I ‘section’ people under the MHA

[Narwhalelife]

I am an Approved Mental Health Professional (AMHP). It is only AMHP’s that can section people.
Little is known about us and our role but lots of people know what ‘sectioned’ means - Ask me anything 😊

[stillvicarinatutu]

It's not just sad .

If he does knife one of his housemates it will be police held to account first - which pisses me right off .

[Hawkins001]

From history and not sure in the present day, but are straight jackets, padded cells, and electro shock therapy still used today ?

[antelopevalley]

The restrictive definitions of relative are a national disgrace. I dealt with a social worker and crisis team nurse when my boyfriend I was living with had some psychosis. We had lived together for two years, he was estranged from his abusive middle-class well-spoken family. They insisted on consulting his family for their opinion. He hadn't spoken to his family for quite a few years. I meanwhile was not allowed to be present at the assessment. I was the one living with him who could tell them what had actually been happening.
Still makes me angry all these years later.

[Briar250]

This seems a very top down post 'section people' and no regard for the poor person who needs to be sectioned.

Its really hard for someone to be detained under the MHA, and I personally would rather see something written like 'the rationale for someone to be detained under the MHA', as opposed to 'I section people'. Even though I understand where you're coming from.

Please be a bit more sensitive in future. Sectioned people are vulnerable people.

So many people in psychiatric hospitals have enough people dictating to them, some even traumatised by the sectioning process, though not all. Best see it from the eyes of the client and 'their' best interest. Its called empathy.

I appreciate you are trying to potentially educate and raise awareness, which is good, just please be mindful.

Thanks!

[LemonSwan]

Mental thread 🤣

And before anyone gets PC - I have been sectioned once and retain the right to a sense of humour.

This is a bit of an odd question and I am not really sure how to phrase it so will just explain my story for context:

When I was ill I had mild psychosis - not an overt seeing or hearing things etc. Just strange thoughts where my family knew I wasn’t quite right IYSWIM. I had gone down a weird thought track - wasn’t a harm to myself or others. Just thought certain music videos were talking about a specific subject - sending political messages through creative imagery and lyrics. It never really bothered me in a negative way, if anything I found it quite exciting hence discussing it with family and I didn’t think they were messages talking to me specifically or anything like that. Basically I think I got a bit obsessed and a bit too in depth but still to this day I can see why I thought that. I don’t really care whether it’s true or not because it doesn’t really matter and who knows except the creatives who wrote and directed these songs/videos. I just look back on it as a ‘well maybe it was, maybe it wasn’t’ - but at the time I was dead certain it was.

Anyway - Obviously this was a lot to explain to people so I didn’t really bother explaining it to the professionals as I knew they wouldn’t understand, and I didn’t think I was unwell. Quite a reserved psychotic - it literally was all in my head. I only got sectioned because I freaked out that my family were trying to section me and ran around town shouting people were trying to section me 🤣 Ironic I know.

Anyway when in section I didn’t obviously have any marked improvement. Because there wasn’t really much to improve upon with regard that when medicated and well I also didn’t bother trying to explain about these messages and I again didn’t think I was unwell.

It dawned on me after 2 weeks that I was going to be stuck in there indefinitely until I showed an improvement and so decided to pretend to be really psychotic and made up stories about how I saw space ships flying through the sky and other rubbish for a week to then be able to make some kind of marked ‘recovery’ to normal to then be let out. In the end that worked.

So my question - if one of the symptoms of is denying your ill then how do you really sift the wheat from the chaff. And how do you deal with patients manipulating the system like I did or those too reserved/naive/honest that they get stuck there (ie. there were some homeless just pretending to be unwell for bed and board, a couple of mothers pretending to be ill for respite from their difficult lives, someone who wanted a temporary holiday from prison (obviously all these people needed to recharge or they wouldn’t have tried to get themselves sectioned but they weren’t acutely unwell with mental illness in my eyes and they certainly didn’t think so either and were quite open about why they were there and what they were doing) and then on the flip side a poor older lady accused of having dementia who absolutely did not have dementia - I still worry occasionally about what happened to her to this day.)

Sorry long post/question!

[Spidey66]

@stillvicarinatutu

And
Police can only detain on a s136 if the person is presenting an immediate danger to themselves or others . And only in a public place . Which ties our hands somewhat . And yet when I persuade someone to go with ambulance to a&e invariably they are kept waiting hours then sent home with absolutely nothing more in place . It's like Groundhog Day .
Of the ones I have s136 hardly anyone has been taken into hospital. I once detained a lady who thought she was Eve - as in the first woman created by god . She was out within 72 hours .
I have , after 12 years being a police officer very very little faith in MH services.
Today got a call for assistance with a s135 for a guy with a diagnosis wielding a knife at his housemates, carving racist slurs into the wall of the communal lounge . No beds . They've postponed the warrant because there are no beds .
Sorry but .....it's exasperating .

