Mental Health Act 1983
The Mental Health Act 1983 (MHA) is one of the cornerstone pieces of legislation in the UK that governs the treatment, care, and protection of individuals with mental health disorders. Its primary objective is to balance individual rights with the need to protect the public and ensure that those suffering from mental health issues receive the necessary care and support. For facilities such as Elizabeth House Hospital, which provide acute inpatient mental health care, understanding the Act is fundamental to delivering appropriate, compassionate, and legally compliant treatment.
Below we aim to outline the Mental Health Act 1983 and how it is applied ensuring that patients, staff, and stakeholders understand the critical aspects of the law and how it supports mental health recovery, treatment, and protection.
Introduction to the Mental Health Act 1983
The Mental Health Act 1983 is a legislative framework that applies to England and Wales. It outlines when individuals can be admitted, detained, and treated in hospital against their will. This legal framework is essential for hospitals like Elizabeth House, where some patients may be detained under the Act when they pose a risk to themselves or others.
Key Objectives of the Act
Protection of individuals – The Act ensures that individuals with mental disorders are protected from harm, particularly when they are unable to make decisions about their treatment due to their mental health condition.
Safeguarding public safety – The Act helps protect the wider public from potential harm caused by individuals suffering from severe mental health conditions.
Promoting recovery – The Act promotes a focus on treatment and recovery, providing a framework within which mental health professionals can help individuals regain their health and independence.
Providing legal safeguards – The Act offers legal protections for individuals, ensuring that their rights are respected and that they can appeal decisions, particularly around detention.
Mental Disorders Defined by the Act
The MHA defines a mental disorder as "any disorder or disability of the mind." This broad definition includes a wide range of conditions such as:
Bipolar disorder
Psychosis
Depression
Personality disorders
Schizophrenia
Anxiety disorders
This broad categorisation is important for hospitals like Elizabeth House, which care for individuals with severe mental distress, ensuring that the necessary interventions are available for a wide array of conditions.
Key Sections of the Mental Health Act
The MHA contains several key sections that govern the circumstances under which an individual can be detained and treated. These sections play a significant role in the day-to-day operations of Elizabeth House.
Section 2: Assessment
Section 2 of the Mental Health Act allows for the detention of an individual for up to 28 days for assessment. This is typically used when there is uncertainty about a patient’s diagnosis, and a period of observation is needed. During this period, treatment can be provided if it is deemed necessary for the individual’s health or safety.
Criteria: The patient must be suffering from a mental disorder of a nature or degree that warrants their detention, and it must be necessary for their own health or safety or for the protection of others.
Duration: Up to 28 days.
Application: Application for detention is made by an Approved Mental Health Professional (AMHP) or the patient's nearest relative and requires the agreement of two doctors, one of whom is a psychiatrist.
For a facility like Elizabeth House, Section 2 is crucial for initial assessments of patients whose mental health status may be uncertain or rapidly deteriorating. This allows staff to observe and treat patients in a safe environment while developing an appropriate treatment plan.
Section 3: Treatment
Section 3 is used to detain an individual for treatment for up to six months. Unlike Section 2, Section 3 is specifically for individuals who have already been assessed and require ongoing treatment.
Criteria: The individual must be suffering from a mental disorder that necessitates detention for treatment, and it must be necessary for their health, safety, or for the protection of others. Additionally, the treatment must be available and likely to benefit the individual.
Duration: Initially, up to six months, with the possibility of renewal.
Application: Requires the recommendation of two doctors and an AMHP.
Elizabeth House’s clinical teams work within the scope of Section 3 when a patient requires a longer-term stay for intensive treatment. It is particularly relevant in managing conditions such as bipolar disorder, psychosis, and severe depression, where treatment is essential for stabilisation and recovery.
Section 4: Emergency Admission
Section 4 allows for the emergency admission of an individual for up to 72 hours. This is typically used in urgent situations where it is not possible to secure two medical recommendations required under Sections 2 or 3.
Criteria: The patient must need urgent admission due to a mental disorder that poses an immediate risk to their health or safety or the safety of others.
Duration: Up to 72 hours.
Application: Requires the recommendation of one doctor and an AMHP.
In a crisis, Section 4 allows for immediate and urgent admission to Elizabeth House, providing an essential safeguard for patients in acute distress.
Section 5: Holding Powers
Section 5 contains provisions for holding patients who are already in hospital. It is split into two subsections:
Section 5(2): Allows a doctor to detain an individual already admitted voluntarily for up to 72 hours if they believe the patient requires further assessment and the patient intends to leave the hospital.
Section 5(4): Allows a nurse to detain a voluntary patient for up to 6 hours if they believe the patient requires further assessment.
These powers are vital in ensuring the safety of patients already admitted to Elizabeth House Hospital if their condition suddenly deteriorates.
Safeguards and Patient Rights
The Mental Health Act 1983 is underpinned by legal safeguards that ensure the rights of individuals are protected while they are detained. Elizabeth House Hospital is committed to upholding these rights as part of its patient-centred care model.
