Who should act as the second medical recommendation for Sections 2 and 3 of the Mental Health Act?

Since 1959, the responsibility to detain a patient in hospital compulsorily has been given to doctors, social workers and hospital managers. The 1983 Mental Health Act stipulates that medical recommendations are made by two medical practitioners (one an “approved” doctor) for compulsory admission for assessment (Section 2) and compulsory admission for treatment (Section 3). When this was debated in Parliament, the importance of the independence of the two doctors making medical recommendations was stressed. This was to avoid collusion, influence or interference with clinical judgement (Bluglass, 1983).

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The working of the 1983 Mental Health Act: the experience of patients, relatives, psychiatrists, general practitioners and social workers involved in compulsory admission

Psychiatric Bulletin ◽

10.1192/pb.13.9.477 ◽

1989 ◽

Vol 13 (9) ◽

pp. 477-479 ◽

Cited By ~ 5

Author(s):

Lynne Webster ◽

Christine Dean

Keyword(s):

Mental Health ◽

Social Workers ◽

General Practitioners ◽

Civil Liberties ◽

Compulsory Admission ◽

Hospital Managers ◽

Mental Health Act

The 1983 Mental Health Act was introduced to increase the safeguards of the civil liberties of patients. One of the new provisions is that it is now the statutory responsibility of hospital managers to inform detained patients of their rights; this is done by giving them a leaflet explaining the appeal procedures. Doubt has been expressed (Dunlop, 1979) about whether this is an efficient means of conveying information to acutely ill patients.

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Audit of delays in the diversion of mentally disordered defendants under the Mental Health Act 1983/2007 at a liaison and diversion service in North West London

BJPsych Open ◽

10.1192/bjo.2021.932 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S352-S353

Author(s):

Seema Sukhwal ◽

Claire Gordon-Ellis ◽

Luneta Tajblova

Keyword(s):

Mental Health ◽

Justice System ◽

North West ◽

Mentally Disordered ◽

Code Of Practice ◽

Mental Health Act ◽

Hospital Bed ◽

Act Assessment ◽

Medical Recommendations ◽

Medical Recommendation

AimsTo ascertain the length of time defendants wait for a Mental Health Act assessment (MHAA) and where necessary, how long they are waiting for a hospital bed.BackgroundThe Liaison and Diversion Service in North West London (the Service) is provided by Central North West London Foundation NHS Trust (CNWL), Barnet Enfield Haringey (BEH) and Together to Willesden Magistrates Court in North West London.One of the core activities of the Service is diverting individuals from the criminal justice system to hospital under the Mental Health Act (MHA).The Code of Practice allows for a period of 14 days between the medical recommendation and conveyance to hospital. Defendants needing admission under MHA are remanded to custody if a bed is not available. This prevents them from receiving the assessment and care they need. We consider that all defendants found to be liable to detention under the MHA should be admitted to a hospital bed on the same day.MethodData were collected between October 2018 and February 2019. All patients referred for a MHAA were included. The time a MHAA was requested, took place as well as how long the defendant waited for a bed was noted.ResultA total of 42 MHAA were requested. 25 individuals were detained under Section 2 of the MHA 1983.The time between referral for a MHAA and the MHAA taking place was obtained in 25 of the 42 referrals. The range of times between a referral being made and the assessment taking placed varied between 1.5 hours and 22 hours. Two defendants were remanded overnight in prison as the MHAA could not take place on the same day as the referral.In the 25 cases where an application for detention under Section 2 of the MHA was made, beds were not available on the same day in 7 cases. In 4 cases defendants required remand in prison custody due to beds not being available.ConclusionThere were some limitations to this audit as data were not available for all 42 individuals referred for a MHAA.Individuals referred for MHAA by the Service had both medical recommendations completed within 5 days and those who required admission to hospital were admitted within 14 days of the recommendations being completed.Whilst these standards are being met, individuals referred for MHAA and those requiring admission to hospital are still facing remand to custody.

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Compulsion under the Mental Health Act 1983: audit of the quality of medical recommendations

The Psychiatrist ◽

10.1192/pb.bp.111.034819 ◽

2012 ◽

Vol 36 (1) ◽

pp. 11-15 ◽

Cited By ~ 8

Author(s):

Julian Mason ◽

Hannah Roberts ◽

Rebecca Northridge ◽

Garyfallia Fountoulaki ◽

Emma Andrews ◽

...

