This is something that comes up in OSCE
stations and you should be familiar with the UK Mental Health legislation.
For PLAB
2, you should be familiar with 4 parts of the Mental Health Act. These are important to understand regardless of what specialty you end up in.
The main Sections you should know about are outlined below. Some scenarios for members to test their knowledge on are to be found at http://www.rxpgonline.com/postlite53977-.html
Section 2
Why?
Assessment of mental illness
How Long?
Up to 28 days
If the patient requires further detention, a Section 3 should be applied for
What reason?
Patient must be suffering from a mental illness and
The patient presents a danger to themselves or others
Who?
2 Doctors (one approved).
Approved Social Worker.
Section 3
Why?
Treatment of a mental illness
How Long?
6 months
Further applications can be made at the end of this Section for a further six months, then for periods of 12 months thereafter.
What reason?
The patient must be suffering from a mental illness, psychopathic disorder or mental impairment which warrants treatment in hospital.
It is in the interest of the patients safety, or the safety of others to be detained in hospital.
In psychopathy, detention must be on the grounds of preventing deterioration of condition.
Who?
2 Doctors (one approved).
Approved Social Worker.
Section 4
Why?
Emergency admission for a mental illness.
It is for emergency situations only. In non emergency cases, a Section 2 would be appropriate.
How Long?
72 Hours.
After this period, a Section 2 or 3 should be applied for.
What reason?
The grounds are the same as Section 2, with the following additions:
-it is of urgent necessity for the patient to be admitted and detained under Section 2, and
-that compliance with the usual Section 2 requirements (that is, getting a second Medical Recommendation) would involve "undesirable delay"
Who?
The section need only be signed by one doctor.
Section 5
Section 5 orders are for patients who are already in hospital, for example a patient on a medical ward who becomes mentally ill during admission. A&E departments are not inpatient and therefore 5 cannot be applied.
Section 5(2)
Why?
Emergency detention of a patient who is already inpatient in hospital for a mental illness.
How Long?
The patient may be detained for 72 hours.
The Section cannot be extended. A Section 2 or 3 must be applied at the end of this period if the patient is to stay in hospital.
What Reason
The patient is deemed to be mentally ill.
Detention in hospital is necessary for the protection of the patient or others.
Who?
The Responsible Medical Officer (RMO) in charge of the patient (or nominated deputy) applies for a Section 5(2).
Section 5(4)
Why?
Emergency detention of a patient who is already inpatient in hospital for a mental illness by a nurse.
How Long?
The Section may not be extended. A Section 5(2) may be imposed, or a Section 2 or 3 applied.
What Reason
The patient is deemed to be mentally ill.
Detention in hospital is necessary for the protection of the patient or others.
Who?
This section is used by Nurses to detain patients already in hospital.
Common Law
Common Law may be used to detain a patient in hospital against their wishes, where a Section of the Mental Health Act cannot be applied. For instance, in an A&E department whilst waiting for a doctor to apply a Section 2 or 4. Generally, Common Law detention should only be used when the patient poses a danger to themselves, or another person and is not deemed in a suitable state to make an informed decision.
Dr T Hudsen
July 2006
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