To think sectioning under the mental health act is rarely done

[User4647]

But it’s shown on tv shows like someone has a breakdown and then they are sectioned. The reality is it’s a battle to even get under secondary mental health care never mind sectioned. AIBU to say very few people are sectioned.

My mum was sectioned many times when I was a child but that was in the 80s so I would imagine lack of beds / mental health help in general would mean that wouldn’t happen so much now maybe. She had bipolar and schizophrenia. She would always fight not to be sectioned and I have horrible memories of her being carried off to the ambulance screaming.

My dh has bipolar and they don’t even want to refer him to a psychologist for help let alone section him...! It’s almost impossible to get any help for mental health now, they just want to give you meds and leave you to get on with it.

@Nomnomarrgh

I don’t know about rarity or not. When I voluntarily went into a mental hospital, I asked whether I would be sectioned if I fought to get out. They said yes, so I didn’t.

Then you were being detained illegally and sadly it happens far too often. If you are there voluntarily you are free to leave anytime you wish.

I was so bored and fed up. I now have a stain on my medical history, as they would only let me leave if I agreed I had post-partum psychosis, despite the fact they admitted my symptoms did not match it. Helped my abusive husband a lot when I finally escaped him.

Seems its more common than I thought.

If you are there voluntarily you are free to leave anytime you wish.

Understandably, patients are given every opportunity to make the choice to be there themselves and avoid being detained as that carries certain consequences. It's not something you want to have on your notes. Saying 'you're free to go but please stay' and then adding 'you're sectioned!' if you actually walk out the door would not be great either.

I don’t know. There could be people who know others that have been sectioned, but have never been any business to you, so never mentioned it.

I have been in voluntary, but as a pp has said, if I had said no, I would have been sectioned as they made it quite clear I wasn’t going home that day.

I hadn’t harmed myself or others, but I was severely unwell (I have bipolar) stayed for approx 11 days. To be honest I made that decision to go in, I knew I had to. I know there’s a lot of talk about having no self awareness. But I did have it to a degree, rang 111 and was hospitalised that evening

It is a last resort - so many times you hear things like 'get him sectioned' 'I need to be sectioned', but it hardly ever happens, not least as there are pretty much no available beds for mental health patients however unwell they are.

Some bizarre misunderstandings on this thread

No-one who wants to 'get sectioned' should be because if they want to be admitted and treated it should just be done voluntarily (informally). If someone is asking to 'get sectioned' then no wonder they aren't. Do people mean 'asking to be admitted'?

Being detained under MHA is and should be a rare thing. It is taking away a persons liberty and treating them against their will when they haven't done anything wrong. This is a draconian step and can only be done if the person's mental illness is severe, causing a risk AND all voluntary treatment options have been refused or exhausted. People who are mentally ill still have rights and choices and are allowed to refuse treatment and behave oddly or anti-socially just like anyone else as long as they are not a risk.

Yes more people with BPAD and schizophrenia would be detained than with depression because they often lack insight into their illness. People with depression in most cases want to be treated and therefore don't need to be detained

If you are already admitted and ask to leave you can be placed on a 72h holding order called S5,2
but in no way is this automatic. Most people who ask to leave can just leave especially if they agree to community treatment. It's only if a Dr determines they are at high risk that they would be detained.
Even if you are placed on S5,2 it does not automatically go on to S2 (28 days max) or S3 (6 months max). S5,2 and S136 (police holding power) aren't really 'being sectioned'. These are for being held for assessment for a short period and may not then be detained.

People who are detained have rights to appeal, their 'nearest relative' has a right to discharge them and they have a right to a 2nd opinion about medication if on S3. 2 Drs and an AMPH have to agree before a person can be detained so it's not really simple to even arrange an assessment. It will usually take most of a day to arrange all the right people to attend. Detention is actually more about giving the person rights and ensuring they are not locked up without recourse to appeal.

There's a million reasons why detention under MHA is not easy or frequent and nor should it be.

