Makindo Medical Notes

🧠 The Mental Health Act (MHA) 1983 (amended 2007) provides the legal framework in England and Wales for the compulsory assessment, treatment, and detention of individuals with mental disorders. It balances individual liberty with the duty to protect patients and the public from serious harm. 💡 Alcohol or drug misuse alone is not sufficient grounds for detention under the Act.

⚖️ About: Jurisdiction

• Applies to England and Wales (separate legislation applies in Scotland and Northern Ireland).
• Permits hospitalisation of individuals with a mental disorder when:
  • Assessment or treatment is required under Section 2 or 3, and
  • The illness poses a significant risk to self or others, and
  • The person is unwilling or unable to consent to admission or treatment.

🏥 Acute use by Hospital Doctors

• In general hospitals, ward doctors may invoke an emergency section (Section 5(2)) if an informal patient deteriorates and refuses to remain for urgent assessment.
• This allows short-term legal detention (up to 72 hours) to enable a full psychiatric evaluation.
• Always seek advice from liaison psychiatry before issuing a section.
• See further local guidance: Section 5(2) procedure – Lancashire & South Cumbria NHS Foundation Trust.

📘 Key Sections of the Mental Health Act

⚠️ Principles

• Least restrictive option should always be used.
• Patient dignity, autonomy, and rights must be preserved.
• Detention should be regularly reviewed and subject to tribunal appeal.
• The MHA is distinct from the Mental Capacity Act (MCA), which governs decision-making for those lacking capacity but not requiring detention.

📚 Case Examples

• 🧩 Case 1 – Section 5(2) Emergency Hold: Mr J, a 45-year-old man with bipolar disorder, was admitted informally following a manic relapse. Overnight he became grandiose, attempted to leave the ward, and expressed intent to drive to London “to meet the Prime Minister.” → The ward doctor issued a Section 5(2) to legally detain him for up to 72 hours pending formal psychiatric review under the MHA.
• 💭 Case 2 – Section 2 Assessment Admission: Mrs L, a 60-year-old woman, presented with new-onset persecutory delusions and stopped eating. She refused admission, believing the food was poisoned. → Two doctors (one Section 12 approved) and an AMHP applied a Section 2 for 28-day assessment and treatment in a psychiatric unit.
• 🚔 Case 3 – Section 136 Police Detention: Mr K was found shouting incoherently and threatening passers-by in a shopping centre. → The police used Section 136 to take him to a health-based place of safety for assessment. He was later transferred under Section 3 for treatment of schizophrenia.

🧠 Teaching Note

Understanding the MHA is crucial for all clinicians — especially hospital doctors — as it defines when treatment can lawfully proceed without consent. The act demands clear documentation, multi-professional input (AMHP + doctors), and continual review of proportionality and necessity. Emergency sections (5(2) and 4) should only bridge to formal assessment, not be used as ongoing detention.

📚 References

• Mental Health Act 1983 (as amended 2007)
• Lancashire and South Cumbria NHS — Section 5(2) Guidance
• NHS England: Code of Practice to the Mental Health Act 1983 (2015)

🕓 Revisions

• 2025-10 — Annotated by Dr O’Kane (Makindo edition)