The Mental Health Act (MHA)

Introduction

The Mental Health Act (2007) refers to a law used in England and Wales which provides a legal framework for both informal and compulsory care and treatment of people diagnosed with having a mental disorder.

A mental disorder is described as any disorder or disability of the mind and can include any of the following:

• Mental illness
• Personality disorder
• Learning disability*
• Disorders of sexual preference (e.g. paedophilia)

*Only if associated with “abnormally aggressive behaviour” or “seriously irresponsible conduct”. There is a draft Mental Health Bill (2022) which aims to reform the Mental Health Act and strengthen safeguards for people with learning disabilities to prevent inappropriate detention under the Mental Health Act. 

Anyone under the influence of drugs and/or alcohol is specifically excluded from detainment under the Mental Health Act.

Individuals involved in the application of the MHA include:

• Section 12 doctor: a doctor approved to make specific medical recommendations.
• Approved mental health professional (AMHP): mental health worker (e.g. social worker, psychologist, mental health nurse, occupational therapist) who has additional mental health training and is approved by the local authority.
• Responsible clinician: an approved clinician with the overall responsibility of patient care, they are responsible for renewing sections and discharging patients from a section.
• Nearest relative: first relative in the MHA list.

Voluntary admission

Section 131

Section 131 of the Mental Health Act is a section of the legislation which covers the informal admission of patients.

This means that patients can be admitted for care and treatment without formal restrictions, and they are free to leave at any time.

To be admitted under section 131, patients must meet the following criteria:

• The patient must have capacity
• The patient must consent to the admission
• The patient must not resist the admission

Involuntary admission

Section 2

Section 2 of the Mental Health Act is used for compulsory detention for assessment.

A person can be detained under section 2 only if both of the following apply:

• The person suffers from a mental disorder that warrants detention in hospital for assessment for at least a limited period.
• The person ought to be detained in the interests of their own health or safety or the protection of others.

The maximum period a person can be detained for assessment is 28 days, which cannot be renewed.

The application for admission can be made by an approved mental health professional (AMHP) or the nearest relative. This application must be supported by two doctors, one of which must be an approved section 12 doctor.

Section 3

Section 3 of the Mental Health Act is used for compulsory detention for treatment.

A person can be detained under section 3 only if all the following apply:

• The person suffers from a mental disorder of a nature or degree that makes it appropriate for them to receive treatment in hospital.
• It is necessary for the health or safety of the person or the protection of others, that the person should receive treatment which cannot otherwise be provided unless the patient is detained.
• Appropriate medical treatment is available for them.

The maximum period a person can be detained under this section is 6 months, which can be renewed.

The application for admission can be made by an AMHP or the nearest relative. The nearest relative can oppose this and/or request it is rescinded (unlike section 2).

This application must be supported by two doctors, one of which must be an approved section 12 doctor. Both doctors must have seen the patient in the last 24 hours.

Emergency situations

Section 4

Section 4 of the Mental Health Act is used for admission for assessment in cases of emergency.

It is primarily used in outpatient services when it is not possible to wait for a section 2 to be arranged. An application can be made by an AMHP or nearest relative and only requires the support of one doctor.

This section allows patients to be detained for a maximum of 72 hours, after which it often changed to a section 2.

Section 5(2)

Section 5(2) is an emergency order where an inpatient who is a voluntary patient in hospital can be detained for up to 72 hours for a mental health act assessment.

Only one doctor (usually the one in charge of the patient’s care) is required to make an application for this section.

Section 5(4)

This is similar to section 5(2), but a patient can be detained by a nurse for up to 6 hours to allow further assessment by medical staff.

The application can be made by a nurse if:

• The patient is suffering from a mental disorder to such a degree that it is necessary for their health or safety or the protection of others, that they are immediately restrained from leaving hospital.
• It is not feasible or practical for a clinician to be immediately available to detain the patient under Section 5(2).

Police powers

Section 135

Section 135 is a court order that allows police officers to enter private property, by force, to remove a person suffering from a mental health disorder and place them in a place of safety (usually an Emergency Department or police station) if there is reasonable cause to suspect that they:

• Have been ill-treated or neglected
• Is unable to care for themselves and are living alone

The patient can be detained under this court order for up to 24 hours (although this can be extended by 12 hours). 

Section 136

Section 136 allows police officers to detain someone suspected of suffering from a mental health disorder, from a public place to a place of safety without a warrant, for up to 24 hours to allow them to be assessed by a medical practitioner.

Community treatment orders

Section 17a

Under section 17a, patients who are on a section 3 can leave hospital for treatment in the community if they are well enough.

The decision is made by the responsible clinician in agreement with the AMHP if the following criteria are met:

• The patient is suffering from a mental health disorder to a degree that is appropriate for them to receive medical treatment
• It is necessary for the patient’s health or safety or the protection of others, that they should receive treatment
• Treatment can be provided to the patient without the need to continue to detain them in hospital
• Appropriate medical treatment is available to the patient

The patient can be recalled to hospital if there is non-compliance with treatment or they do not attend appointments.

Once recalled, they may be detained for up to 72 hours for assessment.

Summary table

Table 1. Summary of the Mental Health Act sections. 

Reviewer

Dr Dawn Collins

Consultant Psychiatrist

Editor

Dr Chris Jefferies

References

• The Mental Health Act 1983 & 2007. [Online]. London: The Stationary office. Available from: [LINK]
• Department of Health.Mental Health Act 1983: Code of Practice. Available from: [LINK]
• Fenton, C., Lodge, K.-M., & Henderson, J. (2016).E ureka: Psychiatry. Scion Publishing Ltd. 
• Azam, M., Qureshi, M., & Kinnair, D. (2016).Psychiatry: A clinical handbook. Scion.