Mental Health Act - Detention under Section 2 or Section 3
|Publication: 15/04/2014 --|
|Last review: 08/04/2020|
|Next review: 31/08/2022|
|Standard Operating Procedure|
Supported by: Mental Health Legislation Steering Group
Approved By: Chief Nurse
|Copyright© Leeds Teaching Hospitals NHS Trust 2020|
This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
Mental Health Act - Detention under Section 2 or Section 3
Standard Operating Procedure
- Procedure to be Followed
- Roles and Responsibilities
- Links to Other Documents
- Monitoring Arrangements
- Appendix A - Nurses Checklist for receiving MHA Papers on Ward
- Appendix B - AMHP Brief outline Report template
- Appendix C - H3 blank form for receiving Nurse-in-charge / Sister
- Appendix D - H3 ‘dummy version for guidance
- Appendix E
Admission to hospital: patient information leaflet - Section 2
Admission to hospital: patient information leaflet - Section 3
- Appendix F - Section 132 Patient Rights Recording Tool
- Appendix G - MHA detention process Flowchart with hyperlinks
When a patient on an LTHT ward is assessed as needing to be detained under the Mental Health Act; then the Nurse in Charge or Nurse looking after the patient have specific legal duties, delegated to them under the MHA.
These duties are described in detail in part 4 of this procedure and the flowchart at Appendix 1. In summary these duties are:
- To formally receive and scrutinise detention papers on the Ward
- To confirm the Detention under MHA by completing form H3 and contacting LTHT MCA/MHA Team
- To give information to the detained patient and their nearest relative about their rights as soon as possible upon detention.
- To report to LTHT MCA/MHA team on all relevant matters relating to a detained patient
Relevant Forms, guidance, procedures are available on MCA/MHA intranet site:
This procedure aims to ensure that:
- All parties involved in the detention of patients to LTHT, understand their specific duties under the Mental Health Act (MHA) and the responsibilities of all others involved.
- Detentions under Section 2 and Section 3 MHA are legally robust and in compliance with MHA Code of Practice.
- Patients thus detained, are supported to understand and exercise their Rights under Section 132 MHA in a timely and person focussed manner.
- LTHT staff are signposted clearly to LTHT MCA/MHA Team for support on all relevant MHA issues.
- All those involved engage appropriately with LTHT MCA/MHA team to ensure that MHA Papers are accurately completed, safely stored/transferred and errors rectified within clearly defined time frames.
The Mental Health Act 1983 (which was substantially amended in 2007) is an Act of the Parliament which applies to people in England and Wales. It covers the reception, care and treatment of mentally disordered persons, the management of their property and other related matters.
It provides the legal framework by which people diagnosed with a mental disorder can be detained in hospital and have their disorder assessed or treated against their wishes, unofficially known as "sectioning".
It prescribes the rights such detained patients have and must be supported to access. Its use is reviewed and regulated by the Care Quality Commission.
The process of detention is laid down in law and must be complied with to ensure that actions are lawful.
The following information details the process to follow, when a patient admitted to, or already a patient in, the Trust, is detained under the Mental Health Act 1983 (MHA).
It is a legal requirement to follow correct procedures when a patient is detained in the Trust under the provisions of the MHA as this will ensure the rights of the individual are recognised, and that any potential for action against the Trust for unlawful detention or treatment is minimised.
The procedure applies to any in-patient, of any age, who is judged in need of detention to the LTHT under the terms of the MHA Sections 2 and 3.
There is a separate Procedure for the use of MHA holding Powers under Section 5 - S5(2) Doctor’s holding powers.
There is a separate Protocol relating to the Transfer of Patients (under MHA Section 19) and a Procedure for the safe conveyance of mental health patients.
It does not apply to Emergency Departments or other public and out-patient areas – there is a separate Procedure and guidance for the use Section 136 MHA that relates to the Police powers to detain a person from a public place to a ‘Place of Safety’ such as A&E.
Mental disorder: Any disorder or disability of the mind, apart from dependence on alcohol or drugs. A person with a learning disability is not considered to have a mental disorder – for the purposes of MHA, unless that disability is associated with abnormally aggressive or seriously irresponsible conduct.
Mental Health Act 1983 (MHA): Legislation mainly about the compulsory care and treatment of patients with mental health problems. It covers detention in hospital for mental health treatment, supervised community treatment and guardianship.
