Mental Health Act 1983 Basics

The Mental Health Act 1983 contains numerous provisions, but the most commonly applied sections include:

• Section 2: Admission for assessment — up to 28 days, used when the nature or degree of the disorder is uncertain.
• Section 3: Admission for treatment — initially up to 6 months (renewable), used when the disorder and treatment needs are known.
• Section 4: Emergency admission for assessment — up to 72 hours, requires only one medical recommendation and an AMHP application in genuine emergencies.
• Section 5(2): Doctor's holding power — up to 72 hours — allows a doctor to detain a voluntary patient already in hospital while a full assessment is arranged.
• Section 136: Police power to remove someone from a public place to a place of safety for assessment — up to 24 hours.
• Section 17A: Community Treatment Orders — allowing discharge from hospital subject to conditions.
• Section 117: Aftercare — duty to provide free aftercare on discharge from certain sections.

An Approved Mental Health Professional (AMHP) is typically a social worker, psychiatric nurse, occupational therapist, or psychologist who has completed specific MHA training and is approved by a Local Authority. The AMHP plays a central role in most MHA assessments:

• The AMHP must carry out a face-to-face assessment before making an application for detention under Sections 2, 3, or 4.
• The AMHP must consider all available alternatives to detention and must apply only when they conclude it is the most appropriate course.
• The AMHP coordinates the assessment — including arranging the required medical recommendations — and makes the final application to the hospital managers.
• The AMHP must consult the nearest relative (unless impracticable) before applying under Section 3, and the nearest relative can object to block a Section 3 application.

An AMHP acts as an independent safeguard against unnecessary detention and must act in the patient's best interests throughout.

The majority of people admitted to psychiatric hospitals in England and Wales are "informal" (voluntary) patients — they have consented to admission and are not detained under the MHA 1983. Informal admission is always preferred over compulsory detention where the person has the capacity to agree to admission and is willing to do so.

Informal patients:

• Can in principle leave hospital at any time (though staff may use holding powers such as Section 5(2) if they try to leave and are assessed as at risk).
• Have the right to refuse treatment — though this is subject to the Mental Capacity Act 2005 if they lack capacity.
• Should be told of their informal status and that they are not compelled to stay.

The Deprivation of Liberty Safeguards (DoLS) or Mental Capacity Act procedures must be used (rather than informal admission) for people who lack capacity to consent to admission but do not object to being in hospital.

Patients detained under the MHA 1983 retain important legal rights:

• Right to appeal to a Mental Health Tribunal: Detained patients can apply to a First-tier Tribunal (Mental Health) to challenge their detention at specified intervals.
• Right to an Independent Mental Health Advocate (IMHA): All detained patients have the right to free support from an IMHA who can help them understand their rights and represent their views.
• Right to information: Patients must be given written information about their section, their rights, and how to access an IMHA.
• Right to have their nearest relative consulted and informed.
• Right to consent to or refuse treatment — subject to the MHA 1983's provisions on treatment without consent (which apply in specific circumstances after a defined period of detention).
• Right to complain to the hospital, Care Quality Commission, or Parliamentary and Health Service Ombudsman.