In answer to a PP
No a psychiatrist cannot detain you at a CPA review
No one single psychiatrist can detain you. It requires a formal assessment by 2 Drs and an AMPH. It is never just one persons opinion.
If your psychiatrist was highly concerned at the CPA review they should first offer community treatment (if safe), then informal admission and only as a last resort
arrange an MHA assessment.
Loads of people seem to think that agreeing to see a psych at all will result in being 'sectioned' but this would never happen at a first appt.

In Scotland you can be detained by 1 psychiatrist on the shorter term detention orders. You also should have the consent of a mental health officer . For a longer term order it requires 2 doctors and a mental health officer to do the paperwork, and a tribunal hearing to determine whether the order is appropriate.
It would be extremely rare for someone to be detained the first time they meet a psychiatrist but not impossible. It would only happen if someone was felt to be so unwell and unsafe that there were no other options. The person would have to lack capacity to make decisions about treatment themselves. A very unusual occurrence .

DM was totally batshit. Dementia. Well hidden by her until very late on.

Hallucinating.
Running out on the main road.
Calling people constantly in the middle of the night.
Not sleeping - for 10 days we reckon.
Insisting I come home to her (a flight away) at 37 weeks pregnant.
Calling the police all the time.
Insisting my sister had called her and had been kidnapped and was being murdered.
Swearing and accusing the (lovely, very patient) neighbours of stealing from her.
Beating up the garage to get "the little girl and her dog out" (didn't exist. obv).
Panic buying domestos wipes.
Obsessing about "talking pillows"
Vomiting constantly.
Trying to find alcohol in the house.
Shouting at my DDad (dead 6 years before).
Calling taxis and then accusing them of stealing her jewellery (which she was wearing).
Calling me at 3am and telling me there was a man on the line who "wanted to fuck her" (wee Irish Catholic lady; very prudish, never gave us the rules of life talk).
Bed hopping around the house and "keeping watch" and then accusing "people' of carrying her about.

Aaaannnnd... no section, ever. It was a total nightmare. I eventually managed to get her into hospital and she pretty much stayed there most of the time until she died there.

So.... I'm not saying being sectioned is a good or a bad thing - will leave that to the experts, but sure as hell it's not a straightforward thing to have done.

She had no family nearby, I was heavily pregnant, my sister was basically disabled until an operation could happen but we couldn't push it any more.

Thankfully, she got the most amazing care and attention in the psych ward. Half of the staff came to her funeral. They were absolute legends and we still talk about them today, 7 years later.

@theld what if there was a psychiatrist, psychologist, mental health co coordinator (also amhp) and health visitor?

@Ratatcat

I have a relative who has been sectioned multiple times. Every time she should have been admitted far earlier than she was and family were begging for the section. In my experience it has been a very last resort when that person has been very sick indeed.

We have a similar experience.

My mil has been sectioned a few times in her life, but every time it was done too late. The family tried to get someone to take it seriously, but it was only when someone outside of the family was threatened that they did anything. She was in complete denial that anything was wrong and it was was horrendous for her children.

This all happened over a span of over 50 years. Mental health services have always been seriously underfunded.

Someone- the specific people you need for an MHA are 2 Drs one of whom is S12 approved (ie a psychiatrist) and an AMPH. Anyone else being there is not relevant and I don't think it would be good practice to have someone not involved eg health visitor there.

It shouldn't happen that a person is invited to a CPA and then ambushed with an MHA. That also is not good practice. I would be very surprised if that happened. It's most likely the CPA meeting is just a CPA meeting to plan care and that's why lots of people are invited. They would not go to the bother of inviting extra people to an MHA assessment.

Admittedly you do not get warning of an MHA as otherwise people would just run away but usually the assessors would come to the persons home address. If they refuse entry you have to get a warrant.

I think the reason it's hard to get detained is actually less due to resources and more due to what the law says.

If you agree to be treated and it's felt you would benefit from treatment you can usually get it in my experience.

The difficulties are when

A) the person wants to be admitted to hospital but in fact clinicians don't agree that hospital admission would help. This is commonly the case with personality disorder for which the treatment is psychotherapy which is not usually available as an inpatient. People believe admission will somehow solve anything but if it's not a drug responsive condition then usually it won't.

