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 😊

Thanks for this thread. I was very unwell a few years ago with OCD and ended up in hospital for a very long time. I couldn't speak to the AMHPs really as I was in terror during our meeting, but they were very kind and made their judgement based on the ward staff's opinions.

Thank you OP for this thread, it's really interesting. I have diagnosed bipolar and adhd and have been in hospital voluntarily for 2 weeks a few years ago. I have a couple of questions, sorry if this has already been answered up thread, but I'm just curious

Obviously back then I was severely unwell and had numerous interventions including HTT for 6 weeks before it got to hospital admission. So I appreciate it's no easy task

When I was first known to services it was the the paramedics who came round to assess me. Was told in no certain terms that I had to go with them to our local psych hospital for assessment. Was this a detention? Obviously I was never told, and probably different language was used to make it more likely for me to comply I have no idea. I had to stay over night (I had been drinking heavily, so had to breathalyser tests to check when I sober enough to talk to them. I was suicidal)

Spoke to a nurse there, and was only allowed to leave if I agreed to see a psychiatrist within the community the same day (she made the appointment) who is still my psychiatrist now. What was going on there? Could she have legally detained me longer if I had refused? I had no diagnosis then

When I was eventually hospitalised it was two people, and it was more or less like an informal "interview" only way I can explain it. Granted my memory is hazy as I was acutely unwell, but I remember it lasting about 2 hours and they would go away to "discuss my case" and come back. Again, I was told if I would like to go in as a voluntary patient, but at the same time was told I wasn't allowed to go home. I had a diagnosis of bipolar at this point. So could they have sectioned me there and then if I refused? I did go in voluntary, so it's by the bye now. But none of these things have ever been explained to me

Sorry for the lengthy post!

Meant to add sorry, I was in the psychiatric hospital already in one of the rooms being assessed. So when I agreed, I was taken in straight away and a bed. Had no spare clothes or anything. Just my handbag that I came in with. Thankfully my DP came up the next day for some fresh clothes for me and a toothbrush!

what do you think of the psychiatrists that you work with? Do you feel they are sufficiently prepared for mental health assessments? I have seen very unprofessional behaviour and discussions outside a patients house, prior to an assessment. To me, they come across as pig headed and make many assumptions. The whole mental health assessment gives professionals too much power.

what are your thoughts?

What are your thoughts on the High Intensity Network’s Serenity Integrated Mentoring (SIM) model?

I hope OP comes back to reply to this. I was under SIM, and it destroyed me.

What is the SIM Model if you don’t mind me asking. I apologise if you don’t want to discuss.

If I could sum it up in one sentence, it would be "being criminalised for having a MH crisis".

Wow that is shocking! I have just found StopSim campaign and it doesn’t paint it in a good light. I am so sorry you are going/ have gone through that

Hi everyone - sorry not been in the thread.

My local authority does not operate the SIM model and hasn’t mentioned doing so, so I can’t comment on that unfortunately. I am vaguely aware of it from other areas but do not know anyone that has been subject to it.

We have had other methods to try and reduce a.136 attendances…such as police not detaining and just taking people to A&E to be seen by psychiatric liaison first as a least restrictive measure but mostly this can just lead to longer waits to be seen in a busy A&E environment so s.136 is sometimes preferable as at least the person is taken to a health based place of safety and it’s a better (than A&E) enviroment…

Sorry for the delay in reply. Thank you for recognising that even when you were so unwell, we really do understand that it’s likely one of the worst days of people lives when we turn up so we do try to manage it as best as we can…

Hello, sorry for the delayed response…paramedics can use the mental capacity act to take people to hospital (and if you were drunk you were unlikely to have capacity) but not the mental health act…so you wouldn’t have been sectioned at that point.

The nurse could not have sectioned you, no, so again she was using the powers of persuasion, if you had left against her advice I imagine they would have notified the police.

People do not need a diagnosis to be sectioned or detained, they only have to be suspected of suffering from a mental illness or disorder.

The conversation you had when they went away to discuss your case sounds dodgy to me and could be what we call a ‘de facto detention’ whereby a person is coerced into staying out without a reliable legal framework - this is a tricky balance to strike as a AMHP as we should be open and honest with people and say that we think it’s best for them to stay but also maximise their participation and independence so if they can stay informally then that can be best, but as you explained trying to have this conversation with someone very unwell is tricky and not always done correctly.

