To wonder why some people are detained under the mental health act and not others

[Wildtimes78889]

For doing the same thing eg if someone is a danger to themselves. How come only some are detained.

It largely depends on whether someone has the capacity to understand the consequences of their actions, and whether their understanding is impaired by mental disorder.

*actions or decisions

If an individual is assessed to have capacity and agrees to work with community services or, if necessary, agrees to hospital admission, then they are not detainable. Even if they don’t agree but are assessed to be making capacitous decisions unimpaired by mental disorder.
Everyone has the right to make poor decisions, the mental health act does not override that.

The mental health act stipulates that the least restrictive option is considered, so detention in hospital is very much a last resort. The decision is based on the level of risk, the patient’s capacity to make decisions about their care and their level of insight and willingness to engage with appropriate treatment. Treatment in the community has to be considered, and it is usual to explicitly state the reasons this is not considered to be a viable option.

Detained by who? It makes a difference who they disclose to.

I live with pretty much constant suicidal thoughts and sometimes intent.

If I were to tell A&E this, they would probably section me. If I were to tell a member of my family, they would take me to A&E which would result in the same outcome.

If I were to tell this to my therapist, he would keep hold of me until I was on an evenish keel and extract a promise from me that I will see him at our next session and if I don't think I can keep to that promise, call him no matter what time it is. He knows that these periods of actual intent are dangerous (I really would do it) but usually short lived and is confident in his ability to talk me down and keep me there until the urge passes.

So it probably depends on who you disclose to and their confidence in dealing with the situation.

This is detained by an an amhp team.

A&E can’t section you. They can request a mental health act assessment whereby 3 independent assessors would make a decision following comprehensive assessment.

The threshold here is a danger to other people. Or it was a few year ago. Yourself, not so much.

An AMHP team is a mental health act assessment. 2 doctors and a social worker making an assessment of risk, capacity, treatment needs etc.
Anyone (professionals or family member) can request a mha assessment.
Unless hospital admission is agreed to, this is (almost) the only way someone can be detained under the mental health act and admitted against there will.

I always thought it was a danger to either yourself or others?

*their

It is.
Risk to self is the most common reason for detention.

But surely if someone does the exact same dangerous thing both people should be detained?

Race, gender and class play a significant role.

@Wildtimes78889

But surely if someone does the exact same dangerous thing both people should be detained?

Not if one person is mentally impaired and their decision making is impacted by that and the other person has no apparent mental disorder but is capacitously making risky decisions with full understanding of the consequences.

@Neondisco

Race, gender and class play a significant role.

No. They don’t.

Shortage of beds often mean are they more of a risk to self and others than another patient
I know loads of people who have quit working in MH services because they don't agree with the decisions they were forced to make

I don’t think it’s a case that two people doing the exact same dangerous act are always of the same risk. I self harm and have been to A&E needing stitches countless times but have never been detained or forced to see the mental health team, I am able to explain that I’m not suicidal and I do it as a release and that I believe I am able to keep myself safe and I am careful to avoid arteries/ tendons/ muscle etc as best I can. I’m not deemed high risk as my intent is not to seriously hurt myself and I always seek out treatment of my injuries independently. They know I’ll do it again but equally that I’m not intending to kill myself so i’m not as significant risk of serious harm.

Another person might cut their arm in the same place/ depth etc but with the intention to kill themselves/ cause irreversible harm, they may not have sought out treatment themselves and may not comply with the medical staff, they may not be able to articulate themselves and they may be clear that they intend to try and hurt themselves again with the intention to end their lives. This person is likely to be deemed far more high risk than me and to be an immediate risk to themselves because next time they may try to do more damage or hurt themselves in another way compared to my injuries in which I try to avoid doing anything that would cause permanent damage and don’t want to die.

People also are only sectionable under the MHA if they refuse to be admitted voluntarily. If someone agrees to be admitted then there is no need to section them whatever the risk to themselves or others is.

My son was once not asked if he wanted to go inpatient and was just sectioned.

The capacity to consent to a potentially sustained informal admission would always be assessed during the MHA.

MHA assessment that should say.

@Wildtimes78889

My son was once not asked if he wanted to go inpatient and was just sectioned.

He may have been deemed not to have the capacity to make that decision. If someone’s mental disorder prevents them from making safe reasoned decisions, they can be detained. If the assessors felt he didn’t have capacity, they would not offer him the choice, as they would have assessed that he was not capacitous to make the decision himself. Hope that makes sense.

Thank you that makes sense