Law and your rights

Informal patients

An informal patient (sometimes called a voluntary patient) is a person who has consented to admission to hospital to receive treatment for their mental health problem.

An informal patient should be given information by the ward staff about their legal rights for example in relation to treatment, the right to leave the ward and how to make a complaint. This information should be provided in a language and a format that they understand.

Treatment

An informal patient has the right to get treatment for their mental health problem. They also have the right to get treatment for physical health problems, just as they would in the community.

An informal patient has the right to refuse treatment, including prescribed medication. They must be given enough information about any proposed treatment to allow them to make an informed decision about whether to accept it.

Spending time away from the hospital

An informal patient has the right to leave the ward at any time and does not need permission from the staff.

The care team will expect a patient to take part in their treatment plan, which will include therapeutic activities and talking to staff. An informal patient may negotiate periods of time away from the hospital as part of their treatment plan.

Most wards are locked; although an informal patient does not need permission to leave the hospital, they will have to let staff know that they wish to leave. Staff should ask about a patient’s plans e.g. where they are going, what are they going to do while away, what time are they going to return.

Leaving hospital

An informal patient has the right to leave hospital if they don’t want to stay. If the care team are concerned that this could put the patient, or other people at risk they may consider detention under the Mental Health Act 1983.

The threat of detention under the MHA must not be used to make an informal patient agree to take treatment or stay on the ward if they don’t want to.

Detained patients

A detained patient (often called a sectioned patient) is a patient who is being kept in hospital under the Mental Health Act 1983. If a patient is detained they can be kept in hospital, prevented from leaving the ward and given treatment for their mental health problems, possibly without their consent.

There are different types of sections, each has different rules about how long a person can be kept in hospital and about treatment. The patient, and in most cases their nearest relative, must be given detailed information about their legal rights under the Mental Health Act. This information must be provided in a format and language which they understand.

If a patient has been detained they have the right to get help from an Independent Mental Health Advocate (IMHA).

Detained patients have the right to appeal to the Hospital Managers and the Mental Health Tribunal to challenge their detention.

Community Treatment Orders

Some patients who have been detained for treatment under the Mental Health Act are discharged from hospital on a Community Treatment Order (CTO). This means that they continue to receive treatment for their mental health problem in the community rather than in hospital. The Responsible Clinician has the power to recall the patient to hospital if they are in urgent need of treatment.

A CTO lasts for 6 months, and can be renewed for a further 6 months, and then annually.

The patient and their nearest relative, must be given detailed information about their legal rights under the Mental Health Act. This information must be provided in a format and language which they understand.

A patient on a CTO has the right to get help from an Independent Mental Health Advocate (IMHA).

CTO patients have the right to appeal to the Hospital Managers and the Mental Health Tribunal to challenge being on a CTO.

What does sectioning mean?

If a person is sectioned, it means that they are detained in hospital under the Mental Health Act 1983 (you can read more about the Act using the link at the side of this page). There are numerous types of sections, each having its own rules and own lengths of time that a person can be kept in hospital for.

When can a person be sectioned?

A person can be assessed under the Mental Health Act if they or someone else has raised a serious concern about their mental health. Most of the time, assessments are carried out by an Approved Mental Health Professional (often a social worker) and two doctors, one of whom must be a psychiatrist who is approved under Section 12 of the Mental Health Act, the other ideally should know the person being assessed. They may decide that the person should be sectioned if they believe that:

they need to be assessed and treated for their mental health problem urgently
their health would be at serious risk of getting worse if they did not get treatment quickly
their safety or someone else’s safety would be at serious risk if they did not get treatment quickly
assessment and treatment can only be carried out in a hospital as it is not safe to do so in the community

Less commonly, a person can be sectioned by some individual professionals if certain circumstances set out in law are met.

What are the most common sections?

