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What happens when you get sectioned?
Despite the many depictions in popular culture, few of us really know what the sectioning process involves. Here's why sectioning happens, and what happens to your rights if you're detained under the Mental Health Act.
For most people, the idea of being sectioned is quite a scary concept. As well as being shrouded in mystery (when did you last hear someone talk openly about the sectioning process?), our ideas of sectioning are often confused by TV and film. We might think of One Flew Over The Cuckoo's Nest, or a similarly dystopian portrayal.
However, being sectioned (detained under the Mental Health Act) can be a lifeline to those who need it, ensuring their personal safety at a time when they're seriously unwell. It's not an intervention anyone would wish on themselves or their loved ones. But as and when it's necessary, it can get people started back on the road to full health.
"People held under the Mental Health Act are often in crisis," explains Will Johnstone, policy manager at Rethink Mental Illness. "This can be very scary for them and they may not fully understand what's happening, or even that they are ill. While this can be difficult, being held under the Act has been a turning point for many people, giving them access to treatments and medication that can help them start to successfully manage their illness."
Who can be sectioned?
Under the Mental Health Act 1983, you can be kept in hospital for a specified period of time if certain conditions apply. These conditions are quite stringent - so you don't need to worry about being sectioned if, for example, you visit your doctor with depression or anxiety. Nor can someone else call for you to be sectioned without good reason.
You can be legally sectioned if you need to be treated for a mental health condition, and you aren't well enough to make decisions about your treatment at that time. Without treatment, your safety or someone else's safety would be at risk, or your health would decline.
"There are specific steps that need to be taken before a person can be detained under the Act," says Johnstone. "In most cases, three medical professionals - two doctors and an Approved Mental Health Professional - need to agree that you need to be detained, although this can be reduced to two if the circumstances require more urgent action. At least one of them needs to have met you before if possible, and all need to have assessed your case within five days of each other."
During the coronavirus pandemic, the rules are slightly different: you only need to be assessed by one doctor rather than two, and while the doctor needs to specialise in mental health, they don't need to have met you before. In some cases, you might see one or more of the professionals via video call.
How long will you be sectioned for?
How long you can be detained for depends on your individual circumstances. The Mental Health Act has different 'sections' (hence the word sectioning), which are used for different reasons. However, the most commonly used is Section 2, which allows doctors to detain you for up to 28 days. This gives them time to decide what type of mental disorder you have, and what treatment you require.
Section 3 (which involves treatment that can only be given in hospital) lasts for up to six months, and can be renewed.
There are also emergency sections, including Section 5 (2) which lasts for no more than 72 hours. Under Section 5 (4), which only applies if you are a voluntary patient receiving treatment for a mental disorder as an inpatient, a specialist mental health nurse can detain you for up to six hours until a doctor or other clinician with authority to detain you can assess you.
Altogether, 49,988 people in England were sectioned between April 1st 2018 and March 31st 2019.
What happens when you're sectioned?
In most cases, you will be admitted to hospital very soon after your assessment (for most sections, it legally needs to be within 14 days). This will normally be by ambulance.
Once there, you will have your rights explained to you and will be given a copy to keep. You will be placed under the care of a responsible clinician (usually a psychiatrist). Most people are also offered the assistance of an Independent Mental Health Advocate, who can help you understand your rights, listen to your concerns and speak on your behalf.
"In very simple terms, the Mental Health Act temporarily suspends some of your rights in order to treat you," says Johnstone. "For example, the right to refuse treatment and freedom of movement - someone under section is likely to be detained in a facility to care for them and to prevent them coming to harm."
Not all rights are removed, however. You retain the right to be visited by family and friends (unless your doctor can justify why they shouldn't see you), and the right to have your detention assessed by an independent tribunal. You should also be permitted some telephone access and correspondence with a solicitor, and you're still allowed to vote.
While you will probably be held in the ward in the first instance, your responsible clinician may give you permission to leave for short periods of time. In some cases, your right to leave might be impacted by the coronavirus pandemic.
Under Section 2, you will be discharged within 28 days, but if your doctor thinks it's necessary for you to stay (and you won't agree to it), you may be placed on a Section 3, under which you can be detained for longer. However, once doctors think you are well enough to leave, you can no longer be held under the Mental Health Act, and staff should start planning your ongoing care.
If you have been detained under Section 3, you have the right to free aftercare, which can cover healthcare, social care and free specialist accommodation.
Being sectioned is an undeniably difficult experience for most people who go through it, but it can also end up being a helpful one - a step towards recovery for those who are in crisis.
"While the Mental Health Act is not perfect, many of our supporters have told us that being held under the Act saved their lives," says Johnstone.