery is himself and you can't keep all that guilt for yourself, maybe you could help by giving him something else to think about, take him to see a film and discuss it afterwards or just borrow a dog and ask him to help you walk it.
Some psychiatric patients feel a lot of guilt from all the "heavy talking" they put their families through and i'm sure he knows deep down you love him, try treating him as if the depression isn't there and brush off any negativities, changing the subject if he starts to get sad.
Most of all encourage him to get the help HE wants, and all the luck in the world to both of you x

Answer 4

You may need to shout very loudly. Speak to social services, insist on having a social worker appointed. They are not just there for vulnerable children. Contact your local MIND gorup, as they should be able to give you some good advice. If you know which GP he has, see if they have a health visitor attatched. They wont be able to tell you much, but should listen to your concerns and then investigate.

Remember that as much as you care for him, if he really wants to let go of the world, NO ONE will be able to stop him. Try and take comfort from the fact that you are one of the few who are willing to try and without your support he would not have coped this long.

Good luck.

Answer 5

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Answer 6

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Answer 7

The Doctor is the quickest way. If they believe they are a danger to themselves they can section them straight away. Units generally won't accept people without a GP referal or unless they've been admitted to hospital for trying to hurt themselves or others.

Answer 8

my husband has been sectioned twice the first step is to get the gp to offer the relative to book there self in hospital if the relative refuses and the relative is a danger to themselves and others. you need to demand that they get this person help this usually takes a docter {it used to be two docters} and a social worker the gp gets the social worker invovled . demand help if this person is threatning suicide they need emergency help. do it now before its too late.

Answer 9

Talk to your Gp, unfortunately the police will need to be involved also, but your gp should be able to help you get the ball rolling.
I hope it all works out ok for you.

Answer 10

you need two professional opinions to have someone sectioned. So for example a doctor and a social worker or the police etc?

They must be deemed a risk to themselves or other.

contact your doctor to start

Answer 11

depression (whatever) theres no such thing , its just an easy way for a person to say i f-in give up!if you guys baby the person the more into hiding they go,personally in my family depression was dealt with by an *** kicking, you even pull that depressed crap and you would literally get your *** beatdown, then they asked you still depressed lol, anyways i think its a copout and a politicaly correct way to say hey look at me i'm a loser , i'm lazy , and i am into self -pity except me cause i'm depressed, hell no get some cohones(big balls) for men or women,and take control of your life , except the hand thats been dealt and try to correct it,being depressed is admitting to yourself your a loser!