Yes and AMHP can section someone if they don’t agree or even if they do agree!

Hope this helps you make sense of some of it and that you are doing better now!

As with all jobs/ professionals some are amazing, kind, compassionate, take the time to listen, read the case, talk to the family, are knowledgeable and truly want the best for people. These are the doctors that I choose every time I can.

But of course there are some that are in a rush, pig headed as you put it and happen to be on call so still get work.

Yes it does. The mental health act is a very old piece of law, although it’s current form is from 1983 it hasn’t changed very much at all since the Victorian days. It needs to be harsh in some cases (to protect the individual and the public) but that shouldn’t give professional reckless abandon with how they use it.

On the whole AMHPs want to work with good doctors and we do have some scope of choice when it come to this so we try to get the best balance.

I’m enjoying reading this thread, thank you for sharing. I’m Bipolar and had a terrible, life changing manic episode which led to my eventual diagnosis.

Do you frequently come across manic patients who are sectioned? Mine was missed, people around me thought I was choosing to act that way and it basically ruined my life. I often wonder how things might of been different had I of been sectioned and helped to get better sooner.

How often do you come across patients with BPD/EUPD? And are you hesitant to section them?
I have heard all sorts.. things like people with EUPD are blacklisted from inpatient care. My own care team kept assuring me that there was no "blacklist".

Absolutely no black list in the mental health act for personality disorder diagnosis.

yes it’s about 40% of our work loads (oldish figures) but I’d say that was true.

yes I do hesitate sometimes because inpatient admission rarely makes things better, but it doesn’t mean it’s never necessary .

I hope you are doing better now.

Its not common, but I do go out to patients in your situation and yes sometimes behaviour can seem that way but in my experience as a professional we can spot mania/ hyper mania a long way off.

What do you think of what's happening with the young people with an autism diagnosis or learning disability that are detained under the mental health act and kept in these facilities for years?
Are the places they require in the community not available for them? Should they really be detained under the mental health act in the first place? From what we hear and see a lot of these young people being detained are because their family has hit crisis point and there is no other help

The mental act has always Been used for people with learning disabilities etc
Sadly people with autism and or learning disabilities being admitted to mental health wards is not a new thing ,I remember working on a psychiatric intensive care unit 20 years ago and a patient with autism and learning disabilities was admitted for 18 months because there was just nowhere else for them ,and that wasn't an isolated case ,now being the parent of a severely autistic child with learning disabilities, the thought of him having to be admitted somewhere like the place I worked in horrified me ,he would be so vulnerable .

@x2boys this is my worry, my son is severely autistic and has learning disabilities, plus an eating disorder, it scares the life out of me him ending up somewhere like that I know he wouldn't cope, the noise, the sound would overwhelm him and cause meltdowns.
I dread the day I am to frail to care for him, I hope the system changes by then

In a lot of ways, yes, it is sometimes caused by lack of resources in the community like appropriate home care, placements, respites and that is only getting worse.

However sometimes people with Autism or LD have a co morbid mental health condition which can be helped in hospital so I have detained people with these diagnoses.

There is an added criteria for people with LD to be admitted long term to a hospital - they must be demonstrating abnormal aggressive or seriously irresponsible behaviour but it doesn’t apply for Autism.

I don’t agree anyone should have to live in hospital but sometimes if the families cannot manage and there is not the appropriate care in the community it’s the only way to keep people safe.

Things absolutely need to change in this respect. But with the current government I can’t see it sadly.

Hi, thank you for this thread.

do you have experience of people who are sectioned beginning relationships with other sectioned people while in hospital? Is there protocol in place to try and prevent this? Or is it ‘allowed’?

Years ago my father was sectioned after taking an overdose in front of me, and members of the public, in a public place (a park). I was 17 and there was DV in our home. Whilst in hospital he met a lady who was schizophrenic (she had taken her child’s life years before) and they started a relationship in hospital. He moved straight into her council flat, got himself on the tenancy and eventually after 8 years of DV she fled (in her 60s). He is still in the flat now, I am estranged but it has left me with questions around how they were able to start a relationship in hospital.

i do remember visiting him, they were in a mixed common room type area and my father was heavily medicated, it seems so strange that he was able to start a relationship in there.