Completely maddening. But we've also had issues getting police to execute a 135!

I'm a CPN. Earlier this year, I was tasked with carrying out an assessment. I knew she wouldn't come to us, so arranged a home visit with a housing support worker.

To cut a long story short, and to avoid outing her, she was a huge risk to herself and others, and her housing was Dickensian (I swear the landlord was Peter Rachman).

She refused to come to hospital informally, the police ( who I had to call to kick her door in) couldn't detain her under a 136, Crisis team felt not appropriate, so I requested a MHA assessment.

As a 135 had to be organised, and police presence requested, it was a week before that could happen. She was then assessed as being liable to be detained under s2. Except......no beds. She then had to be reassessed when there was a bed. .

All in all, my original assessment, recommending a MHA assessment was in February. She was admitted in April and HTT weren't going in. I screamed and shouting and stamped my foot as to why an emergency admission took 2 months. All the right noises were made but things won't change.

[Narwhalelife]

@Hawkins001

From history and not sure in the present day, but are straight jackets, padded cells, and electro shock therapy still used today ?

No straight jackets anymore but in very few cases there is specialist clothing people can wear to protect their dignity and keep them safe but it doesn’t restrict movement.

psychiatric intensive care units usually have a a seclusion room that has softer walls, but they are not padded so to speak.

yes electric shock therapy is still used.

[Narwhalelife]

@JimmyGrimble

Thank you for what you do. My boy became unwell at the age of 22 whilst at university at the other end of the country and ended up dropping out. We brought him home and his behaviour over the next year became increasingly bizarre. I tried everything to try and get him engaged with services but nobody would see him. After a traumatic day when he attacked his Dad we were forced to call the police, he was locked up in cells and the next thing we heard he was in hospital. He ended up on an s2 and later an s3 with severe psychosis and was hospitalised fir 6 months. He came back to us aged 24 on depo and suffering side effects. He is now off the depo and adamant he will never go on it again. He has used drugs (rarely but still) and tells us that he will be going to several festivals this summer. We know that a relapse will likely entail a schizophrenia diagnosis. How common is relapse though? We’ve spoken to his team but they just fob us off. My suspicion is that it’s very common and particularly in drug complicated cases? I just don’t know how we’ll ever get him to accept treatment again. He’s still under home treatment team.

Sorry to hear about your son’s situation. If he has come off the depot himself and there isn’t any other oral medication in place then this would increase the risk of relapse, and sadly any form of drug or alcohol use can also increase the risk.

It is not inevitable though, some people have episodes of psychosis that can be treated and recovered and that’s it. I would be making clear to the team looking after him so far as you can about your concerns and if you feel necessary mention hospital admission.

[Narwhalelife]

Very odd for it to have been taken this far in my experience if no one had tried to contact you and speak to you first or popped round without police to see if they could see you.

But if people are concerned for your welfare and they cannot contact you, some professionals will ask the police to do a ‘welfare check’ to see if you are ok. but these checks should not be used as a way to get in to your home to assess you under the mental health act.

AMHP’s can obtain a warrant to enter your home with police but the threshold for this is very high and unlikely to have been granted without a lot of evidence to say you are mentally unwell and at risk inside your home.

[Narwhalelife]

@antelopevalley

The restrictive definitions of relative are a national disgrace. I dealt with a social worker and crisis team nurse when my boyfriend I was living with had some psychosis. We had lived together for two years, he was estranged from his abusive middle-class well-spoken family. They insisted on consulting his family for their opinion. He hadn't spoken to his family for quite a few years. I meanwhile was not allowed to be present at the assessment. I was the one living with him who could tell them what had actually been happening.
Still makes me angry all these years later.

agreed with this to a point, we often encounter people who have no contact with their nearest relative and it’s sad but the law is the law.

A person would be deemed the nearest relative if they have been living with another person as though they are husband and wife for a minimum of 6 months, so in your case I can’t see how they would not have concluded you to be the nearest relative.

with regards to estranged family we should have good reason to consult with anyone - I don’t know the details of this case obviously but I think if you were to complain or at least contact your local AMHP service you would get a better explanation of what they were thinking and why.

[Narwhalelife]

@Briar250

This seems a very top down post 'section people' and no regard for the poor person who needs to be sectioned.

Its really hard for someone to be detained under the MHA, and I personally would rather see something written like 'the rationale for someone to be detained under the MHA', as opposed to 'I section people'. Even though I understand where you're coming from.

Please be a bit more sensitive in future. Sectioned people are vulnerable people.

So many people in psychiatric hospitals have enough people dictating to them, some even traumatised by the sectioning process, though not all. Best see it from the eyes of the client and 'their' best interest. Its called empathy.

