What Do All The Sections Mean?!

It has only just occured to me to write a post like this, but now that it has, it seems one that was obviously needed months ago! … what do the different sections of the Mental Health Act 1983 mean, especially in relation to policing?

Incidentally, if you’re a cop with a SmartPhone why don’t you save this page on your homescreen – start a little folder with MH reference stuff like this and the Quick Guides?  I know some officers have done so and started using it at jobs and showing it to mental health professionals to influence outcomes! <<< Not the original intention of the blog, but if it helps …

Here is a very quick run down, necessarily a snap-shot, so I’m not going to explain all the ins and outs of every section listed – mental health law books are thousands of pages long!  You could argue about detail on this if you really wanted to but instead, I’d encourage you to read Mental Health Law Online, a website and goldmine of resources, if you want something more specific:

  • Part I
  • Section 1 – the definition of mental disorder: “‘mental disorder’ means any disorder or disability of the mind; and ‘mentally disordered’ shall be construed accordingly”.
  • Part II – this is the terminology you will hear AMHPs and MH professionals using:
  • Section 2 – the power to detain someone believed to be suffering mental disorder for assessment (and treatment).  The order lasts for up to 28 days and cannot be extended or renewed.  It is imposed after application by an AMHP and two DRs one of whom must be “section 12 approved”. <<< You see? … paradoxically, you need this guide just to understand it!?>!  The patient has a right of appeal against detention to a Mental Health Review Tribunal.
  • Section 3 – the power to detain someone for treatment of mental disorder.  This order lasts for six months and can be renewed.  It is imposed after application by an AMHP and two DRs one of whom must be “section 12 approved”.  Right of appeal against detention to a Mental Health Review Tribunal.
  • Section 4 – the emergency power to detain someone for assessment for up to 72hrs.  This is in effect a s2 detention, but is imposed where an AMHP and only one s12 Doctor believe it is needed and delay for a 2nd doctor is impracticable.  No right of appeal.
  • Section 5(2) – a ‘holding power’ for DRs to detain an inpatient in hospital for up to 72hrs for assessment under the Act.  Cannot be used in A&E because the patients there are not (yet) “inpatients”.  Can be used by non-psychiatric doctors on inpatients with psychiatric problems who are on ‘general’ medical wards in a non-psychiatric hospital.
  • Section 5(4) – a ‘holding power’ for a nurse of the prescribed class – usually a more senior psychiatric nurse – to detain someone for up to 6hrs: either for consideration by a DR of whether to use their 5(2) holding power; or to arrange an MHA assessment.  Again, this holding power can only be used on patients already admitted.
  • Section 6 – the AMHPs authority to detain and convey someone to hospital for admission under the Act.
  • Section 7 – this allows patients to be received into “Guardianship”, which obliges them to reside in a particular place, but still allows them a level of personal autonomy.
  • Section 12(2) – Various things in the MHA can only be done by or must include a “section 12 approved doctor”.  Such DRs are those “having special experience in the diagnosis or treatment of mental disorder.”
  • Section 13 – the AMHPs duty to undertake MHA assessments and make applications for admission.
  • Section 17 – the right of hospitals to grant leave as part of rehabilitation and recovery.  Such leave might be very brief when first granted – an hour or so – and it may be supervised by a staff member.  However, as patients near release it may be for a weekend, for several days or longer.  It is a very necessary part of rehabilitation and recovery for patients.
  • Section 17A – the right of hospitals to release a patient from detention subject to Supervised Community Treatment (SCT), otherwise known as a Community Treatment Order (CTO).  Excuse the comparison, (but this page is being mainly written for police officers!) – it is effectively like “bail conditions”.  If the conditions are not complied with, a person can be recalled and failure to return makes them ‘AWOL’ under the Act.
  • Section 18 – the power to (re-)detain AWOL patients and return them to hospital.  There is NO power of entry in order to do so.  Can only be exercised in a public place or where legal permission to enter a private building or dwelling has been obtained.
  • Section 19 – the authority of hospitals to transfer patients between different MH facilities.
  • Part III – these are sections relevant to decisions by criminal courts and prisons
  • Section 35 – power for a criminal court to remand an accused person to hospital for psychiatric reports. Lasts for twelve weeks but can be renewed for further twelve week periods.
  • Section 36 – power for a criminal court to remand an accused person to hospital for treatment pending trial. Also lasts for twelve weeks and can be renewed.
