WIBU to try and get friend sectioned?

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And is it possible to section them in this circumstance? I'm relatively confident that I wouldn't be unreasonable to try and get them detained and get them help.

A friend has been in and out of psych hospital this month as a voluntary patient. They have been self harming and have had two wound infections during this time. The first one they took the antibiotics for as they were still in hospital and it cleared up.

This time they have been seen by minor injuries due to other incidents of self harm and have been given antibiotics. They are refusing to take the antibiotics.

I am at my wits end, I have been watching the infection get worse and spread to their other wounds. I took them up to minor injuries today as they needed stitches out and both myself and the nurse tried to talk some sense into them. The nurse quite clearly told them that if they didn't take the antibiotics then the infection would get worse leading to sepsis if left untreated. Nurse even said 'take your fucking medication!' in a nice way, not threatening, but she was obviously concerned. At the moment she said that there is nothing that she can do as my friend has capacity to make their own decisions. However she also said that next time my friend is there if they haven't taken the antibiotics then she will send her to the big hospital for IV antibiotics.

I am really worried, my friend has been suicidal recently and I'm pretty confident that they are refusing to take the antibiotics as a way to end their life. I've been trying to read through bits of the mental health act, but it's a bit unclear on refusing treatment for a physical health condition. Does this class as being related to their mental health condition as it initially started with deliberate self harm?

What would happen if I took them up to A&E currently? Or do I need to wait until they are showing signs of septicaemia so that doctors no longer need consent to treat them as it's emergency life-saving treatment?

They have visits from the mental health team every other day. The MH team know they're not taking the antibiotics but aren't currently doing anything about it. I want to scream at them, this is so dangerous! My friend clearly isn't thinking straight, but professionals seem unable to do anything to save them!

What can I do??!

It's really difficult to get someone sectioned but I think you would be right to try.

Someone has to reach crisis point, usually with police intervention, before a sectioning is considered.

I would seriously consider ringing the police if you think your friend is that much of a danger to themself and getting them to intervene.

Can the police do anything if they are at home though?

The infection is still spreading, without any treatment it will lead to septicaemia / sepsis / death. Surely there must be some way to prevent this?!

Yes, the police can intervene and take them to hospital. Happened with one of my parents when they presented as a clear danger to themself and someone called the police.

I don't know but well done for being a lovely friend. Can you talk to their GP???

No you can’t, unless you are their nearest relative.

The good AND the bad thing in this country is that mental health treatment is designed so that someone cant be wrongfully committed. Usually it takes some kind of self referral which obviously isn't really an option in your case.

Sorry not to be of more help. I really understand and sympathise with what is an incredibly difficult situation.

No-one can predict that this will definitely lead to septicaemia. I think you might be best to keep close contact with her and also contact her MH team if you are worried that they do not know the whole picture. You can be sectioned and compulsory treated only for mental disorder. The issue would be whether the assessing doctors thought this was a manifestation of mental disorder. Where it started may not be relevant. I think you would be unlikely to get her sectioned if there is just a bit of infection (must be mild if nurses did not try and admit?) This seems like another way of self-harming and hospital treatment can actually make things worse if people have BPD which perhaps is the case for your friend?

Getting appointments with their GP is a bit like hens teeth unfortunately. And if I'm honest I'm not sure how long we have got before they start to go drastically downhill. I'm not sure it can wait until Monday. That's when minor injuries have asked to see them next.

I'm in regular text contact with them, going to go over to theirs tomorrow afternoon and will consider calling the police then to see what they can do. It wouldn't be fair to call the police on them In the middle of the night

Police can only detain under S.136 of the Mental Health Act if the person is in a public place and they are a danger to themselves or others. No powers inside the house, that would all be voluntary.

sunglass they already have a low grade fever although were adamant that it was to do with the heat. The minor injuries is about half an hour away from the big hospital, they said that at the moment it would still clear up with oral antibiotics, but it is going to progress.

I'm just worried that nobody will be able to intervene until it's too late

@jacket S.135 states that police can take you to a 'place of safety' even if you are in your own home and section you. Albeit the 'safe place' can be your own home but they can come in and take you to a hospital. I've seen it happen.

OP. Worth a scout around this website--www.rethink.org/advice-and-information/rights-restrictions/police-courts-and-prison/section-135/

It could be to do with the heat then I guess? I hope that is it

You can remove someone from their own home under section 135. You could contact her GP if you are worried. Would she agree to a visit from them? What has happened to de-stabilise her do you think?

www.rethink.org/advice-and-information/rights-restrictions/police-courts-and-prison/section-136/

I am a mental health liaison nurse. The Mental health act covers treatment for mental illness not physical but if the mental illness is the main driver for refusing treatment then certain illnesses are treated under the act such as an anorexic being tube fed. In your friends situation in theory if they were felt to be detainable under the act then they could be sectioned to a general hospital and the physical treatment given under the mental capacity act. The mental health act always overrides the mental capacity act legally. I see lots of people like your friend who initially refuse antibiotics but often change their mind. there are lots of other factors to consider as well, such as diagnosis, history. As a friend you cannot request a mental health act assessment in the same way a nearest relative can. I would suggest a review by a crisis team or a liaison team when she is back in A &E if she will be seen.

