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Compulsory Admission to Psychiatric Hospital

A Guide for Patients and Relatives

If you or a relative needs to be admitted to hospital under the Mental Health Act 1983, this information explains what this means. It has been designed to give you a clear picture of your rights as well as your responsibilities under the Act. If you have any questions about your detention, or that of a relative, please contact an approved social worker at your nearest local office.

Why compulsory admission?

We all experience mental or emotional distress from time to time. Often we cope with this alone, or with the help of our families and friends. But sometimes specialised medical or other professional help may be needed.

Occasionally, mental or emotional distress may lead to personal breakdown needing psychiatric help. Usually people are helped as out-patients or day-patients. But sometimes it is better for the person to be admitted to a psychiatric hospital.

Very occasionally, people lose touch with what is happening to them, perhaps putting themselves or others at risk of harm. If this happens and the person refuses to go into hospital voluntarily, then the nearest relative, doctors and the approved social worker have the legal power and the duty to take action so that the person receives appropriate care and treatment. This is done to safeguard both the distressed person and the people around them.

The powers to admit someone to hospital without their consent are laid out in sections 2, 3, 4 and 136 of the Mental Health Act 1983.

Section 2 (Admission for assessment)

Under section 2, people can be admitted to hospital for up to 28 days for assessment (which may also include treatment). For this to happen, a specially approved doctor, usually a consultant psychiatrist, and another doctor (ideally the patient’s GP) must complete a ‘medical recommendation for admission assessment’ form.

An ‘application for admission for assessment’ must be signed by either an approved social worker or the patient’s nearest relative (a definition of nearest relative can be found at the end of this leaflet).

Where the approved social worker intends to sign the application form, the nearest relative must be consulted, but his or her decision is not binding. If a nearest relative cannot be contacted at the time of admission, he or she must be informed as soon as possible afterwards.

The nearest relative will also be told about:

his or her powers to discharge the patient.
the patient’s right of appeal to a Mental Health Review Tribunal

and to the hospital’s Mental Health Act Manager.

Section 3 (Admission for treatment)

Under section 3, patients can be detained in hospital for treatment for up to six months. In practice the patient is often discharged earlier but if necessary, the ‘section’ can be renewed for another six months in the first instance, and then annually.

For this to happen, two doctors (one a specialist and the other ideally the patient’s GP) must complete a ‘medical recommendation for admission for treatment’ form. The application form must also be signed by an approved social worker or the nearest relative.

Under section 3 there are a number of legal safeguards to protect

the rights of patients and their relatives:

If the ‘application for admission for treatment’ is to be made by an approved social worker, then the patient’s nearest relative must be consulted, unless this would cause unreasonable delay (e.g. where a nearest relative is on holiday) or where it is not possible (e.g. where a nearest relative is frail).
If the nearest relative is asked to sign the application, but does not wish to do so, he or she may ask the approved social worker to sign. If the nearest relative objects to a section 3 admission, the approved social worker cannot go ahead at this stage.
If the approved social worker and doctors wish to continue with a section 3, despite the nearest relative’s objections, they

must seek a court order under section 29 of the Act. The court will need to be satisfied that there are good reasons to make the

order, for instance if the nearest relative is mentally disordered or their objections are unreasonable and could endanger the patient or members of the public.
When a section 3 is completed, the nearest relative will be told about their powers to discharge the patient and their right of appeal to a Mental Health Review Tribunal and to the hospital’s Mental Health Act Manager.

Section 4 (Emergency admission)

This form of admission is rarely used. It is only used when patients are so disturbed that they need immediate admission to a hospital for assessment and there is no time to arrange for a second opinion.

For this to happen a doctor must sign a ‘medical recommendation for admission for assessment’ form and an approved social worker or the patient’s nearest relative must also sign an ‘emergency application for admission for assessment’ form. Under section 4, the patient can be detained in a hospital for up to 72 hours. As soon as possible after admission a second doctor’s opinion should be sought. This second opinion must be given within 72 hours (it may recommend that the patient is detained under section 2). Failure to seek a second opinion within 72 hours means the patient becomes an informal patient and they can either discharge themselves or stay as a voluntary patient.