Section 2

A person can be detained if:

they have a ‘mental disorder’ as described in the Mental Health Act which is serious enough to justify their detention in hospital

and

it is necessary for their own health or safety, or for the protection of other people

A person can be detained for:

Up to 28 days. This gives doctors time to assess what type of mental disorder the person has, if they need treatment and how the treatment will affect them. Section 2 is likely to be considered if the person has never been assessed in hospital before or it is a long time since they were last assessed. Someone detained under section 2 may be offered treatment for their mental disorder in hospital. If they refuse it can be given without permission.

Section 2 cannot be renewed, but the individual may be assessed before the end of the 28 days to see if further detention under another section of the Act is needed.

A person can be discharged from section 2 by their nearest relative, their responsible clinician, the hospital managers or the Tribunal; you can find out more about Tribunals on this website.

Section 3

A person can be detained under section 3 if:

they have a ‘mental disorder’ as described in the Mental Health Act which is serious enough to justify their detention in hospital

and

they need to be detained in hospital for treatment as it cannot be given if they are not detained

and

it is necessary for their own health or safety or for the protection of other people

and

appropriate treatment is available in hospital

A person can be detained under section 3 for:

Up to 6 months; the section can be renewed by the individual’s responsible clinician:

for a further 6 months following the initial 6 months of detention
after that, for 12 month periods. There is no limit to the number of times the responsible clinician can renew the section 3.
A person can be discharged from section 3 by their nearest relative, their responsible clinician, the hospital managers or the Tribunal; you can find out more about Tribunals on this website.
If someone’s mental health gets worse again in the future, they could be sectioned and taken to hospital again on a new section.

Section 4

A person can be detained under section 4 if:

they have a ‘mental disorder’ as described in the Mental Health Act
it is urgently necessary for them to be admitted to hospital and detained under section 2
waiting for a second doctor to confirm that a person needs to be admitted to hospital on a section 2 would cause “undesirable delay”

Only one doctor (together with the approved mental health professional) is required for this ‘emergency’ section.

A person detained under section 4 cannot be treated without their consent. They can be detained for up to 72 hours, during which time a second doctor must assess the person. If a second medical recommendation is made, the person will be detained under section 2.

Section 5 (2):

Section 5 (2) of the Act may be used if a person is in hospital voluntarily, they decide they wish to leave or refuse treatment, and a doctor feels that they must remain in hospital for assessment or treatment. The doctor needs to inform the hospital managers that they have detained someone under section 5 (2), and a full Mental Health Act assessment needs to take place within 72 hours of the detention.

Section 5 (4):

This is similar to section 5 (4) but can be used by a nurse. Assessment by a doctor must take place within 6 hours of the nurse detaining the person.

Section 136:

This section of the Act gives powers to the police to detain someone under the Act.

If it appears to a police officer that a person has a mental disorder and is “in need of immediate care or control”, they can take them to (or keep them at) a place of safety. The person will be kept there so that they can be seen by a doctor and interviewed by an approved mental health professional, and any necessary arrangements can be made for their treatment or care, including detention in hospital under other sections.

Section 117:

Health authorities and local social services have a legal duty to provide free aftercare for people who have been detained under Mental Health Act sections 3, 37, 45A, 47 or 48.

Aftercare services are provided free of charge as part of a person’s care plan.

Community Treatment Order:

A person who is detained on section 3, 37 or 47 may be discharged from hospital on a Community Treatment Order (CTO). Their responsible clinician can give supervised treatment in the community, rather than them staying in hospital, but the person can be recalled to hospital for up to 72 hours if necessary.

There are certain conditions added to a CTO, which the individual is expected to follow, and they can include things such as attending appointments they need for treatment.

CTOs last for 6 months from the date of the order and can be extended by the person’s responsible clinician.

A person can be discharged from their CTO by their nearest relative, their responsible clinician, the hospital managers or to be discharged from a CTO, an application can be made to the Mental Health Tribunal; you can find out more about Tribunals on this website.