Have you got a contact at the Crisis team? If not look on your NHS trust’s website or
call NHS 111.

www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/dealing-with-a-mental-health-crisis-or-emergency/

No. The police cannot detain someone under the MHA in their home. They have no powers unless a magistrate has signed a s135 warrant. You are not this person's Nearest Relative either.

I don't see how pp think you would be able to get a magistrate to sign a s135 warrant, otherwise we would all be vulnerable to the whims of random people wanting us detained on their say so. Your friend does still have human rights, you know.

The MHA cannot be used to force physical medical treatment on someone. It is only for the treatment of mental disorder.

The Mental Capacity Act would be considered if a person did not have the capacity to make decisions - bearing in mind that everyone with capacity has the right to make decisions others may consider unwise.

In an emergency situation, if your friend is still able to communicate and is still considered to have capacity to refuse treatment then it would be illegal for anyone to treat them.

Broadly, capacity means a person can understand, retain, and evaluate the information relevant to their decision, has not been coerced, and can communicate their decision. The decision itself does not have to be what others would consider a "good" decision. We all have the right to make "bad" decisions.

I understand you're worried, but you can't restrict or remove people's liberty on demand simply because you're not happy with their decisions.

I therefore say this out of concern for you and the desperate tone of your posts: if you took steps to detain your friend yourself or hold them somewhere against their will that would be false imprisonment, which is a crime.

There are powers inside the home but they are only with a warrant and under s135(1) or s135(2) of the Mental Health Act. This requires an approved mental health professional to apply to the magistrates court for a warrant. There is an overnight/weekend magistrate on call for each area for purpose of hearing warrant applications. (These are done by email and teleconference call). Then if, and it is if not a guarantee, the warrant is issued the police can go to the home and force entry if required to take the person to a place of safety for a mental health assessment. They can only do this if the person would refuse to come voluntarily.

There are more conditions that this but ultimately it is for the MH team to make the application, the police can help enforce it but they can’t make the warrant application.

In your friends case it seems that the MH team are not yet at the point they think your friend needs to be sectioned and meets the criteria required.

If you are concerned you would be better to phone the mental health crisis team rather than the police.

Good luck to you and your friend.

This is a tight rope situation & the stakes are rising day by day if treatment is not followed. Please do not leave going to A&E until it seems they cannot argue about it.

As they have attended a minor injuries unit today, it is hard to argue that they are neglecting themselves - & self-neglect alone is not enough to detain someone under the MH Act - even though they will not take the anti-biotics.

It does seem that your friend is falling between the threshold urgencies of the MH team who are managing more acute MH cases & the limited facilities of the minor injuries unit where they will not have MH specialists.

Any change in their condition & the place to take them is directly to the local A&E where they have rapid sepsis assessment, IV meds AND MH specialists to call upon for any MH assessment indicated. It may be a long wait at A&E but the risk of sepsis cannot be overlooked.

That your friend may be declining the anti-biotics as a route to clinical attention - I am not saying attention seeking - is moot, but the danger of neglected wounds & sepsis is real.

So any worsening of the wound or their wellbeing, go to A&E.

Cross posted with several people but we seem to be saying the same thing.

A section 135 is much more complex to implement and needs more professionals involved than the police. As stated by someone else a 136 cannot be used in your home. it is very unlikely the police would get involved in this case as the police officer detaining under their powers has to consider the person to be mentally ill, If someone can articulate why they are refusing treatment for infection a police officer probably won't question it. a crisis team review is the best step.

There's rules on whether professionals can enter the house etc in terms of MH, when DH was assessed at home they asked me if we jointly owned the house so that they could enter without his permission, otherwise they needed extra paperwork from their end.

Do they have any relatives you can speak to? It's generally only "nearest relative" that can request an assessment, and speaking as someone who's requested one, they aren't done lightly either. As they still have "capacity" I'm not sure you'd get far , but you can either request a review in A&E or if they will allow you to talk to their MH team then voice concerns there.

Heartbreaking to watch but the cruxi of it is they are deemed to have capacity.
To get someone sectioned is a massive process in all honesty I don't think you'd get them sectioned form what you have said .

Thanks for all of the replies. I'm going to try and get some sleep now. Will try calling the crisis team in the morning, that's who has been visiting friend. If I take them up to a&e I think they would stay there with me, but then just continue to refuse treatment. But yes, there are MH specialists at the big hospital, so that is the place to be.

You haven’t disclosed a diagnosis, but a combination of self-harm plus existing involvement of a MH team who don’t appear to be doing a great deal screams personality disorder to me.

If this is the case, don’t expect anyone to be able do much, I’m afraid. A&E are virtually under orders not to admit ‘frequent flyers’ with personality disorders as it basically ramps up self-harming behaviours and suicide threats. MH crisis teams will also give a wide berth, particularly if the service user is already known to them, for the same reason.

And what everyone else has said about sectioning. It’s unlikely to happen given what you’ve described, sorry.

OP - you sound like an amazing friend. Kudos to you and I hope your friend recovers from this.

I'm sorry, this must be hideously stressful and upsetting for you. But I'm afraid you do not have the right - either legally or ethically - to get your friend sectioned, or to have your friend compelled to take medicine. People's bodies - and, ultimately, their lives - belong to them. Your friend's behaviour is not endangering anyone else, though it is clearly causing you a lot of distress. Please make sure you look after yourself while all this is going on.