Patients admitted under section 4 have no right of appeal to a Mental Health Review Tribunal and the nearest relative has no power to discharge them from hospital.

Section 136 (Removal to a place of safety)

Under this section, a police officer may take a person from a public area to a ‘place of safety’ if it is believed he or she needs care or control. The person is usually taken to a police station or a hospital. The police officer must arrange for the person to be seen by a doctor and an approved social worker within 72 hours.

Mental Health Review Tribunals

People who are admitted to hospital under section 2 or section 3 can appeal to the Mental Health Review Tribunal. Patients under section 3 will have their cases automatically referred to a Tribunal if the ‘section’ is renewed after six months.

If a section 3 is further renewed and the patient’s case has not been before a Tribunal for three years or more (or one year or more if the patient is under 16) then the hospital managers must refer the case to a Tribunal.

Tribunals are made up of a doctor, a lawyer and a lay person who is prominent in the local community. Hospital staff must tell patients about their right to appeal, and must give advice on how to appeal. The hospital cannot stop a patient from appealing to a Tribunal. Patients and their nearest relatives are advised to consult a solicitor when they make an application to a Tribunal. Some local solicitors are members of the Law Society’s Mental Health Panel and are therefore recognised as having particular experience in this area.

A list of these solicitors is available from approved social workers. Information about legal aid is available from Citizen’s Advice Bureaux, most solicitors’ offices and law centres.

Help and advice may also be available from local mental health groups such as the National Association of Mental Health (MIND), or National Schizophrenia Fellowship (NSF), both of which have local branches in Bath and Bristol.

If you are a relative who is concerned about a patient’s admission to hospital , you should contact the hospital doctor or the approved social worker involved in the case. If you are still not satisfied, you should seek legal advice.

Appeals to Mental Health Act Managers

Patients subject to section 2 and 3 can also appeal to the hospital’s Mental Health Act Managers. The process is similar to an appeal to a Mental Health Review Tribunal.

The staff of the hospital must inform patients of their right of appeal and advise them how to exercise that right. The hospital cannot stop a patient from appealing to Mental Health Act Managers.

Definition of ‘nearest relative’

Under the Mental Health Act the term ‘nearest relative’ has a precise legal meaning. There are certain situations where it may refer to a person other than the next-of-kin.

The nearest relative is usually the person ‘first described’ in the following list, with the eldest in each category taking precedence:

1. husband or wife

2. son or daughter

3. father or mother

4. brother or sister

5. grandparent

6. grandchild

7. uncle or aunt

8. nephew or niece.

Sometimes people who are not relatives may be consulted as if they were the nearest relative (where the patient has lived with a person for at least five years). Couples who have lived together for more than six months count as husband and wife for the purposes of the Mental Health Act.

The following may not be treated as the ‘nearest relative’:

a) Any relative (apart from husband or wife) under the age of 18.

b) A husband or wife who is permanently separated from the

patient.

c) Any relative who is not normally resident in the UK, the Channel

Islands or the Isle of Man.

Local psychiatric hospitals

HILL VIEW LODGE

Royal United Hospital

Combe Park

Bath BA1 3NG

Tel: 01225 428331

ST MARTINS HOSPITAL

Midford Road

Bath BA2 5RP

Tel: 01225 832383

We promise:

at all times to treat you with respect and to be honest and open.
to make sure you receive clear and accurate information about

our services.
to provide information in a different format or language if you

request it.
to involve you in decisions about the services you receive.
to take your comments or complaints seriously and do our best

to resolve problems quickly and fairly.
to consult you regularly so that you can tell us what you think

about our services and how we can improve them.

This information can be made available in a range of languages, large print, Braille, on tape, electronic and accessible formats. Contact the Information Officer on 01225 477983, Minicom 01225 477043 or email information_officer@bathnes.gov.uk