You don’t need to have encountered a doctor to be on the receiving end of the Mental Health Act. In fact, many of the patients (like the one in my earlier post) come in via the police using Section 136 – the right of the police to remove a person considered to be a risk to themselves or others from a public place to a place of safety (but only for the purpose of a mental health assessment). A ‘place of safety’ could be a psychiatric unit, a hospital A+E or, where necessary, a police cell. The section lasts up to 72 hours, and an assessment by a psychiatrist must be carried out in the first 12.
We get a lot of Section 136 patients coming through our ward. It’s a mixed bag of people ranging from men found wondering in the street in dresses trying to have their picture taken by the papers to depressed people who have attempted suicide (or threatened it convincingly enough to someone for them to get the police involved). You never know what you’ll get when you walk into that assessment room – only yesterday we had someone who was basically there to try and beggar money off us (frustrating) and prior to that a man who was eyeing up the window throughout the interview, and not just because he wanted to escape.
Once the assessment is complete, there are are number of options:
Discharged: In the opinion of a psychiatrist this person does not need to be admitted to an acute unit. They may have psychoses or depression but are not currently a risk to themselves or others and may safely be managed in the community.
Admitted voluntarily: as an ‘informal’ patient i.e. not under section. If someone needs admitting this is the preferred way to do it and a surprising number of patients will happily be admitted despite having little to no insight into why they are there in the first place.*
Section 2: 28 days of detention and treatment, but for the purpose of assessment and management of a new diagnosis. Must be reviewed by an independent psychiatrist for a second medical opinion, and another trained mental health professional who is there to look out for the patients interests.
Section 3: 6 months of detention and treatment for an existing diagnosis. Same safeguards are in place as for a Section 2.**
In the case I wrote about earlier, the man in question was admitted informally. I mentioned that he could still be sectioned if he tried to leave and I think, bearing in mind his history, that he probably would be at the moment. A single doctor may detain any patient in a hospital for up to 72 hours if they are concerned they have a mental health problem and are at risk (section 5.2 – there’s a section for everything!). As you can see, voluntary admission may be something of an illusion of freedom in many cases.
It is quite a responsibility to be able to detain and treat people against their will. I can see why, in the past, it was a simple solution to admit difficult people to an asylum and lock them away forever for the secrets they held (or just because they were a bit difficult to manage in a regular hospital, which was arguably much more common). I’ve not seen anyone actively resist treatment while I’ve been on this attachment and I’m glad of it – while patients here can (and do) argue and complain they will take their pills. The idea of having to hold someone down while you forcefully inject them with medication is quite the anathema to me, and rightly so I think. The power to legitimately perform the former is frankly, terrifying and I’m glad of the safeguards in place that make it just that bit more challenging to abuse. With the often tiny differences in thinking and cognition between a healthy and psychotic mind, it really makes you contemplate just how easily it could be you in the chair being assessed, unsure of why you are being locked up, with a few molecules out of place in your head turning your world upside down.
Yes, I’m a sucker for drama but it’s true – bit of extra dopamine here, a bit less protein there, and you stop being able to differentiate between your imagination and reality. Or between being dead or alive. Rich or poor. Friends and foes. My theory on psychiatry is that it is all just normal function of the brain but pathologically exaggerated or reduced. Hearing voices is a good example – people tend to hear voices that give a running commentary on their lives, criticise them, or tell them to do things. If you talk to yourself ever, think about what you say. Do you comment on what you’re doing? Do you say ‘Damn, that was stupid of you’ when you forget something? When you’re lacking motivation, do you command yourself to do it: ‘Right! I’m going for a run, NOW!’. Similarly, depression is pathological sadness, mania pathological happiness, phobias are pathological fears and compulsions pathological habits. Just a few examples. In other news, I think this is the longest footnote I’ve ever written. My apologies.
*Of course, you can always be sectioned later if you try to leave and are still a risk, so it’s win some, lose some. Nevertheless, convincing someone to stay and be treated is preferable, no?
**There are lots of sections to the mental health act. Read a little more about the key ones here.