Sectioning a Patient under the Mental Health Act

Introduction | Roles of Health Professionals | Current Legislation for Physician Associates (PAs) | Future Implications: GMC Regulation of PAs | References

Introduction

The Mental Health Act 1983 (amended in 2007) is the key piece of legislation in England and Wales that allows for the compulsory detention and treatment of individuals with a mental health disorder when they pose a risk to themselves or others. This process, commonly referred to as "sectioning," involves specific criteria and roles for various healthcare professionals, including doctors, nurses, and other mental health professionals.

Roles of Health Professionals

Several healthcare professionals are authorised under the Mental Health Act to perform specific roles in the sectioning process:

Approved Mental Health Professional (AMHP)

An AMHP is usually a social worker, but they can also be a nurse, occupational therapist, or psychologist who has received additional training and approval to carry out specific duties under the Mental Health Act:

• Role: The AMHP is responsible for assessing whether a patient meets the criteria for sectioning and coordinating the assessment process. They ensure that the patient's rights are upheld and that the least restrictive option is considered.
• Authority: The AMHP can apply for a patient to be sectioned under various sections of the Mental Health Act, most commonly Section 2 (for assessment) or Section 3 (for treatment).

Doctors

Two doctors, one of whom must be a psychiatrist, are required to recommend sectioning under the Mental Health Act:

• Section 12 Approved Doctors: These are doctors, usually consultant psychiatrists, who have received specific training in the application of the Mental Health Act. They are authorised to assess patients and provide one of the medical recommendations required for sectioning.
• Second Doctor: The second medical recommendation can come from a doctor who is familiar with the patient’s case, such as a GP, but they must not be closely involved in the patient’s care to avoid conflicts of interest.
• Role: Both doctors assess the patient independently and provide medical recommendations based on the criteria set out in the Mental Health Act. Their assessments focus on whether the patient has a mental disorder that warrants compulsory detention and whether treatment is necessary for their health or safety, or for the protection of others.

Nurses

Certain nurses have specific powers under the Mental Health Act, particularly in emergency situations:

• Section 5(4) - Nurses’ Holding Power: This allows a registered mental health or learning disability nurse to detain a patient who is already receiving inpatient care for up to 6 hours. This holding power is used when the nurse believes that the patient is at immediate risk of harming themselves or others, and it is not possible to wait for a doctor or AMHP to attend.
• Role: The nurse must immediately inform a doctor or AMHP, who will then conduct a full assessment to decide whether further detention under the Mental Health Act is necessary.

Physician Associates (PAs)

Currently, Physician Associates (PAs) are not authorised under the Mental Health Act to carry out sectioning or hold any formal roles in the sectioning process. PAs can contribute to the care and assessment of patients with mental health disorders, but they must work under the supervision of a doctor who holds the appropriate authority under the Mental Health Act.

Current Legislation for Physician Associates (PAs)

As of now, PAs are not regulated by a statutory body, and their roles are defined by the supervision and delegation from their supervising doctors. This means that while PAs can assist in the assessment and management of patients with mental health disorders, they cannot independently make decisions regarding sectioning under the Mental Health Act. All actions taken by a PA must be within the scope of practice agreed upon with their supervising doctor, who retains ultimate responsibility for decisions made.

Future Implications: GMC Regulation of PAs

The regulation of PAs by the General Medical Council (GMC) is anticipated to bring significant changes to their scope of practice. Once regulated by the GMC, PAs may have an expanded role in the assessment and management of patients under the Mental Health Act, potentially including the authority to participate more directly in the sectioning process. However, specific details regarding these changes will depend on forthcoming legislation and guidelines established by the GMC. It is expected that PAs will undergo additional training and certification to take on these expanded roles.

References

1. Legislation.gov.uk (1983) Mental Health Act 1983. Available at: https://www.legislation.gov.uk/ukpga/1983/20/contents (Accessed: 26 August 2024).
2. General Medical Council (2024) Physician Associates: Regulation by the GMC. Available at: https://www.gmc-uk.org/ (Accessed: 26 August 2024).
3. Royal College of Psychiatrists (2024) The Mental Health Act: An Overview for Professionals. Available at: https://www.rcpsych.ac.uk/ (Accessed: 26 August 2024).

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