Guide to the 1983 Mental Health Act For detained service users South London and Maudsley NHS Foundation Trust Page SLaM A5 16pp temp (v7 PLAIN).ind1 1 22/09/2008 10:30:49
Introduction This booklet is for anyone detained under the 1983 Mental Health Act (MHA). It tells you about the main sections of the MHA. If you are on a section, a nurse should have given you a rights leaflet and explained what your section means. Both that leaflet and this booklet are to help you know more about what being on a section means and what your legal rights are. If you have any comments about this booklet or any suggestions on how to make it better please contact: Bob Lepper MHA Policy Lead/Adviser 111 Denmark Hill Maudsley Hospital London SE5 8AZ Telephone: 020 3228 2588 Page 2
What are the main sections of the MHA? There are six main sections. Sometimes your section can be changed while you are in hospital. You should know which section you are on. There are other sections which apply to someone who comes to hospital from court or from prison. If you are under one of those sections you should know which section it is. These sections are not covered in this booklet. If you are confused about what section you are on please speak to a member of staff. Section 2 This section lasts for up to 28 days. Two doctors and an Approved Mental Health Professional decide when someone is put on Section 2. While on a Section 2 a senior doctor known as a Responsible Clinician will be in charge of your care and treatment. Appeal rights against this section are dealt with on page 7-9 of this booklet. Section 3 This lasts up to six months. Two doctors and an Approved Mental Health Professional decide when someone is put on Section 3. While on Section 3 a senior doctor called a Responsible Clinician will be in charge of your care and treatment. The main purpose of Section 3 is to treat you for your mental health problem. Page 3
If you are under Section 3 and are ready to leave hospital you have a right to aftercare (known as Section 117). This aftercare is to help meet your needs back in the community and is free of charge. Appeal rights against Section 3 are dealt with on page 7-9 of this booklet. If you are under Section 3 your Responsible Clinician may talk to you about leaving hospital under Supervised Community Treatment. Sometimes this is called a Community Treatment Order (CTO). Leaving hospital under a CTO means that you must carry on having treatment in the community. While on CTO in the community you might be brought back to hospital if your care team are concerned about you. Section 4 If you were brought to hospital under Section 4 it means the Approved Mental Health Professional assessing you was very concerned about you and needed to act quickly. Section 4 means only one doctor saw you. Section 4 only lasts for up to 72 hours and is usually followed by Section 2 or Section 3. Page 4
Section 5(2) If you came into hospital without being on a section you were an 'informal' or 'voluntary' patient. If you wanted to leave and this was not considered appropriate the decision was made to assess you under Section 2 or Section 3. It takes time to carry out an assessment and sometimes a person is placed under Section 5(2) to stop them leaving. Section 5(2) is done by one doctor and only lasts up to 72 hours. It is sometimes called a holding power. During the 72 hours you were assessed for Section 2 or 3. Section 5(4) If a doctor was not available to use Section 5(2) (see above paragraph) a nurse may have stopped you leaving by placing you under Section 5(4). This section only lasts up to six hours and ends when a doctor comes to see you. Section 136 A small number of people are brought to hospital under Section 136. This is a power which a police officer can use if you were in a public place and that police officer had concerns about you. Page 5
What happens when you are under a section? Treatment The team caring for you should always talk to you about your treatment, including medication. The treatment should be explained to you in a way you understand and the team should try to get your agreement. If you are under Section 2 or Section 3 and you refuse to take medication, the law allows the team to make you take it. If after three months you still do not want to take the medication (or you are not able to make the decision) a Second Opinion Appointed Doctor (SOAD) will visit you on the ward. This doctor is called a SOAD and is completely independent of your hospital doctor. The SOAD will then decide what medication you need to have. Your hospital doctor should then tell you why the SOAD has made that decision. Leave If you are on a section, any time you have off the ward needs to be agreed by the Responsible Clinician looking after you. This is called Section 17 leave. If you are given leave, you should be told how much leave you have and whether you need a nurse or someone else to escort you. If you do not follow any conditions attached to your leave (for example returning by an agreed time) the police may bring you back to the hospital. Page 6
