What does it mean to be sectioned?

Detention under the Mental Health Act

Why is someone sectioned? Do you have to be mentally unwell? Do you have to break the law? Does it mean that you’re locked up in a ‘mental institution’?  In short, what does it really mean to be ‘sectioned’?
 
** Please note: this article refers to the law in England and Wales. The law in Scotland and Northern Ireland differs slightly – there are some links below. The basic principles are similar. **

What does the term ‘sectioned’ mean?

‘Sectioned’ is a commonly used term that refers to someone who is detained under a section of the Mental Health Act in a psychiatric hospital.  The law enables people to be admitted, treated and detained in hospital against their will, as long as certain procedures are followed. Once sectioned, there are provisions in place for people to be given medication without their consent. This can mean that people are restrained and given medication by injection. The focus by the professionals in most cases is to provide treatment and then discharge the individual from hospital in the safest way as soon as possible.
 

Who can be sectioned?

Anyone with a mental disorder or a learning disability (in limited situations) can be sectioned if they require assessment or treatment. It must be necessary and in the interest of the person’s health, safety or for the protection of others. It’s worth bearing in mind that a mental disorder includes depression and other mood disorders, eating disorders and some types of personality disorder, as well as psychotic disorders. The exact definition under the Mental Health Act is ‘any disorder or disability of the mind’. As you can see, this is a rather wide definition.

You do not need to have committed a criminal offence to be sectioned. The Mental Health Act is designed to be used for both the general public and for those in the criminal justice system. Accordingly, there are separate sections which apply to people who have committed a criminal act and the courts can send people to hospital instead of prison if they are mentally unwell.
 

How long can someone be sectioned for?

For the general public, the two most significant powers to detain people last for up to 28 days (Section 2) and six months (Section 3) respectively. The longer-term section can be renewed, if needed, for a further six months and yearly thereafter.

Someone can only be detained under these sections if there is a medical recommendation by two psychiatrists. There is also an emergency section for a period of up to 72 hours when only one medical recommendation is required. Detention must be supported by a specialist social worker or nearest relative. The ‘nearest relative’ (usually your next of kin) can also object to the longer detention taking place. 

For those detained under the longer-term section, they may be released under a ‘Community Treatment Order’ which allows them to live in the community but only under certain conditions. In practice, this usually includes a requirement to take medication. The law also guarantees ‘aftercare provisions’ for those who were detained under the longer-term section. This is an important safeguard as it entitles them to support once they leave hospital.
 

How can people be discharged once they are sectioned?

This depends on the section, but generally, someone has to be discharged if they become well and can manage in the community. This can be decided by the doctor in charge of the case, or by a Mental Health Tribunal at a hearing. The Tribunal is made up of an independent panel consisting of a doctor, a legal member and a specialist tribunal member. The Tribunal is an extremely important process as it allows the patient to challenge their detention and to be represented by a legal representative, free of charge, who acts solely for the patient.

The nearest relative can also request for a person’s discharge and the consultant must discharge the patient within 72 hours unless certain risks apply. The hospital managers will also consider a person’s case on their request and the managers have the same powers of discharge as a Mental Health Tribunal.
 

Is it fair that people still get locked up for being unwell?

Last year over 50,000 detentions were authorised under the Mental Health Act in England and Wales. And this number is increasing. Regardless of the necessity, being sectioned can be an undignified and terrifying experience.  It is a sad reality and something that I grapple with on a regular basis. These people are not, in the normal sense of the word, free. And they are, in every sense of the word, people.

The fact is that psychiatric hospitals are not beautiful places (and sometimes they are far worse than that) but nor are they prisons. They are hospital wards for people who are there not because of any wrongdoing, but because they need medical help and the law dictates that the safest place for them is in hospital.

As a mental health lawyer, I have the privilege of calling sectioned ‘patients’ my clients. And I have yet to meet any mental health professional that likes the fact that people are locked up for being mentally unwell. The Mental Health Act attempts to provide a fair and just system in an overwhelmingly complex and difficult situation. I spend my professional life making representations for people to be released from hospital. Sometimes my submissions are agreed with, more often they are not. The harsh reality is that the decision to lock people up in hospital can seem unfair but can also be (uncomfortably) correct.
 

More Information:

 
England and Wales:
An overview of the England and Wales legislation written by a firm of solicitors who represent detained patients [PDF]
The summary prepared by leading mental health charity Mind
The Government website for the Mental Health Act 1983

Scotland:
An overview of the Scottish legislation (written by a brain injury charity)
The Government website for the Mental Health (Care and Treatment) (Scotland) Act 2003.

Northern Ireland:
A resource from a Carer’s charity