To wonder why people are sectioned under the mental health act for short periods

[Why53737]

I’ve got a relative that after suicide attempts/thoughts is often sectioned for maximum of a week. I’ve read that an assessment section is 28 surely more time is needed to do an assessment? Or are they not doing one?

A section 2 is for 28 days, but can be rescinded prior to that if the clinician in charge decides so.
How many suicide attempts are we talking? Maybe being on the ward is very unhelpful for your relative, and the plan is to discharge immediately after the period of crisis with support from the care at home team.
Do they have a diagnosis?

It's up to 28 days.

It's always best to use the least restrictive practice so if it is felt after a few days the patient can be managed informally or discharged from the ward completely (maybe with the HTT.) Sometimes it is clear the patient does not need to be detained eg they were under the influence of drugs which once these had left the system meant they were symptom free..

The patient also has the right to appeal to e=the Mental Health Review tribunal. Under S2 this happens quickly and the Tribunal can discharge them.

PS I agree with puddlejuice as well. Acute mental health wards can be full of very disturbed patients and are not always the most appropriate places for someone who is depressed or anxious.

There are different sections of the MHA with different time lengths. Maybe they were sectioned under something like section 4 which would last up to 72 hours? In my experience, usually the shorter times are used initially because trying to find another professional to sign off on the patient would lead to delay in treatment. Potentially the patient then didn't need this section extended?? Does your relative have short lived episodes of acute mental health crisis, that could possibly explain what you see happening here?

Oh and another thing....during the pandemic they have avoided admitting people as much as possible because obviously the virus can spread very quickly in such environments, plus there has been high levels of sickness, self isolation and shielding amongst the staff.

Because acute mental health crises are often quite short and long term care is better delivered in the community. Or at least that's how it would work if we had any community mental health care left after all the cuts

Depends on the type of section really. Each has different purposes. (This is really simplified and im sure someone will come along and tell me ive got bits wrong)
Theres several shorter sections that allow you to hold people in order to ask the mental health team to assess them. This includes ones for nurses and drs to hold you for example in a+e to await a psychiatrist (and specially approved doctors and clinicians) who can assess you under the act. This also includes the police powers to detain someone in public such a 136. If it is deemed by the 2 drs and an amhp that they need further detention then there are further types of section

A section 2 is the 28 day one you are probably thinking of. The purpose of a section 2 should normally be to assess someone, eg someone who hasnt got an existing diagnosis.

Section 3 is longer and is for treatment and comes with more ability to do things such as complete medication changes against someones will.

You can renew a section (normally a section 3 as otherwise you'd have to explain why you failed to complete the assesment in a given time frame), and people in longer term placements may for example beheld longer. You shouldn't automatically renew an assement and theres lots of checks in place such as getting external drs in, and various types of hearings and tribunals to check you arent holding people unnecessarily (to prevent situations like asylums) Theres obviously also forensic sections

All of the sections are an "up to" and most people in my experience are discharged before the time frame. Hospitals now are seen as a short place for stablisation in acute illness, and that most of your recovery is expected to be held in the community. In my old trust we had an aim for a roughly average stay of 14 days where possible but some people were in for much more, some much less.

Someone with suicidal thoughts for example wouldnt be expected to have 0 thoughts of harming themselves but would typically discharged when they felt these were managable as the effective treatment of therapies etc is long term and community based

A bit like if you were admitted with a physical issue, they would do short term fixes such as change your meds, drips etc but your longer term treatment would be within specialist outpatient where possible, even when the condition is serious like awaiting a kidney transplant

Because they're essentially depriving your relative of their liberty using sectioning powers is something that should be very much a last resort and for as short a time as possible. Once they are stabilised and not at immediate risk of harm it may be that the doctors feel a voluntary approach is more appropriate in your relative's particular circumstances.

Lots of conditions don't require/don't benefit from staying on a ward, it would make them worse. As soon as they're not a danger to themselves or the public they'll be discharged.

28 days is the fairly arbitrary maximum legal time of an assessment section. It doesn't have much relevance to clinical reality.

It really does not take 28 days to assess a mental disorder in the majority of cases especially if (as you say) this is not a first presentation. In an outpatient clinic you'd be able to assess a mental disorder in 1 hour for a new patient or 30mins for follow up.
So it's not obvious why you'd need 28 days as an inpatient.

What do you feel has not happened that you think should have done?

I'm guessing you are upset that the person did not get better and this keeps happening but that is treatment you are wanting not assessment and not all mental disorders are very treatable certainly not in a short time frame.

I'm surprised they've had multiple section 2s, in my experience it's been straight to a s3 if someone's already known to services.

Because mental health services are crap.

I guess they don’t want to put her on a section 3 as that means they have to legally provide proper aftercare.

The mental.health act is quite complex ,when I trained and qualified as a mental health Nurse in the 90,s patients were often kept in hospital for much longer than they really needed to be which often was,nt in the best interest ,s of patients ,some would argue it's gone the other way with patients being discharged before they are often well enough ,but it's a fine balancing act , the cuts in mental.health have,nt helped and these were going on for years ,the cuts in the mental health trust I worked for started about 15 / 20 years ago.