Can I appeal against my Section? NOTE - If you are on Section 2 you must appeal within the first 14 days of the section. There are appeal rights against Section 2 and Section 3 and the nurse who gave you information when you were sectioned should have told you about these rights. The leaflet you were given tells you about these rights too. Appeals to the Tribunal Under Sections 2 and 3 you can appeal to the Mental Health Review Tribunal. The Tribunal is completely independent of the hospital and you are entitled to legal aid if you want a solicitor to help you put your case to the Tribunal. You will be told where and when the Tribunal takes place. The Tribunal will consider reports written by members of your care team. The Tribunal will also hear your views or you can ask your solicitor to put your case. At the end of the tribunal it will be decided whether your section will end or not. Page 7
Appeals to the Hospital Managers You can also appeal against your section to the Hospital Managers. In this Trust these people are called Associate Hospital Managers. They are appointed by the Trust Board but should not be confused with people who are employed by the Trust as managers. You will be told when and where your Managers Hearing is to be held. Reports by members of your care team will be presented to the panel of three Managers and the panel will also want to hear your views. At the end of the hearing the panel will decide whether to end your section or not. Ending Sections If you are under Section 2 or Section 3 your Responsible Clinician can decide to end your section at any time if he or she thinks you are well enough. Your section could also be ended by the Tribunal or the Hospital Managers (see above) after they have considered your case. A Section 2 cannot last longer than 28 days and cannot be extended. A Section 3 is sometimes extended beyond six months if your Responsible Clinician feels that you are still unwell and need further treatment in hospital. Page 8
Nearest Relative The MHA gives important rights and responsibilities to someone called the patient's nearest relative. Not every patient has a nearest relative but if you have one the Approved Mental Health Professional (who sectioned you) told you who that person is. Normally it will be your partner (if you have one) or a family member. Your nearest relative is not always the person you would choose to be your next of kin. If you are unhappy with who has been identified or do not want them to know about your care and treatment please tell a member of the care team looking after you. Your nearest relative does have the right in law to ask for your section to be ended. If they do request this, your Responsible Clinician has up to 72 hours to consider the request and decide whether it is safe for you to leave hospital. Page 9
Other Rights The Care Quality Commission Under the MHA a body called the Care Quality Commission is an important safeguard for detained patients. People called Commissioners regularly visit hospitals. If they plan to visit your ward you will be told they are coming. You are free to meet them in private and tell them about any concerns you have. Detained patients can also complain to the Commission about any part of their care and treatment but normally it is best to use the hospital complaints system first (see the back page of this booklet). Independent Mental Health Advocates An Independent Mental Health Advocate (IMHA) is someone completely independent of your care team. It sometimes helps to have an independent person to explain about being on a section and this is what an IMHA does. If you want to speak to or meet with an IMHA one of the nurses on your ward will put you in touch with them. Having an IMHA does not stop you also having a solicitor or general advocate or a member of the PALS team to offer you support Page 10
Notes This page is for you to write down information about your section. Name: Date section began: Date section ends: Name of my Responsible Clinician (senior doctor): Name of ward doctor: Name of my primary nurse: Name of my care coordinator (if one has been allocated): Name of my solicitor and contact details: Name of my advocate: Date of Tribunal or Managers Hearing (if one has been arranged): Page 11
Date of Publication: 29/05/2009 Reference Page : lc00001666 Options available If you d like a large print, audio, Braille or a translated version of this leaflet then please ask us. Complaints If you are not happy about something but not sure you want to make a formal complaint you can speak to a member of staff directly. Alternatively you can contact the PALS Office on freephone 0800 731 2864. If you decide you want to make a formal complaint this can be done by contacting the Complaints Department: Complaints Department, Maudsley Hospital, Denmark Hill, London SE5 8AZ T: (020) 3228 2444/2499 E: complaints@slam.nhs.uk W: www.slam.nhs.uk Useful contact details SLaM Switchboard: 020 3228 6000 SLaM 24hr Information Line - Advice on how to access SLaM Services: 0800 731 2864 Contact our Patient Advice and Liason Service (PALS) for help, advice and information: T: 0800 731 2864 W: www.pals.slam.nhs.uk E: pals@slam.nhs.uk www.tfl.gov.uk/journeyplanner For the quickest way to plan your journey anywhere in greater London use journey planner: 020 7222 1234 (24hrs) South London and Maudsley NHS Foundation Trust SLaM A5 16pp temp (v7 PLAIN).ind4 4 22/09/2008 10:30:49