Keyword(s):

Mental Health ◽

Gold Standard ◽

Community Treatment ◽

Mental Health Practitioners ◽

Mental Health Act ◽

Health Practitioners ◽

Medical Recommendations ◽

Medical Recommendation ◽

Relevant Education

Aims and methodTo audit the quality of medical recommendations for detention under the Mental Health Act 1983, Section 2 and 3. The recommendations were tested against a gold standard based on the statutory criteria. Two cycles were completed, the first containing 214 recommendations, the second 202. Relevant education took place after the first cycle.ResultsThe percentage of medical recommendations containing clear statements of why each of the statutory criteria was met increased in the second cycle. It reached 87% for mental disorder; 87% for nature and/or degree; 75% for why community treatment was not possible; 64% for why detention was in the interests of health; 60% for safety; 55% for protection of others; and 70% why informal admission was not possible.Clinical implicationsDoctors, scrutineers and approved mental health practitioners welcomed clear guidance about what is expected in a medical recommendation for detention and endorsed the gold standard described. Armed with a better understanding of what is expected and a template to follow, there was an improvement in the reasons given for detention.

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Section 29

The British Journal of Psychiatry ◽

10.1192/bjp.109.459.202 ◽

1963 ◽

Vol 109 (459) ◽

pp. 202-205 ◽

Cited By ~ 14

Author(s):

H. F. Paterson ◽

A. R. Dabbs

Keyword(s):

Mental Health ◽

General Hospital ◽

Mental Hospital ◽

Psychiatric Ward ◽

Compulsory Admission ◽

Mental Health Act ◽

Medical Recommendation

The wording of the Mental Health Act, 1959 makes it clear that an application under Section 29 replaces both the old Urgency Order and the D.A.O.'s three-day order as a means of compulsory admission to a mental hospital or the psychiatric ward of a general hospital. It was intended to be limited to cases where the patient's mind is so acutely deranged as to make him a grave and immediate danger to himself or others, so that the delay in obtaining a second medical recommendation required for admission under Section 25 might spell disaster.

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General practitioners' referrals for compulsory admission under the Mental Health Act, II: the process of assessment

Psychiatric Bulletin ◽

10.1192/pb.16.3.139 ◽

1992 ◽

Vol 16 (3) ◽

pp. 139-141 ◽

Cited By ~ 2

Author(s):

Michael Sheppard

Keyword(s):

Mental Health ◽

Mental Disorder ◽

General Practitioners ◽

Social Worker ◽

Emergency Admission ◽

Compulsory Admission ◽

Mental Health Act ◽

Process And Outcome ◽

The Law ◽

Medical Recommendations

This is the second of two articles on GP referrals for compulsory admission, and seeks to examine the process and outcome of assessment by (a) comparing GP with other section assessment referrals and (b) comparing GP referrals who were compulsorily admitted to hospital with those not compulsorily admitted or voluntarily admitted. In relation to the law the main relevant sections for this article are sections 2, 3 and 4. There are two basic grounds for admission: that the patient is suffering from a mental disorder and that admission is in the interests of his/her own health or safety or for the protection of others. Section 4 requires one and sections 2 and 3, two medical recommendations, as well as an application by an approved social worker (ASW) or nearest relative. Section 2, admission for assessment, involves admission for up to 28 days; section 4, emergency admission for assessment, involves admission for up to 72 hours; and section 3, admission for treatment, allows admission for up to six months, and is renewable.

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The 1983 Mental Health Act in Five Local Authorities: a Study of the Practice of Approved Social Workers

International Journal of Social Psychiatry ◽

10.1177/002076409203800303 ◽

1992 ◽

Vol 38 (3) ◽

pp. 189-207 ◽

Cited By ~ 16

Author(s):

Barbara Hatfield ◽

Hadi Mohamad ◽

Peter Huxley

Keyword(s):

Mental Health ◽

Social Workers ◽

Local Authorities ◽

Mental Health Act

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The law

Oxford Handbook of Learning and Intellectual Disability Nursing ◽

10.1093/med/9780199533220.003.0013 ◽

2009 ◽

pp. 459-498

Keyword(s):

Mental Health ◽

Human Rights ◽

Compulsory Admission ◽

Sexual Offences ◽

Disability Discrimination ◽

Mental Health Act ◽

Assessment And Treatment ◽

Human Rights Act ◽

Disability Discrimination Act ◽

Health Review

Mental Health Act 1983 460 Mental Health Act 2007 462 Compulsory admission to hospital for assessment and treatment 464 Emergency holding powers 466 Mental Health Review Tribunals 468 The Mental Health Act Commission 470 Sexual Offences Act 472 Disability Discrimination Act 2005 474 Human Rights Act ...

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