Section 2: Section 2 of the Mental Health Act allows the compulsory admission to hospital for assessment, or for assessment followed by medical treatment, for a duration of up to 28 days. Section 2 cannot be renewed and if somebody needs to stay in hospital after the 28 days, then an assessment for detention under a Section 3 must take place.
Section 3: Section 3 of the Mental Health Act allows people to be admitted to hospital and detained for treatment for up to 6 months. Detention under Section 3 can be renewed for a further period of 6 months, and then for further periods of one year at a time. (Detention under Section 3 can only be renewed if the patient has been seen and assessed by the doctor responsible for their care during the 2 months before the date at which the Section 3 is due to expire).
Responsible Clinician: The Responsible Clinician is the Approved Clinician who will have overall responsibility for the patient’s treatment for mental disorder. They must be trained and registered as an Approved Clinician under the terms of the MHA and would usually be a Consultant Psychiatrist. In LTHT this function is delegated to the relevant Hospital Mental Health Team in the employ of Leeds and York Partnership NHS Foundation Trust.
Approved Clinician: A mental health professional approved by the Secretary of State for Health to act as an Approved Clinician for the purposes of the MHA.
Approved Mental Health Professional (AMHP): An AMHP can be a social worker, a psychiatric nurse, an occupational therapist or a clinical psychologist with specialist MHA training and approval. They work as autonomous professionals though employed on behalf of a Local Authority. Their role is to complete Mental Health Act assessment on the basis of the medical recommendations and to decide whether to apply for detention under the Act or not.
Detention: refers to a patient who is held compulsorily in hospital under the MHA for a period of assessment or medical treatment.
Hospital managers: In the context of the MHA refers to the individual or body responsible for MHA matters for a particular hospital Trust. In LTHT the ‘Hospital Managers’ is the Trust Board.
Nearest Relative: MHA s26 defines who a person’s Nearest Relative for the purposes of the Act. They have specific rights and responsibilities under MHA to safeguard the patient’s rights. The Nearest Relative is not necessarily the same as a person’s Next of Kin.
MHA Application and detention process
1st and 2nd medical recommendation by Psychiatry team (Pink Form):
- Recommending Doctors (Psychiatry) make entry in Patient record.
- Doctors might attend Ward separately but must be within 5 days of each other. (Section 2: 2x Form A4 / Section 3: 2x Form A8)
- Doctors may attend and assess together and complete joint recommendation. (Section 2: 1x Form A3 / Section 3: 1x Form A7)
- Doctor must handover Recommendation Forms to identified Nurse-in-charge or Ward Sister and confirm with LTHT MCA/MHA team.
- Nurse-in-charge keeps Recommendation Forms safe on Medical record.
- Nurse-in-charge contact LTHT MHA team with patient, ward and location of Forms details. This must happen on receipt of the first Form (i.e. as early in the procedure as possible)
AMHP application to detain (Pink Form):
- AMHP completes assessment of patient;
- Makes application to detain( section 2: A2 / Section 3: A6)
- AMHP and Nurse-in-Charge / Ward Sister check all Pink Forms using “Nurses’ Checklist for receiving MHA Papers on Ward” at Appendix A.
- Nurse-in-Charge / Ward Sister completes H3 in presence of AMHP
- AMHP and Nurse-in-Charge / Ward Sister sign AMHP Short Report.
- Original AMHP short report kept with all other original MHA papers by Nurse-in-Charge / Ward Sister
- Nurse-in-Charge / Ward Sister Fax all Forms (Medical recommendations / AMHP Application / AMHP Short Report / H3 immediately to LTHT MHA Office on 66541
- Nurse-in-Charge / Ward Sister contact LTHT MCA/MHA team immediately to arrange secure storage of originals (originals will be collected and held in LTHT MHA office or secured on ward if the patient is about to transfer to a psychiatric bed)
Provision of information about Patient’s Rights (MHA Section132):
The Hospital Managers have a statutory duty under section 132 to ensure that all patients subject to the MHA are given certain information as soon as practicable after the start of detention.
- Nurse-in-Charge / Ward Sister must make an initial attempt to explain the basic information by using the relevant ‘Admission to hospital: patient information leaflet’ (Section 2- S2 / Section 3 - S3) and recording their actions in the S132 Rights Recording Tool
- Nurse-in-Charge / Ward Sister contacts LTHT MCA/MHA team to arrange a S132 visit by the team.
- Nurse-in-Charge / Ward Sister keep S132 recording tool secure on patient record for completion/collection by LTHT MCA/MHA team.