  • Section 37 – power for a Crown Court to impose a hospital order upon a person convicted of or found responsible for an offence.  This order can be imposed after a full conviction or following conviction for manslaughter on the grounds of diminished responsibility; it can also be used following a successful insanity defence or after a finding of unfitness to stand trial. The order lasts until such time as the Responsible Clinician believes it needs to be discharged but patients retain a right of appeal (under different rules) to a Mental Health Review Tribunal.
  • Section 38 – an interim hospital order: can be imposed on a convicted or responsible person to undertake assessment and treatment as to whether a full hospital order is the right outcome.
  • Section 41a restriction order, sometimes known as a ’37/41 order’.  The Crown Court can ‘restrict’ an order made under s37 which subsequently prevents the DR from taking decisions to released the patient, transfer the patient to a different (kind of) mental health hospital or to allowing them periods of s17 leave from hospital.  It obliges the DR to have such decisions authorised by the Ministry of Justice Mental Health Unit.  Such restriction orders can only be imposed if the original court was satisfied that the patient posed a “significant risk of harm to the public.”
  • Section 42 – anyone detained under a restricted hospital order is never just ‘released’.  They are always released under this section, in what is known as conditional restricted release.  Again, pleased excuse the comparison, but with my police audience in mind, it amounts to being released on licence, again with some potential restrictions or conditions.  If those restrictions or conditions are breached, the Secretary of State for Justice, through the MoJ Mental Health Unit, can issue a warrant for the return of that patient to a named hospital.  They then assume the status of a s37/41 restricted patient.
  • Section 47 – a “transfer direction” authorises the moving of a convicted prisoner to a hospital, if they develop a need for mental health treatment whilst serving their sentence.  By virtue of s47(3) MHA, such a patient is then treated in hospital ‘as if’ they had been sentenced to a s37 hospital order by a court.  This is sometimes referred to a ‘Notional s37’ and I have written a specific post about this.
  • Section 48 – same power as per s47, but for remand and other prisoners (such as immigration detainees) in contrast to s47 for convicted prisoners.
  • Section 49 – a “restricted transfer direction” imposes restrictions upon leave, discharge or transfer without Ministry of Justice permission, as per s41 MHA.  Sometimes, this is known as a ’47/49 order’, but it for our purposes the same as ’37/41 order’.
  • Section 50 – is a “remission direction” to remove a s47 MHA patient back to prison if their detention in hospital for mental health treatment is no longer required but their sentence of imprisonment is not yet up.
  • Parts IX and X – offences and police powers
  • Section 126 – criminal offence of forgery (with respect to MHA documents) or possession of forged items.
  • Section 127 – criminal offence of wilful neglect of an inpatient.
  • Section 128 – criminal offence of assisting a person to absent themselves without leave from hospital; or harbouring such patients after absenting themselves.
  • Section 129 – criminal offence of obstruction of an AMHP or refusing to withdraw from an AMHP.
  • Section 132 – the rights which must be explained to someone when detained in hospital, including where detained under s135(1) or s136 as a place of safety.
  • Section 135 – warrants under the Act for (1) assessments on private premises; and (2) recovering patients who are absent without leave.
  • Section 135(6) – legal definition of a place of safety.
  • Section 136 – police power to detain someone in immediate need of care or control and remove them to a place of safety.  Power to detain lasts for 72hrs.
  • Section 137 – authority to regard someone subject to an application for admission under the Act as being ‘in legal custody’.
  • Section 138 – power to do two things: a) recover someone who has absented themselves from detention under s135(1) or s136 and return them to a place of safety.  Power lasts for 72hrs after they went missing or after arrival at the place of safety; whichever is sooner; and b) power to take someone into custody who has absconded whilst liable to being detained under Part II of the MHA.
  • Section 139 – protection from legal liability for individuals who aim in good faith to do things in pursuance of objectives under the MHA. The law requires permission from the High Court or Director of Public Prosecutions to be obtained ahead of any proposed legal action, either civil or criminal.
  • Section 140 – a requirement upon Clinical Commissioning Groups and Local Health Boards to stipulate those hospitals in their areas which are able to receive patients ‘in circumstances of special urgency’ and those which are suitable for patients under the age of 18.