I appreciate you are trying to potentially educate and raise awareness, which is good, just please be mindful.

Thanks!

Sorry it has come across like his - I think I mention in a PP the difficulties with language and the reason I put ‘section’ in air quotes.

it’s very hard to do a one size fits all rationale as it’s so so different for everyone but there is of course a legal structure to all detentions under the mental health act

I absolutely agree with what you say about the affects of being assessed and in my team we conduct research into the effects it has on people and strive constantly to ensure that the process is better than it has been but we are working with very old legislation without adequate resources.

It is always a decision to protect the person from more harm or harm coming to others. And although the nature the mental health act means it is always against a persons wishes, we do have a duty to consider their wishes at every stage and I like to think that as AMHP’s we do this although obviously cannot speak for every practitioner.

[Louisa4987]

This thread is quite bizarre, and as a police officer it reads terribly. There are things you've written which are factually incorrect and to be honest some of your comments just read like police bashing with no real evidence to back it up.

It's a bit weird that you're so desperate to tell everyone "I section people" and then tell everyone else they're wrong when they try and tell you that actually it's not just AMHP's that can detain people under the MHA.

[Narwhalelife]

@LemonSwan

Mental thread 🤣

And before anyone gets PC - I have been sectioned once and retain the right to a sense of humour.

This is a bit of an odd question and I am not really sure how to phrase it so will just explain my story for context:

When I was ill I had mild psychosis - not an overt seeing or hearing things etc. Just strange thoughts where my family knew I wasn’t quite right IYSWIM. I had gone down a weird thought track - wasn’t a harm to myself or others. Just thought certain music videos were talking about a specific subject - sending political messages through creative imagery and lyrics. It never really bothered me in a negative way, if anything I found it quite exciting hence discussing it with family and I didn’t think they were messages talking to me specifically or anything like that. Basically I think I got a bit obsessed and a bit too in depth but still to this day I can see why I thought that. I don’t really care whether it’s true or not because it doesn’t really matter and who knows except the creatives who wrote and directed these songs/videos. I just look back on it as a ‘well maybe it was, maybe it wasn’t’ - but at the time I was dead certain it was.

Anyway - Obviously this was a lot to explain to people so I didn’t really bother explaining it to the professionals as I knew they wouldn’t understand, and I didn’t think I was unwell. Quite a reserved psychotic - it literally was all in my head. I only got sectioned because I freaked out that my family were trying to section me and ran around town shouting people were trying to section me 🤣 Ironic I know.

Anyway when in section I didn’t obviously have any marked improvement. Because there wasn’t really much to improve upon with regard that when medicated and well I also didn’t bother trying to explain about these messages and I again didn’t think I was unwell.

It dawned on me after 2 weeks that I was going to be stuck in there indefinitely until I showed an improvement and so decided to pretend to be really psychotic and made up stories about how I saw space ships flying through the sky and other rubbish for a week to then be able to make some kind of marked ‘recovery’ to normal to then be let out. In the end that worked.

So my question - if one of the symptoms of is denying your ill then how do you really sift the wheat from the chaff. And how do you deal with patients manipulating the system like I did or those too reserved/naive/honest that they get stuck there (ie. there were some homeless just pretending to be unwell for bed and board, a couple of mothers pretending to be ill for respite from their difficult lives, someone who wanted a temporary holiday from prison (obviously all these people needed to recharge or they wouldn’t have tried to get themselves sectioned but they weren’t acutely unwell with mental illness in my eyes and they certainly didn’t think so either and were quite open about why they were there and what they were doing) and then on the flip side a poor older lady accused of having dementia who absolutely did not have dementia - I still worry occasionally about what happened to her to this day.)

Sorry long post/question!

I suppose in short we don’t always get it right. An AMHP has to be satisfied so far as possible it’s the right thing to do but once in hospital it’s down to the nurses and doctors to assess recovery and essentially how long a person stays there.

i will say that the law gives us scope to ‘catch people before they fall’ so to speak so we can detain people on the nature of their illness alone, meaning that it’s highly likely given the type of illness without intervention now things will just get worse. This protects peoples safety and dignity as no one wants a very poorly person left if we know we can stop it in its tracks.

but it is a tough call sometimes and I have certainly considered detention and gone back a few days later and the whole situation has changed (think UTI in older people).

There is an interesting study competed in the 60’s where a psychiatrist sends his junior doctors to a mental health hospital to pretend to be mentally unwell, some got in and stayed a while, some didn’t and some got in and could never convince them it was a study! And I imagine starting to say ‘actually I’m a doctor and this is all fake’ set alarm bells ringing on a mental health ward!

there are industry secrets which I won’t go in to detail here (as they are secrets! Lol) as to how we gauge whether a person is truly ok and whether they are just masking a situation - including tone of voice, the way the question is asked and responded to, history etc.