Right to Appeal: Patients detained under the MHA have the right to appeal against their detention. They can appeal to the Mental Health Tribunal, an independent body that reviews the legal grounds for their detention. At Elizabeth House, the hospital ensures that all detained patients are made aware of their right to appeal and have access to legal representation if needed.
Right to Advocacy: Under the Mental Health Act, patients have the right to access an Independent Mental Health Advocate (IMHA). The IMHA helps patients understand their rights, including the reasons for their detention and the treatment options available to them. Elizabeth House Hospital supports patients in accessing IMHAs as part of its commitment to collaborative, inclusive care.
Consent to Treatment: For patients detained under Section 3, consent to treatment is governed by strict rules. For the first three months, treatment can be given without the patient’s consent. After this period, treatment can only continue if the patient consents or if a second opinion from an independent doctor is obtained. This ensures that patients’ autonomy is respected while also allowing for necessary treatment when individuals lack capacity.
Detention and Admission Processes at Elizabeth House
At Elizabeth House, the process of detaining a patient under the Mental Health Act is conducted with the utmost professionalism, sensitivity, and respect for the patient’s dignity. The hospital follows the protocols outlined in the MHA to ensure that patients are admitted and treated in compliance with the law.
Admission Process
Referral: The process typically begins with a referral from a community mental health team, GP, or psychiatrist. For urgent cases, referrals can also come from emergency services or an AMHP.
Assessment: Upon referral, a detailed assessment is conducted by a team of mental health professionals, including psychiatrists, psychologists, and social workers.
Application for Detention: If the patient meets the criteria for detention, an application is made under the relevant section of the MHA.
Admission: Once the application is approved, the patient is admitted to one of Elizabeth House’s acute wards, depending on their gender and condition.
Collaborative Care
Elizabeth House’s multidisciplinary team works closely with patients, their families, and community mental health teams to ensure that all treatment is holistic and focused on recovery. Detention under the MHA is not viewed as a punitive measure but as a necessary step in stabilisation and treatment, with the goal of helping patients return to community living as soon as possible.
Our Role in Recovery and Discharge
Elizabeth House Hospital provides a range of therapies, support services, and care aimed at helping patients recover from severe mental health conditions. The hospital’s model of care aligns closely with the principles of the Mental Health Act 1983, particularly in its emphasis on treatment, recovery, and discharge.
Stabilisation and Treatment: The primary goal of treatment under the MHA is to stabilise the patient’s condition. Elizabeth House Hospital offers a range of therapies, including one-to-one counselling, group therapy, and medication management, all aimed at addressing the underlying mental health disorder.
Discharge Planning: From the moment a patient is admitted, discharge planning begins. Elizabeth House Hospital works closely with community mental health teams to ensure that patients have the necessary support to transition back into the community. Discharge is typically based on the patient’s progress in treatment, their ability to manage their condition, and the availability of community-based support services.
Aftercare (Section 117): Patients detained under Sections 3, 37, or 47 of the MHA are entitled to free aftercare under Section 117 of the Act. This includes support with housing, access to mental health services, and any other services required to prevent the individual from being readmitted to hospital. Elizabeth House’s discharge teams collaborate with local authorities and health services to ensure that aftercare is in place before a patient leaves the hospital.
Amendments to the Mental Health Act and Our Compliance
The Mental Health Act has undergone several amendments, most notably in 2007. These amendments introduced new safeguards for patients, including changes to the definition of mental disorder and the introduction of Supervised Community Treatment (SCT).
Supervised Community Treatment: SCT allows certain patients who have been detained under Section 3 to be treated in the community under specific conditions. This helps ensure continuity of care and reduces the risk of relapse. Elizabeth House Hospital is fully compliant with these amendments, ensuring that SCT is used appropriately for patients who can benefit from treatment outside of the hospital environment.
Compliance with CQC and NHS Guidelines: Elizabeth House’s operations are guided not only by the MHA but also by Care Quality Commission (CQC) regulations and NHS guidelines. The hospital regularly undergoes audits and inspections to ensure that it adheres to all legal requirements, including those set out by the Mental Health Act.
The Mental Health Act 1983 is an essential legal framework that supports the care and treatment of individuals with severe mental health disorders. For Elizabeth House, the Act provides the foundation for delivering high-quality, patient-centred care, ensuring that individuals receive the necessary treatment while safeguarding their rights.
Elizabeth House’s commitment to the principles of the MHA is reflected in its approach to care, which emphasises safety, recovery, and dignity. By adhering to the provisions of the Act, Elizabeth House ensures that its patients receive the compassionate, evidence-based care they need to stabilise and recover, ultimately aiming for successful discharge and reintegration into the community.
Understanding and applying the Mental Health Act 1983 is not just a legal requirement for Elizabeth House but a crucial aspect of delivering effective mental health care in a manner that respects the rights and dignity of each individual. Through careful adherence to the law, Elizabeth House ensures that it remains a safe, supportive, and therapeutic environment for all its patients.