Handout 6: The Mental Health Act (1983)

Key general points

1. The Act is only relevant for a person with a mental disorder.
2. The Act is only concerned with the treatment (or assessment) of the mental disorder. [Thus, the Act is not relevant to the treating of physical disorders (unrelated to the mental disorder) of patients with a mental disorder].
3. Being a Statute (Act) the MHA 'trumps' common law - but only, of course, within its scope of reference.
4. The most important aspects of the MHA concern the issue of compulsory detention in hospital.

Compulsory detention in hospital

A key term is mental disorder. It is broader then the term mental illness.

The definition of mental disorder is given as: "mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind".

The Act also states that promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs are not sufficient grounds for mental disorder.

The key term 'mental illness' is not further defined. To some extent it had been defined by accepted practice and by the effective workings of MHA Commission. In general compulsory admission is only used when patients are suffering from a psychotic illness (but this is somewhat 'rule of thumb'). Compulsory admission might also be used with a depressed patient who was not psychotic but who was considered to be at high risk of self-harm.

Section 2 Assessment

• Application by approved social worker or nearest relative.
• 2 medical recommendations.
• Suffering from mental disorder warranting detention in hospital for assessment.
• Detention for own health, or safety, or protection of others.
• 28 days.

Section 3 Treatment

• Application and medical recommendations as for 2.
• Suffering from mental disorder (except for the part defined only by "any other disorder or disability of mind"), which requires treatment in hospital.
• For health, safety, or protection of others.
• 6 months.

Section 4 Assessment in emergency

Only one medical recommendation (i.e. designed for GP to use if psychiatrist not available) - should not normally be used.

Grounds as for section 2 but only lasts 72 hours.

Section 5 For detention of patients already in hospital

5 (2): Essentially the consultant in charge (or nominated deputy) may report to the managers of the hospital that an application for admission under sections 2 or 3 ought to be made. The patient can then be detained for up to 72 hours.

5 (4): Allows a registered mental nurse to detain the patient for 6 hours (essentially while waiting for the doctor).

Consent to treatment and the MHA

The Act essentially divides treatment into three categories:

1. Severe treatments (psychosurgery and hormone implants). These require competent consent and a second opinion (from a doctor appointed by the MHA commission). [Note that a competent patient cannot by him/herself agree to such treatment even if there is a doctor willing to give the treatment].
2. Moderate treatments (ECT; drug treatments beyond the first three months whilst detained). These require competent consent or a second opinion.
3. Mild treatments (most others). These require neither competent consent nor a second opinion.

For further information on Treating People without their Consent:

• the UK Clinical Ethics Network web site has a detailed discussion around these issues .
• Hope T, Savulescu J, and Hendrick J - Medical Ethics and Law : the Core Curriculum. Edinburgh: Churchill Livingstone, Elsevier Science, 2003. The main text book used for the University of Oxford Medical Ethics and Law course provides more details for both teachers and their students.
• Hope T - Medical Ethics; a Very Short Introduction. Oxford: Oxford University Press, 2004.
• Ashcroft A, Lucassen A, Parker M, Verkerk M, and Widdershoven G - Case Analysis in Clinical Ethics. Cambridge: Cambridge University Press, 2005.