B) the Drs and family think the person would benefit from being admitted but the patient disagrees and refuses so they need to be detained (sectioned). The law puts this as a last resort with a high barrier to getting detained against your will. The law in the Uk allows people to do unwise and dangerous things because personal freedom is valued. All community treatment options need to be tried and be shown to have failed before you can be detained. Often families do feel things are left too late but the law does not allow for early intervention. Patients have a right to stop taking their meds and up to the point where there are serious risks they cannot be forced.
Even if you do force a person into treatment against their will you can only do that for max 6 months or until they use their right of appeal and then it may all go back to square one so in the long term compulsory treatment is not usually the answer and often serves to alienate people from services.

It's a little known fact that if you are the nearest relative under MHA (not same as NOK but usually their spouse or eldest child if not married or eldest sibling if they have no spouse or children) you have the right to request an MHA assessment directly by ringing the AMPH office to request (Ring the mental health hospital switchboard and ask for the number)

That's not to say the person will be detained but you have the right to request. So if you feel services are not doing the right thing you are allowed to bypass them in fact.

NR has loads of power. You have to be consulted as NR about a detention and if you object to S3 it cannot go ahead and you have the right to discharge your relative from detention even if that is against medical advice.

NHS Digital say 50,000 people were detained under the MHA in 2018/19 but that is an under reported figure as not all providers submit data.

Thats an incredibly high number.

@Someone1987

Can a psychiatrist section someone at a CPA?

It needs a psych, a doctor who specialises in mental health, and a social worker to section someone.

I've had experience of two older relatives who ended up under Section 3, due to dementia.

It needs a psych, a doctor who specialises in mental health, and a social worker to section someone.

No, you don't need a social worker.

So if a perinatal psychiatrist, psychologist, mental health care coordinator (amhp) were there, is that enough?

@TheId

Some bizarre misunderstandings on this thread

No-one who wants to 'get sectioned' should be because if they want to be admitted and treated it should just be done voluntarily (informally). If someone is asking to 'get sectioned' then no wonder they aren't. Do people mean 'asking to be admitted'?

Being detained under MHA is and should be a rare thing. It is taking away a persons liberty and treating them against their will when they haven't done anything wrong. This is a draconian step and can only be done if the person's mental illness is severe, causing a risk AND all voluntary treatment options have been refused or exhausted. People who are mentally ill still have rights and choices and are allowed to refuse treatment and behave oddly or anti-socially just like anyone else as long as they are not a risk.

Yes more people with BPAD and schizophrenia would be detained than with depression because they often lack insight into their illness. People with depression in most cases want to be treated and therefore don't need to be detained

If you are already admitted and ask to leave you can be placed on a 72h holding order called S5,2
but in no way is this automatic. Most people who ask to leave can just leave especially if they agree to community treatment. It's only if a Dr determines they are at high risk that they would be detained.
Even if you are placed on S5,2 it does not automatically go on to S2 (28 days max) or S3 (6 months max). S5,2 and S136 (police holding power) aren't really 'being sectioned'. These are for being held for assessment for a short period and may not then be detained.

People who are detained have rights to appeal, their 'nearest relative' has a right to discharge them and they have a right to a 2nd opinion about medication if on S3. 2 Drs and an AMPH have to agree before a person can be detained so it's not really simple to even arrange an assessment. It will usually take most of a day to arrange all the right people to attend. Detention is actually more about giving the person rights and ensuring they are not locked up without recourse to appeal.

There's a million reasons why detention under MHA is not easy or frequent and nor should it be.

You've summed up what I couldn't put into coherent words.

@U2HasTheEdge

It needs a psych, a doctor who specialises in mental health, and a social worker to section someone.

No, you don't need a social worker.

Ah, right. There was one needed for one relation (I was in the room when it happened), but as I recall not for the other one.

Social workers can be AMHPs, but you don't specifically need a SW, just two doctors and an AMHP.

The lack of mental health beds probably means people who need sectioning can't always be sectioned.

@U2HasTheEdge

Social workers can be AMHPs, but you don't specifically need a SW, just two doctors and an AMHP.

That must be it. Thanks.