[Narwhalelife]

@Louisa4987

This thread is quite bizarre, and as a police officer it reads terribly. There are things you've written which are factually incorrect and to be honest some of your comments just read like police bashing with no real evidence to back it up.

It's a bit weird that you're so desperate to tell everyone "I section people" and then tell everyone else they're wrong when they try and tell you that actually it's not just AMHP's that can detain people under the MHA.

I haven't bashed the police at all - please highlight where this is and il explain or correct if necessary.

one word was pointed out which I later corrected and it was a slip up replying on my phone and people the comments were coming fast and I see police - I correct it later to say I meant detain instead of arrest.

please highlight the inaccuracies (other than the one minor one I corrected earlier?)

I do understand the tensions between mental health and police - but that isn’t what this thread is about. It was about questions about my role which people, including police, usually don’t know the intricacies of.

police can only detain to allow a full mental health act assessment to take place, it is not the same as detaining someone to hospital for treatment which is what my role is. Also would call the midwives, train drivers, solicitors etc ‘desperate’ for there AMA posts?

[clpsmum]

What an interesting thread. Thank you for the work you do
Op x

[sunja]

So psychiatrists cannot section people? I thought that psychiatrists did?

[Narwhalelife]

@clpsmum

What an interesting thread. Thank you for the work you do
Op x

Thank you! ☺️

[Narwhalelife]

@sunja

So psychiatrists cannot section people? I thought that psychiatrists did?

No psychiatrists can only recommend someone is detained under the mental health act.

like police - in hospitals they do have short holding powers to allow for a person to be assessed for detention but they cannot complete this - Only an AMHP can ☺️

[Newgirls]

Very interesting thank you OP

[Crazyhousewife]

@Narwhalelife

@Crazyhousewife absolutely not.

I actually know of this happening to someone. A social worker signed the section 136 and she was sectioned. So what happens in this instance as she was actually made to stay despite several patients bullying her for having nothing wrong with her. The children services wanted to place the child with foster care but the mother didn’t agree and asked why the child couldn’t be placed with family. The child was undiagnosed with behavioural problems which is why they were trying to remove them. However when she checked the paperwork with the police about who signed the section 136 they quoted the child’s social worker. What would happen legally in this case.

[Spidey66]

A s136 is a police section. If they see someone in a public place acting bizarrely and have reason to believe they have a mental health problem they can take them to a 'Place of Safety' (ie a MHU) under s136 to be assessed further. The 136 lasts up to 72 hours. An AMHP can 'sign them off' ie the patient can then either go home or stay informally, or else they can recommend further detention, usually a S2 (for assessment) or a S3 (for treatment). An 'ordinary' SW can not detain ANYONE under the MHA, they have to be an AMHP. An AMHP cannot detain anyone under a S136.

[antelopevalley]

@Narwhalelife

agreed with this to a point, we often encounter people who have no contact with their nearest relative and it’s sad but the law is the law.

A person would be deemed the nearest relative if they have been living with another person as though they are husband and wife for a minimum of 6 months, so in your case I can’t see how they would not have concluded you to be the nearest relative.

with regards to estranged family we should have good reason to consult with anyone - I don’t know the details of this case obviously but I think if you were to complain or at least contact your local AMHP service you would get a better explanation of what they were thinking and why.

I was the one who said his family were abusive to them. They just said we would be heavily criticised if we did not speak to the family. They did ask if I had proof of abuse i.e. hospital admissions or SS involvement. I said no as it was more complex than that. And at that point he was no longer interested.
The social worker did speak to me at the beginning, but refused to allow me in the assessment and said he had to meet with my boyfriend alone. But there was no way he could answer questions.
It was many years ago, and I am now married to someone different. But I have never forgotten how awful the assessment process was. I was the one who called the GP. The fallout from the social worker's contact with his family was awful. He made me promise never to contact medics again.
When he had another period of psychosis I managed him at home myself and we did not tell anyone.
The social worker made his life much worse. It was a fucking disgrace.

[Narwhalelife]

@Spidey66

A s136 is a police section. If they see someone in a public place acting bizarrely and have reason to believe they have a mental health problem they can take them to a 'Place of Safety' (ie a MHU) under s136 to be assessed further. The 136 lasts up to 72 hours. An AMHP can 'sign them off' ie the patient can then either go home or stay informally, or else they can recommend further detention, usually a S2 (for assessment) or a S3 (for treatment). An 'ordinary' SW can not detain ANYONE under the MHA, they have to be an AMHP. An AMHP cannot detain anyone under a S136.

S.136 is 24 hours now. Can be extended by a doctor to allow for medical treatment.

the policing and crime act amended this to pull it in line with custody detention time scales.