LTHT MCA/MHA Team role:
- LTHT MCA/MHA team will provide legal scrutiny, advice, education, co-ordination and case support regarding detained patients.
- The team are responsible for governance and assurance arrangements relating to MHA matters.
- The team will make regular visits to patient to ensure all other S132 Rights are explained and written information given to Patient and their Nearest Relative as required.
- The team will make automatic referrals to IMHA service for patients detained to LTHT who are unable to give a valid / clear refusal.
5.1 Mental Health Act Administrator LTHT: Responsibility for receiving and scrutinising all Mental Health Act documentation for LTHT and ensuring appropriate action is taken, or that documentation related issues are resolved. To provide liaison and support to Ward staff on the completion, rectification and storing of Mental Health Act papers. To maintain the LTHT MHA data set and produce quarterly data as directed by Head of Mental Health Legislation.
5.2 Lead Professional MCA/MHA: To work with all professional groups throughout Leeds Teaching Hospitals NHS Trust (LTHT), all stakeholders and partner agencies across traditional inter-agency and professional boundaries to provide robust clinical leadership, expert specialist advice and support to a comprehensive range of multi-disciplinary professionals dealing with patients subject to consideration under the Mental Health Act 1983.
5.3 Nurse Advisor MCA/MHA: to provide on-ward continuity between LTHT MCA/MHA team and Wards where a patient is detained. To co-ordinate and facilitate the completion of Section 132 Rights and information on behalf of Hospital Managers, including sharing information with the Nearest Relative
4.4 Head of Mental Health Legislation: to provide overall leadership on all MHA and MCA matters across the Trust. To ensure MHA frameworks are followed, monitored, reported through appropriate Governance structures and remedial actions are identified. To provide quarterly assurance, design education packages for relevant staff; provide expertise to operational staff and the Executive leadership and to represent LTHT at relevant MHA meetings.
5.5 Nurse -in-charge / Ward Sister (LTHT): must be aware of and comply with the contents of this procedure by ensuring:
- Specific checks are undertaken on all section papers for section 2, 3 and section 19 transfer.
- That the receipt of section papers is appropriately documented by completion of the ‘Nurses checklist for receiving papers’
- Support any AMHP with their Mental Health Act assessment of a patient and ensure that AMHP short Report and H3 are completed prior to the AMHP leaving the Ward
- That invalid detention papers are identified and action taken to remedy.
- The patient subject to the MHA are supported to understand and access their Rights in accordance to MHA section 132.
- That original MHA papers are secured together on the patient record and arrangements made with LTHT MHA Administrator for collection for safe storage in MHA office or in a specific location on the Ward in circumstances where the patient is to be transferred imminently.
5.6 Hospital Mental Health Team / Child and Adolescent Mental Health Service (in reach Psychiatry):
- Complete medical recommendations on appropriate forms (‘pinks’)
- Ensure that they record visits - time and dated- in patient’s electronic PPM+ record (once this facility is agreed) or on the patient medical record.
- To contact LTHT MHA Administrator with patient and ward details when completing a First/Second Medical recommendation for detention under MHA.
- To allocate Responsible Clinician (RC) for each patient detained to LTHT and provide the name and contact of the RC to LTHT MHA Administrator.
5.7 Approved Mental Health Professional:
- To respond to request for MHA assessment within prescribed timescales
- Must assess the patient in person on the ward.
- Must identify themselves to the Nurse in Charge / Sister
- Must remain on the ward to support Nurse-in-charge or Sister to complete routine scrutiny of section papers and H3 form.
- AMHP short report (original) and application must be handed to Nurse-in-charge/Sister for safe keeping (a copy can be taken for their own record).
- Must respond in a timely manner to requests from LTHT MHA Administrator for error rectification or issues regarding fundamentally defective papers.
|Target patient group:||Patients subject to Mental Health Act|
|Target professional group(s):||Secondary Care Doctors
Secondary Care Nurses
LTHT MHA Scheme of Delegation,
MHA Protocol for Joint Working
Safe Transfer of patients to mental Health Bed Procedure
LTHT MCA Procedure
LTHT Deprivation of Liberty safeguards Procedure
Care Quality Commission (Registration) Regulations 2009
Mental Health Act (1983) as Amended (2007). TSO: London
Mental Health Act, Code of Practice (2008). TSO: London
Reference Guide to the Mental Health Act (2008). TSO: London
Mental Capacity Act Code of Practice (2008)
Deprivation of Liberty Code of Practice (2009)
LHP version 1.0
Equity and Diversity
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