Page 5 | I ‘section’ people under the MHA

Narwhalelife · 2022-07-13T21:26:13+00:00

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 😊

Original poster

Narwhalelife · 14/07/2022 10:07

Narwhalelife · 14/07/2022 10:06

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.

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Should add, can be extended once for 12 hours only.

OP posts:

Ontheboard · 14/07/2022 10:07

Narwhalelife · 13/07/2022 23:56

@Ontheboard thank you.

Almost impossible for me to answer because we take a lot of information into account including history, but he shouldn’t have to wait to get seriously unwell before hospital can be considered. Whoever is his nearest relative (they should have been identified before and inform) they do have the right to request a mental health act assessment, to do this just Google your local AMHP service or contact the crisis team and they will have the number.

We are trained to ‘see through’ even the most plausible people if we have the history and I have hours with people to see if their presentation change.

i watched about 4 episode of PMQ’s with a gentleman once before he finally revealed exactly what his family had been telling services.

Thanks so much for your reply, I understand it’s hard to answer without a full history.

Ontheboard · 14/07/2022 10:16

Ontheboard · 14/07/2022 10:07

Thanks so much for your reply, I understand it’s hard to answer without a full history.

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Apologies, posted too soon! There’s a super annoying ad on this page at the moment and it’s making it impossible to post or read threads.

We will try again with the mental health team. Thanks again

FrozenSky · 14/07/2022 10:19

Have you ever been physically attacked when you sectioned someone who didn't want to be sectioned?

I was sectioned a long time ago as a teenager, but really I didn't mind at the time, but I do think as someone with EUPD, if I didn't want to be sectioned, I could become extremely physically volatile in that situation.

Original poster

Narwhalelife · 14/07/2022 10:25

FrozenSky · 14/07/2022 10:19

Have you ever been physically attacked when you sectioned someone who didn't want to be sectioned?

I was sectioned a long time ago as a teenager, but really I didn't mind at the time, but I do think as someone with EUPD, if I didn't want to be sectioned, I could become extremely physically volatile in that situation.

I have been chased a few times and I have had things thrown at me. A lot of verbal abuse and I was locked in someone’s home once. But never physically attacked - sadly some of my colleagues have been but it’s thankfully rare.

OP posts:

TheGreatBobinsky · 14/07/2022 10:44

Why are so many suicidal people just sent home with no interventions? Is it because you think they are lying? I have a diagnosis of EUPD and have never had so much as a phone call after suicide attempts. There are so many failures in the service and it feels like a lot of us are sent home to die to ease pressure on the NHS because its just easier if we weren't here.

Thunderpunt · 14/07/2022 10:51

Louisa4987 · 14/07/2022 07:54

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'm not entirely sure what you've been reading but i really don't see this as a police bashing thread at all. In fact the only 'negativity' seems to come from a frustrated police officer, who also takes the time to say that those frustrations are directed at the general MH services and not directed at the OP

clpsmum · 14/07/2022 10:54

@Narwhalelife unrelated to work question. But is if pissing you off everyone questioning how well you know your job and trying to prove you wrong because if is me!!!!

antelopevalley · 14/07/2022 10:54

I share Louisa frustration. I think OP is talking about how the mental health system should work, not what happens in reality.

CheltenhamLady · 14/07/2022 11:24

Interesting thread OP

I have a relative who is diagnosed as Schizophrenic but has had no involvement with her Pysch team for years.

Unfortunately, she now has numerous other physical illnesses such as Diabetes, HBP, High Cholesterol and failing eyesight. However, she simply refuses to take her medication and will not give a reason why. She says she will take it, then when asked says she has, but then admits she hasnt.

Her health is deteriorating but we all seem powerless to help.
Could she be sectioned for that? For her own good?

tulips27 · 14/07/2022 11:25

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This message has been withdrawn at the poster's request

AndSoFinally · 14/07/2022 11:35

yes AMHP’s make the final decision independently

Strictly speaking this is true, but it would be a very brave AMHP who refused to apply for detention after getting 2 medical recommendations 😝

AndSoFinally · 14/07/2022 11:39

@tulips27 you can apply to the court to have your nearest relative displaced and a new one appointed. If the court agrees that will remove their power to request a MHA assessment

Original poster

Narwhalelife · 14/07/2022 12:10

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This message has been withdrawn at the poster's request

Sorry Tulips I’m trying to catch up. As @AndSoFinally mentions there is a mechanism to remove a nearest relative through the courts but I will say can be a very long drawn out process so I see how people don’t often go for this option - plus it isn’t widely known.

OP posts:

Original poster

Narwhalelife · 14/07/2022 12:11

@AndSoFinally true, but I have definitely done this especially with support of other services to f

OP posts:

Original poster

Narwhalelife · 14/07/2022 12:12

@AndSoFinally follw up bespoke plans in the community - plus we always have 14 days to make a decision about admission and see if an alternative plan works

OP posts:

LemonSwan · 14/07/2022 13:03

LemonSwan · 14/07/2022 02:05

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!

Thanks OP for reply.

I just googled that study and that has sent me on a fascinating internet journey. It’s a much more succinct example of the ‘denying your ill’ conundrum I was trying to explain.

It seems to be mainly an issue with those diagnosed with schizophrenia and psychosis and I wonder whether part of it is an in built bias to label anything a ‘psychotic’ person says as delusional. I have to admit that was the one thing which scared me the most. The thought that if something awful happened to me eg. I was raped - no one would likely believe me.

What I found most interesting about the study was that nearly a third of patients could identify the imposters but the staff couldn’t at all. Obviously inpatients don’t feel the need to be ‘guarded, mask or manipulate’ other inpatients so they are either getting a truer picture than team, or the guarding, masking, manipulation is so common that the team just cant see the wood for the trees.

