Sectioned

This is one of those posts I’ve done before but I’m now writing again in a different way because the situation just keeps on happening.  In the last weeks and months I’ve heard police officers say countless times that someone had become ‘sectioned’ when they absolutely had not!  This would rarely be a grave matter, except where this misunderstanding is then the basis for what are sometimes protracted, illegal detentions in custody —

  • When some enters custody and detention is authorised, they remain in custody subject to the timescales and caveats of their original grounds for detention until any Mental Health Act application is made.
  • Someone becomes ‘sectioned’ (informal language, not a legal term) when an application is made to the hospital for their admission under whichever section of the Act is relevant, usually s2, 3 but it could less occasionally be s4.
  • Strictly speaking, the person is not even ‘sectioned’ at that point – they are actually just ‘liable to be detained’ and they become ‘sectioned’ when they’re are accepted as an inpatient on arrival at that hospital.
  • So if the were originally arrested for a crime, you have 24hrs to hold them, then you must charge the person or release them, unless an Appeoved Mental Health Professional’s application gives you new grounds on which to hold someone.
  • If the person was originally detained in custody as a Place of Safety, you have 72hrs in which to make any necessary arrangements for that person’s treatment of care.  After that, they must be released unless new grounds are provided by which to detain someone.

So what happens if you reach the 24hr or 72hr time limits and there is no application for admission?  Well, strictly speaking, you must restore the detainee’s liberty and a failure to do so gets you directly into Article 5 ECHR territory – detained quite arbitrarily in a process not prescribed by law.  Of course, even within legal timescales for detention, there could be other ECHR issues – as we saw in the Article 3 case, MS v UK (2012).

AN INVIDIOUS DECISION

So do you release a vulnerable person who is, by definition an obvious risk to themselves or others, or do you keep them detained pending the eventual making of an application?  Well, the situation should not come about in the first place.  So there are two things to say —

1. What should have happened?

Clinical Commissioning Groups are responsible for ensuring adequate health provision for their areas and this includes commissioning sufficient inpatient beds for admissions to occur in a timely way.  NHS England is responsible for commissioning more specialist beds like CAMHS and adult forensic services.  Their duties to do so extend to having civil contingencies around the management of these important resources and section 140 makes it clear that CCGs have a legal duty to specifiy hospitals that are in a position, from time to time, to receive patients in circumstances of special urgency and those designated to receive children. (Interesting that s140 doesn’t mention NHS England’s commissioning responsibilities.)

So old advice use to be: if you need to make an application and can’t immediately find a bed, go to the list provided under s140 and take it from there.  Unfortunately for us all, I found out when I made about three dozen Freedom of Information applications for CCG s140 lists that they had all failed in their duty to comply with this requirement.  Section 140 was totally unmentioned by the MHA Code of Practice (2008) and by the accompanying Reference Guide but has now started to emerge, in the new Code (2015) and in CQC MHA reports.

2. How do we manage this when it happens?

Firstly, flag up the potential for this situation to duty inspectors, the AMHP and the first-assessing DR as soon as it looks likely to occur. Point out the legal constraints to your ability to lawfully detain.  Flag it up again when it actually occurs and ask for an application to be made or the invidious decision must be taken.  Remind the AMHP and DR about the s13 criteria that determine that applications ‘shall’ be made and the duty of CCGs under s140.  Document all of this.

You then have to decide! – in circumstances not of your making, you become responsible but you need to know at this point about section 139 MHA.  This section basically protects people from legal liability for any actions they’ve done “in pursuance of an objective under the Act” as long as they’ve done it in good faith and with reasonable care.  So if you start relentlessly challenging and escalating to senior police officers and health managers, you will have some wriggle room.  Document all of this!

In one case back in 2004, Greater Manchester Police took their challenge on this issue to court, seeking a Judicial Review in the High Court of alleged failures by the AMHP / DR and wider NHS.  Oddly enough, the found a bed quite quickly when legal action was about to start.  Police officers have a positive duty to ensure the European Convention rights of those in their custody and we are very used, professionally speaking, to handling situations in which people break laws. Don’t let yourself be fooled into viewing this situation as anything else, it’s just that these laws are enforced in a different way, if they do need enforcing.  Document all of this!!

FINALLY!

Then! – record this as a Health & Safety ‘near miss’ and ask that it be referred to whichever oversight group reviews the joint police / mental health trust protocols and ask that CCG commissioners be invited to that review.

But remember this: no-one is ‘sectioned’ or liable to be detained until that AMHP makes that application to a hospital and any detention up to the point where that is done has to be justifiable under PACE or s136 and subject to the ECHR.

Hold The Line! 


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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6 thoughts on “Sectioned

  1. 28 February 2015
    Dear Mentalhealthcop,
    I am very interested to know what is the position then when a person is transferred from one hospital to another and there is no formal Section documentation at that point. Is the person free to leave? If the person has been assessed by 2 Section 12 doctors who have said yes the person should be able to go into hospital under section 2, and the AMHP has not at that point made their recommendation, what is the legal position? It seems a bit haphazard to me? If the application is made electronically to the hospital is that the time when the “sectioning” then occurs?
    Thank you very much for your elucidation.
    Best wishes
    Rosemary

  2. Me thinks you are being a bit harsh on the AMHP here & as you know the doctor will be long gone, with medical claim form fee tucked in pocket! AMHPs are general good, but lack the ability to walk on water or change water into wine or force the NHS to produce a bed when one is needed.

    As you know the MHA states that the doctor should identify the bed, if it is required. However as you also know they don’t do this anymore & the issue of the bed has be delegated to Bed Managers – btw there is no mention of Bed Managers anywhere in the MHA or CoP or Reference Guide!

    I get the bit about Sec 140, but if it place doesn’t exist the AMHP can’t make it up & the place (bed, Hospital) has to be willing to accept. I think I recall on another post where someone explainins why Sec 140 might not be the secrect weapon we would all like. Unless there is somewhere the AMHP cannot make an application.

    It would be nearly impossible to co-ordinate the conveying of a person liable to detention to a non existing place that was not willing to accept the person. Can you image the response from the ambo! You could try it, & I have, with a person that was compliant & willing to go along with the plan, but really it is not practical at all. Can you imagine the AMHP, person & the ambo & maybe the police knocking on the door of said hospital. It would be even more difficult with a person who was resistant.

    Btw in the days before bed managers I have done this & simply rocked up & forced the matter on the ward. But I knew there was a bed there. With bed managers & 120% bed occupancy it is almost impossible to do. I once also suggested that I would take the person to the nice new MH Trust HQ. But I could not convince others (police, nurses, medics, ambo, hospital security etc) that my plan was a good one. The person/patient was willing btw😀

    The other option that you don’t mention & it’s not one I like to see used, but again I have. If the person has been arrested for an offence & the 24 hrs is up & they are unwilling to hang around & let’s remember some people are willing to wait, others are not. Release them & then use Sec 136 to keep them or others safe. It’s far from ideal & might very well be open to legal challenge & again simply letting the NHS of the hook. Indeed there is nothing in law that prevents the reuse of Sec 136, but again what a rubbish idea😞 I have seen advise from a very well known Prof on this matter that would place you in a pickle & mean that the police would be using Sec 136 more often!

    So yes ask the AMHP, certainly ask the doctor (it’s their job btw) but they won’t be there! But also ring up the MH trust & ask them, the on call director or the on call CCG manager. Me confident that the AMHP will hang around to help you. Even if the AMHP is 15 hour into their working day.

  3. I get the point & am probably being overly defensive about the AMHP role in all this. But then someone has to be 😄 enjoy your weekend😄

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