This run down is not perfect! – far from it.  I’m happy to tweak if you think it would add value.

Michael./


IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


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12 thoughts on “What Do All The Sections Mean?!

  1. Really useful-have emailed this to work , so I can share with student nurses. One of the best quick guides to the MHA I’ve seen.

  2. Thank you for that. As a GP who trained in Scotland (where the MHA is different) but now works in England I’ve learned a lot from that short blog.

    1. Thanks great to hear – the text shows I had cops in mind, but I’ve been really glad it appears to have helped various healthcare professionals – a bonus bi-product.

      I’ll gladly add your kind feedback to the pile. Many thanks!

      1. 17 June 2012
        Dear Mentalhealthcop,
        I fully endorse the plaudits given to you above – you are brilliant as a facilitator and educator.
        I was unaware that the Police could become involved regarding wilful neglect of an inpatient.
        Parts IX and X – offences and police powers
        Section 127 – criminal offence of wilful neglect of an inpatient.

        Have you any instances where this is known to have happened?

        Is this similar to the Mental Capacity Act 2005 Section 44?

        May I ask you to make a comparison between the two acts as the Office of the Public Guardian has informed me that a person under the Mental Health Act 2007 can ALSO be constrained by the Mental Capacity Act 2005 AT THE SAME TIME. But I had previously been informed that these are mutually exclusive acts, and I am totally CONFUSED! LOL!

        IF ANYONE CAN EXPLAIN IT, IT WILL BE YOU!

        Thank you so much,

        Rosemary

      2. Thanks Rosemary – much appreciated. I’ll put it on the ‘blogs to do’ list, but a quick answer about real examples and offences is Winterborne View in Bristol. Many of the professionals charged adn convicted there, were prosecuted under s127 MHA.

        It is similar to s44 and I’l explore that more in the blog, but it relates only to detained MHA patients. I am also aware of investigations in my own force area which were conducted into whether such offences were committed and a google search can identify more in other areas.

        Hope that helps?!

  3. Hi MH Cop. As an AMHP, who we are and what our role is (S13) could be usefully included. Also something about the existence of the Code of Practice, its important, its principles. However the more you add the less readable it becomes…

  4. Very informative and useful to my nursing studies. Will surely be passing it on to my friends. Thank you very much!

    1. Section 132 rights apply to a person who is detained in a hospital under the MHA – and this includes sections 135/6 as well as sections 2,3,4, and 5. Their rights under this section mean they are entitled to be told the specific section under which they are being held (and therefore, how long it can last) and what rights, if any, they have to apply to a Mental Health Tribunal. So if you are detained under ss2, 3 or 37 MHA, you have rights to go to a tribunal, but under ss4, 5 or 135/6, you don’t because they are short-term holding powers which will lead to a formal review by an AMHP of whether you are further detained.

    2. Section 132 rights apply to a person who is detained in a hospital under the MHA – and this includes sections 135/6 as well as sections 2,3,4, and 5. Their rights under this section mean they are entitled to be told the specific section under which they are being held (and therefore, how long it can last) and what rights, if any, they have to apply to a Mental Health Tribunal. So if you are detained under ss2, 3 or 37 MHA, you have rights to go to a tribunal, but under ss4, 5 or 135/6, you don’t because they are short-term holding powers which will lead to a formal review by an AMHP of whether you are further detained.

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