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22 Mental Health

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1. Introduction

2. What is the Mental Health Act for?

3. Who decides if I should be detained in hospital?

4. When can I be detained in hospital?

The Mental Health Act sets out the circumstances in which you can be admitted to hospital and detained there.

'Admission for assessment ' (section 2 of the Mental Health Act)
This is used if the doctors and the approved social worker think you need a period of assessment in hospital. For example, you can be detained for this reason if this is the first time you have been in contact with psychiatric services.

You can be admitted to hospital and detained there only if the approved social worker and the doctors believe that:

  • your mental disorder is of 'a nature or degree' that means you need to be detained in hospital for assessment or for assessment followed by medical treatment; and
  • you should be detained in hospital in the interests of your health or safety, or to protect other people.

A section 2 detention lasts up to 28 days and cannot be renewed. However, if your doctor thinks you should stay longer in hospital but you don't want to, they will arrange an assessment to decide whether you should be detained for 'Admission for treatment' (section 3 of the Mental Health Act - see below).

'Admission for assessment in cases of emergency' (section 4 of the Mental Health Act)
This is used if you need to be detained in hospital urgently, and there is not enough time for a second doctor to see you. However, the same conditions as for section 2 detention must be met. In this case, you can be detained in hospital on one doctor's recommendation for up to 72 hours.

If a second doctor examines you in this time and recommends that you are detained under section 2, the section 4 admission will become a section 2 admission.

'Admission for treatment' (section 3 of the Mental Health Act)
The conditions for being admitted to hospital and detained there under section 3 are stricter than for section 2. You can be detained under section 3 only if all the following conditions are met:

  • You have a specific form of mental disorder - mental illness, mental impairment, severe mental impairment or psychopathic disorder. See 'Terms used in mental health law' for definitions of these.
  • Your mental disorder is of a 'nature or degree' that means the treatment you need should be given to you in hospital.
  • You need treatment for your health or safety, or to protect other people, and this treatment can be given only if you are detained under section 3.
  • If you are diagnosed as suffering from a psychopathic disorder or mental impairment, the treatment must be likely to improve your condition or stop it getting worse.

You can be detained in hospital for up to six months to begin with. But the detention can be renewed for six months and then each year after that, as long as your doctor thinks you need to stay in hospital and receive treatment for your mental disorder.

What powers does my family have?
Under the Mental Health Act, you have a 'nearest relative' who will be involved in decisions about whether you will be detained. You cannot choose your nearest relative - he or she is a person who is related to you or someone you live with, as described in the Mental Health Act.

Different people may become your nearest relative as your situation changes. For example, if you are married, your husband or wife will be your nearest relative. However, if you divorce or separate permanently, someone else will become your nearest relative. This could be the older of your parents or your eldest child (if the child is over 18).

What if my nearest relative doesn't want to take on this role?
If your nearest relative doesn't want to take on this role, they can write to one or more of the doctors or other people responsible for your care, naming someone else to act as your nearest relative. Your nearest relative can also change their mind at any time about whether someone else should take on this role, but they need to make their instruction clear in writing.

What can my nearest relative do for me?
Your nearest relative has several rights, powers and responsibilities:

  • They can apply for you to be admitted to hospital (although usually an approved social worker does this).
  • They should, when practical, be told if the approved social worker has applied (or is applying) for you to be detained under section 2 of the Mental Health Act.
  • They must be told if the approved social worker plans to detain you under section 3 of the Mental Health Act (unless it is not practical to tell them, or it would cause an unreasonable delay). They can object to the application to detain you. However, the approved social worker can ask the court to appoint someone else as your nearest relative if he or she thinks the objection is unreasonable.
  • They can apply for you to be discharged from hospital (allowed to leave), although the doctor in charge of your treatment can stop this.

In deciding whether it is practicable to contact your nearest relative about an application to detain you under section 2 or section 3, the approved social worker can take into account factors such as whether you object to involving the nearest relative. However, there would need to be a good reason for excluding the nearest relative.

What happens if I agree to go into hospital?
If you agree to go into hospital and get the treatment the doctors think you need, you can be admitted on an informal basis. You will then be free to leave hospital whenever you want.

However, the doctor in charge of your treatment has the power to stop you leaving if they think you need to stay in hospital. This 'doctor's holding power' can last for up to 72 hours. A qualified nurse would also be able to detain you on the ward for up to six hours if they thought you should be immediately stopped from leaving hospital. These 'holding powers' are meant to give the doctors and the approved social worker time to decide whether you need to be detained in hospital.

What are the main effects of being detained in hospital?
If you are detained in hospital, you will be able to leave only if you get permission from the doctor in charge of your treatment (called the 'responsible medical officer' or RMO).

You may be treated for your mental disorder without your permission.

5. When can I be given compulsory treatment?

6. What treatment can I be given?

7. Who can discharge me from hospital?

8. What are my rights in hospital?

9. What if I am unhappy with my care and treatment?

10. Will I get help when I leave hospital?

11. What powers do the police have against people with mental health problems?

12. Mental health and The Human Rights Act

13. Terms used in mental health law

14. Further help

15. About this leaflet

This leaflet is published by the Gurkha Free Legal Advice (LSC). It was written in association with Camilla Parker, and independent consultant specialising in mental health law and policy.

The leaflets are regularly updated but the law may have changed since they were printed so the information in them may be incorrect or out of date.

Leaflet Version: January 2007

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