In England people with mental illness can be detained to assess whether they need treatment, or for treatment. Treatment can be provided against their will, and violent force can be used to do so....
In England people with mental illness can be detained to assess whether they need treatment, or for treatment. Treatment can be provided against their will, and violent force can be used to do so. Treatment is supposed to use the least restrictive option at all times. These powers are given by the Mental Health Act 1986 (and revisions in 2007).
Detention under Section 2 is for 28 days and is to assess whether someone needs treatment. Detention under Section 3 is for 6 months and is to provide treatment. S3 can be extended. There are other forms of detention (the courts and prisons have forensic sections; the police have a power to detain (not strictly an arrest) and take to a place of safety) but S2 and S3 are most common.
To be detained under section 3 you need to i) have a mental disorder ii) you, or other people, are at risk of harm and iii) you cannot be treated at home. Normally you are assessed by 3 people - a doctor who knows you, a doctor who's had special training, and an Approved Mental Health Professional (AMHP). AMHPs used to be exclusively social workers, but now anyone with the right training can be an AMHP. The doctors make a recommendation, the AMHP listens to them, and the patient, and the patient's "nearest relative" and makes the decision. A core part of AMHP work is protecting the patient's human rights.
Detention is a really serious thing. It's a huge impact on a person's human rights. We need to make sure that we do it properly if we're going to do it.
During pandemic NHS England said that mental health act assessments could be done remotely, as an emergency thing, and only if it was not possible to do a face to face assessement. (I'll try to find that guidance, sometimes they're tucked away from the public). Some mental health trusts have continued to do them. This is not because we're still in a pandemic and we need to keep vulnerable people safe from infection -- they're not eg wearing masks[1] -- it's because it's cheaper and easier and the NHS is under enormous strain.
Anyway, the courts looked at it and said, basically, "no, this is obviously not okay what on Earth are you thinking quite clearly this is wrong stop doing it good grief".
I'm always interested in different approaches to compulsion, and the balance between "doing what we can to make the person feel safe and comfortable and thus accepting treatment" versus "we don't have the time or money to faff about so let's just restrain them in a chair and give them a vaccination / dental care / haircut / etc". (In case it's not obvious, I am strongly in the "restraint must almost never be used" camp).
Very interesting. I definitely think that you cannot achieve a true assessment remotely. You don’t know where the person is, who else is in the room/house, you can only see part of the body language
Very interesting. I definitely think that you cannot achieve a true assessment remotely. You don’t know where the person is, who else is in the room/house, you can only see part of the body language
The flip side of this concern is the perilously low funding to the NHS's mental health provision. For them to to be willing to expend some of their scant resources you would need to be so far over...
The flip side of this concern is the perilously low funding to the NHS's mental health provision. For them to to be willing to expend some of their scant resources you would need to be so far over the line of legitimate concern that there's little chance of erroneous committal.
In England people with mental illness can be detained to assess whether they need treatment, or for treatment. Treatment can be provided against their will, and violent force can be used to do so. Treatment is supposed to use the least restrictive option at all times. These powers are given by the Mental Health Act 1986 (and revisions in 2007).
Detention under Section 2 is for 28 days and is to assess whether someone needs treatment. Detention under Section 3 is for 6 months and is to provide treatment. S3 can be extended. There are other forms of detention (the courts and prisons have forensic sections; the police have a power to detain (not strictly an arrest) and take to a place of safety) but S2 and S3 are most common.
To be detained under section 3 you need to i) have a mental disorder ii) you, or other people, are at risk of harm and iii) you cannot be treated at home. Normally you are assessed by 3 people - a doctor who knows you, a doctor who's had special training, and an Approved Mental Health Professional (AMHP). AMHPs used to be exclusively social workers, but now anyone with the right training can be an AMHP. The doctors make a recommendation, the AMHP listens to them, and the patient, and the patient's "nearest relative" and makes the decision. A core part of AMHP work is protecting the patient's human rights.
Detention is a really serious thing. It's a huge impact on a person's human rights. We need to make sure that we do it properly if we're going to do it.
During pandemic NHS England said that mental health act assessments could be done remotely, as an emergency thing, and only if it was not possible to do a face to face assessement. (I'll try to find that guidance, sometimes they're tucked away from the public). Some mental health trusts have continued to do them. This is not because we're still in a pandemic and we need to keep vulnerable people safe from infection -- they're not eg wearing masks[1] -- it's because it's cheaper and easier and the NHS is under enormous strain.
Anyway, the courts looked at it and said, basically, "no, this is obviously not okay what on Earth are you thinking quite clearly this is wrong stop doing it good grief".
I'm always interested in different approaches to compulsion, and the balance between "doing what we can to make the person feel safe and comfortable and thus accepting treatment" versus "we don't have the time or money to faff about so let's just restrain them in a chair and give them a vaccination / dental care / haircut / etc". (In case it's not obvious, I am strongly in the "restraint must almost never be used" camp).
Mental Health Act 1983
Mental Health Act Code of Practice PDF The "Five Guiding Principles" on p22 are most important here.
Mental Health Units (Use of Force) Act
Some examples of using person-centered care to reduce use of restraint: Reducing the need for restraint and restrictive intervention How to support children and young people with learning disabilities, autistic spectrum conditions and mental health difficulties who are at risk of restrictive intervention.
Very interesting. I definitely think that you cannot achieve a true assessment remotely. You don’t know where the person is, who else is in the room/house, you can only see part of the body language
The flip side of this concern is the perilously low funding to the NHS's mental health provision. For them to to be willing to expend some of their scant resources you would need to be so far over the line of legitimate concern that there's little chance of erroneous committal.