Sectioning requires clarity of action
The Mental Health Act 1983 can admit someone over the age of 16 who will not agree to a voluntary admission, is suffering from a mental disorder and is a danger to themselves or others. The different types of section are common questions in most GP exam multiple choice questions.
An internet search with the keyword 'sectioning' gives an account of all the different sections. Sections 2, 3 and 4 are the most common types of sections used in general practice.
Section 2 of the Mental Health Act is used to admit a patient for assessment and/or treatment of a mental disorder. The usual scenario is a patient who presents with a new illness and will not agree to admission. This section can last for 28 days and can then be converted into a section 3 if required.
The application for the section is usually made by the nearest relative or an approved social worker (ASW). This is a social worker who has specific experience in the Mental Health Act. An application can, of course, also be made by the GP or psychiatrist.
The application must be supported by two doctors, one of whom must be approved under section 12 of the Act. This means that they have specialist experience in mental health. In practice, this is usually a consultant psychiatrist or specialist registrar. The second doctor must know the patient and is usually the GP. The two opinions must agree that the patient is suffering from a mental illness and detention is in the best interests of the patient's safety.
Section 3 is similar to section 2; the sectioning process takes place in the same way. In section 3, the detention is for treatment of an established mental disorder and can be for a duration of up to six months with the possibility of extension if required.
Section 4 allows a doctor to detain the patient in an emergency for assessment.
A common scenario is a patient who has self-harmed and expresses suicidal intentions. This section lasts for up to 72 hours, after which it must be converted to a section 2 if the patient is still at risk. The application can be made by an ASW or the nearest relative. They must be supported by one doctor who must have examined the patient within the previous 24 hours.
The GP's part in the section
When asked to take part in a section, it is important to liaise promptly with the relevant people; these are the section-12-approved doctor and the ASW. In the past, I have obtained the relevant names from the patient's CPN, the on-call psychiatry team or social services.
Usually the section takes place at the patient's home, although in theory it could be anywhere - but GPs are not obliged to visit patients outside the practice area. It is important to get the proper address and know where you are supposed to be going.
A section 2 or 3 can be time consuming if you are trying to fit surgeries into the day. Try, if possible, to find out when the other doctor and the ASW will be there and attend promptly with patient's notes. Both doctors will assess the patient and if a section is deemed necessary, both doctors will fill in form 7 and the ASW will complete form 6. The forms are provided by the ASW.
If they do not know the patient, the GP must be section 12 approved, together with the psychiatrist. This applies to GPs from an on-call co-operative.
Always document the findings of the assessment and the type of section used. Contact the hospital to arrange a bed and also order an ambulance for the time of the psychiatrist's arrival.
If the patient absconds or is violent, you should call the police. They have a legal duty to ensure a sectioned patient gets to hospital. Don't forget to claim the standard fee for the GP's attendance from social services (the ASW will usually have the forms if the surgery has none). In section 4, GPs should keep a supply of the relevant forms because the duty ASW may not be available.
Additional sections to know for the MCQ exam and AKT
Sections 5(2), 5(4) are concerned with emergency holding powers applied to inpatients. Section 5(2) concerns doctors; section 5(4) gives certain powers to registered mental health nurses.
Section 7 is used in relation to guardianship. Section 115 covers right of entry of an ASW to remove a person at risk to a place of safety. Section 135 is the same as above, but relates to an approved police officer. These last two sections require the application of a magistrate.
- Dr Croton is a GP registrar in Birmingham