What is the MHA?

It is legislation that governs patients’

• Compulsory detention
• Treatment
• Discharge
• Aftercare

It can be used to hospitalise patients that have a mental illness which:

1. Requires assessment or treatment
   and
2. Poses a threat to the self or others
   and
3. Results in the patient not being able to consent

There are various Sections to the MHA. You can read it in full here.

The Sections most pertinent to the work of junior doctors are 2, 3, 4, 5(2), 5(4), 135 and 136. Here, we will give a brief run-down of each of these Sections, followed by relevant/practical knowledge for use in the hospital:

Section 2

• Admission for assessment
• Allows treatment to be given whilst the patient is assessed within a psychiatric setting
• Duration = up to 28 days
• Must be signed by two doctors and an AMHP. One of these doctors must be Section 12 approved
• Cannot be renewed
• Patients can appeal

Section 3

• Admission for treatment
• Duration = up to 6 months
• Allows treatment to be given for mental illness for the first 3 months. For the following 3 months, the patient must consent to treatment or a third opinion must be obtained
• Must be signed by two doctors and an AMHP. One of these doctors must be Section 12 approved
• Patients can appeal

Section 4

• Admission for assessment in cases of emergency
• Duration = up to 72 hours
• Must be signed by an AMHP and a doctor
• Does not allow treatment against the patient’s will

Section 5(2)

• “Doctor’s Holding Power”
• Emergency holding power for current inpatients – used to prevent patients from leaving the hospital
• Can be signed by the patient’s responsible consultant or their nominated deputy
• Duration = up to 72 hours
• Does not allow treatment against the patient’s will
• Discussed in more detail below

Section 5(4)

• Another emergency holding power for inpatients
• Can be signed by a registered mental health nurse
• Duration = up to 6 hours
• Does not allow treatment against the patient’s will

Section 135

• Used by the police to bring people who are believed to be mentally unwell from their home to a ‘place of safety’
• Duration = up to 24 hours, with an option to extend for a further 12 hours
• Requires a warrant to be obtained by a social worker
• Does not allow treatment against the patient’s will

Section 136

• Used by the police to bring people who are believed to be mentally unwell from a public place to a ‘place of safety’
• Duration = up to 24 hours, with an option to extend for a further 12 hours
• Does not allow treatment against the patient’s will

Note that the MHA does not consider alcohol/drug dependency alone to be a mental illness that justifies detention.

In general, your seniors will be involved when it comes to using the MHA as a foundation doctor. You should always attempt to contact them when you believe a patient may need to be detained. The section most likely to be useful to you when working in the hospital is Section 5(2) (the “Doctor’s Holding Power”).

In summary:

This allows the detention of a current inpatient for up to 72 hours, whilst waiting for an official assessment for detention under Section 2 or 3. You may apply a Section 5(2) to a patient if you have a full medical registration i.e. FY2 and above. Regardless, you should aim to discuss this with your consultant/relevant senior whenever possible.

It cannot be applied to any outpatients or patients in the emergency department (as they are technically not inpatients). You cannot admit a patient solely for the purpose of detaining them under Section 5(2).
To apply a Section 5(2), you must complete Form H1 (after examining the patient yourself). This is a pink form and should be available on every ward. Familiarise yourself with the form when you can, so that it’s easier to fill in should it be needed.

You should always inform the patient of the reason they are to be detained. Once the form has been completed, return it to the Sister in Charge who will then forward it to the appropriate managers. The Section then becomes active.

A Section 5(2) will allow sufficient time for a full assessment for Section 2 or 3 to take place. Note that a Section 5(2) alone does not allow treatment to be given to the patient against their will.

Once again, this is a summary of the MHA to aid with your familiarisation. All decisions regarding detaining patients should ideally be made in conjunction with your seniors. Importantly, remember to maintain the patient’s safety and dignity at all times, along with your own safety.

Written by Caio Redknap FY2