That fascinates me immensely because I can’t see how you can really get round that when in the team side.

I wonder whether they need to start having undercover doctor inpatients 🤣

LemonSwan · 14/07/2022 13:07

Oh shit I quoted myself lol 🤦‍♀️

bigkoalacliphug · 14/07/2022 20:36

Hi OP, thanks for starting this thread.

I know it's difficult for you to comment on individual cases but I wonder if I could ask your opinion on eating disorders please?

My DD18 has been diagnosed with bulimia and anorexia, along with anxiety. She also displays traits of OCD and 3 people involved in her care have advised she may be "on the spectrum", but she's never been assessed as her EDs took priority.

Diagnosed with bulimia 3 years ago at 15 and struggled at home with camhs support. Diagnosed with anorexia approximately 9 months ago. She was admitted to a specialist unit in February but discharged herself after 6 weeks. While there she was never assessed for capacity despite openly stating she'd rather die than gain weight. She left the unit weight 6.5st and now weighs under 5.5st. Sees a MH nurse once weekly and is under the care of an OT, dietician, psychiatrist.

Lives with her dad now due to verbal aggression towards me, in relation to her conditions. Eg, would become abusive if I ate anything. She's now gone NC with me but when I spoke to her last, around a month ago, she was considering discharging herself for all services completely.

I guess my question is, what will it take for her to get better / get sectioned? While an inpatient I begged for her to get sectioned as she kept threatening to discharge herself...and then she did. She's lost over a stone since being discharged and DNAs for community appointments.

I'm desperately worried about her 🥲

Briar250 · 15/07/2022 00:56

Narwhalelife · 14/07/2022 07:50

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.

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aww you're very nice :)

And good luck with the AMHP, you have passed the friends and family test!😀

Felix125 · 15/07/2022 11:09

This might have been asked already, so I apologise if so.

Can a person who has addictions to alcohol or drugs be deemed as having a mental heath issue? As a police officer, we get called to loads of cases where someone appears to be having a complete mental health crises/breakdown. We take them to a local mental health hospital where we have to sit with them until the effects wear off. They then can assessed and they are deemed fit to go back home - but then next day, we are back in the same situation. At what point should the mental health service look at their addictions and section them?

Also (whilst I'm here) people who are deemed to have 'attention seeking' issues never seem to be sectioned. The typical scenario is a person who stands on a bridge and threatens to jump. After quite some time we manage to talk them down and taken them to a mental health hospital - but they are deemed to be 'attention seeking' and are released as fit. A few days later, we have the same scenario. At what point do we say that they have a mental health issue?

Spidey66 · 15/07/2022 14:21

CheltenhamLady · 14/07/2022 11:24

Interesting thread OP

I have a relative who is diagnosed as Schizophrenic but has had no involvement with her Pysch team for years.

Unfortunately, she now has numerous other physical illnesses such as Diabetes, HBP, High Cholesterol and failing eyesight. However, she simply refuses to take her medication and will not give a reason why. She says she will take it, then when asked says she has, but then admits she hasnt.

Her health is deteriorating but we all seem powerless to help.
Could she be sectioned for that? For her own good?

I can help with that (I’m a CPN).

she will need a full assessment of her mental health and her capacity to make decisions. If she is displaying psychotic symptoms meaning she won’t take her meds (eg believing her tablets are poisoned etc) there may be grounds to detain her on the grounds she has mental health problems which are likely to deteriorate and her health and safety are at risk. As she has a diagnosis, and is known to services, this may be a S3 (for treatment) as opposed to a S2 (for assessment).

if her mental illness is relatively stable, and she has the capacity to refuse to take her medication, it would be seen as an ‘unwise decision’ and she couldn’t be detained.

is she open to mental health services currently? If she’s currently closed it may be worth contacting the GP and/or crisis line to get her reopened to request an assessment. If she is open, please contact services directly x

Spidey66 · 15/07/2022 14:23

Ah I see she is closed…please contact the GP. It may also be she has other issues as well, eg early signs of dementia or an underlying infection or illness causing her to have further difficulties

Otterses · 15/07/2022 14:30

What are your views on the seemingly increasing number of those with serious and complex mental health issues who are currently being supervised by the probation service? Do you feel there is a place for mental health orders, and do you feel that court directed intervention would impact up the volume of those needing to be sectioned?

antelopevalley · 15/07/2022 14:44

LemonSwan · 14/07/2022 13:03

Thanks OP for reply.

I just googled that study and that has sent me on a fascinating internet journey. It’s a much more succinct example of the ‘denying your ill’ conundrum I was trying to explain.

It seems to be mainly an issue with those diagnosed with schizophrenia and psychosis and I wonder whether part of it is an in built bias to label anything a ‘psychotic’ person says as delusional. I have to admit that was the one thing which scared me the most. The thought that if something awful happened to me eg. I was raped - no one would likely believe me.

What I found most interesting about the study was that nearly a third of patients could identify the imposters but the staff couldn’t at all. Obviously inpatients don’t feel the need to be ‘guarded, mask or manipulate’ other inpatients so they are either getting a truer picture than team, or the guarding, masking, manipulation is so common that the team just cant see the wood for the trees.

That fascinates me immensely because I can’t see how you can really get round that when in the team side.

I wonder whether they need to start having undercover doctor inpatients 🤣

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I know of a case of a man with severe enduring mental health problems who went to his Drs surgery saying he could not get into his flat as someone had changed the locks. He got dismissed as they thought it was a delusion. Ended up wandering into a charity. a volunteer accompanied him to his flat and discovered the police had wrongly broken the wrong flat door down in a drugs raid, changed the locks and left a note on his door. He was telling the truth.

It is very easy to dismiss someone with a mental health issue as being delusional when they may be simply saying something unusual has happened.