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57-692: The Commission was established under the Mental Health Act 1983 and consisted of some 100 members (Commissioners), including laypersons, lawyers, doctors, nurses, social workers, psychologists and other specialists. The Health and Social Care Act 2008 replaced the Healthcare Commission , the Commission for Social Care Inspection and the Mental Health Act Commission with a single, integrated regulator for health and adult social care -

114-567: A donor or deputy , or decision of the Court of Protection . Absence or "leave" from hospital can be granted by the RC for a patient detained under either a Section 2 assessment order or Section 3 treatment order, and the RC will ultimately be responsible for discharging a patient under such an order. Following discharge from a Section 3 treatment order, the person remains subject to the after-care provisions of Section 117 indefinitely . These provisions include

171-425: A (usually brief) assessment by the RC or his deputy, which, in effect, means any hospital doctor, including psychiatrists but also those based on medical or surgical wards. It lasts up to 72 hours, during which time a further assessment may result in either discharge from the section or detention under section 2 for assessment or section 3 for treatment. Section 5(4) is a nurse's holding power. It can be applied to

228-400: A Crown Court. Courts can enact either of these sections on the medical recommendation of one Section 12 approved doctor. Both these sections are rarely used in practice. Section 37 is a treatment order, similar in many regards to the civil treatment order under Section 3, and is fairly frequently used. It is applied to persons recently convicted of a serious crime (other than murder), which

285-410: A Section 135 magistrates' order or Section 136 police officers' order is at a place of safety, they are further assessed and, in some cases, a Section 2 assessment order or Section 3 treatment order implemented. Section 131 allows for patients to be voluntarily admitted as an inpatient, and voluntarily remain after other sections cease to apply. Voluntary inpatients may be prevented from leaving by

342-412: A formal discharge planning meeting, and provision of personal care if necessary. Section 4 is an emergency order that lasts up to 72 hours. It is implemented by just one doctor and an AMHP, in an emergency in which there is not time to summon a second suitable doctor in order to implement a Section 2 assessment order or Section 3 treatment order. Once in hospital, a further medical recommendation from

399-510: A hospital, at a police station, or in a person's home. If the two doctors agree that the person has a mental disorder and ought to be detained in hospital in the interest of the patient's own health or safety, or for the protection of others, they complete a medical recommendation form and give this to the AMHP. If the AMHP agrees that there is no viable alternative to detaining the person in hospital, they will complete an application form requesting that

456-677: A new kind of institution called a "mental deficiency colony" rather than an insane asylum or a prison. Examples include the Farmfield State Institution in Horley and Etloe House in Leyton . Once a person was deemed "mentally deficient", they could only get the categorisation removed if their family wrote to the Board of Control proving that they could look after the person. The act applied to England and Wales . An equivalent piece of legislation

513-508: A person of any category who had been abandoned, neglected, guilty of a crime, in a state institution, habitually drunk, or unable to be schooled. Every local authority had a "Mental Deficiency Committee" that parents and guardians could apply to if they were struggling to care for someone under the age of 21. People could also be referred to the committee by magistrates, prisons, asylums, and industrial schools. Two doctors had to sign off on each case. In 1916, reasons for people being referred to

570-505: A physician under section 5(2) or any nurse under section 5(4) for 72 hours before being assessed for commitment through section 3 or section 2 . Part III and other various criminal sections of the Act apply to sentenced prisoners and persons subject to proceedings of the criminal justice System. Although they are invariably implemented by a court, often upon the recommendations of one or more psychiatrists, some of these sections largely mirror

627-466: A second doctor would convert the order from a Section 4 emergency order to a Section 2 assessment order. Section 4 emergency orders are not commonly used. Section 5(2) is a doctor's holding power. It can only be used to detain in hospital a person who has consented to admission on an informal basis (i.e. not detained under the Act) but then changed their mind and wishes to leave. It can be implemented following

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684-496: A second opinion to confirm that the treatment being given remains in the person's best interests. A similar safeguard is used for electroconvulsive therapy (ECT), although the RC can authorise two ECT treatments in the event of an emergency for people detained under Section 3 treatment orders. ECT may not be given to a refusing patient who has the capacity to refuse it, and may only be given to an incapacitated patient where it does not conflict with any advance directive , decision of

741-511: Is a healthcare professional who is competent to become responsible for the treatment of mentally disordered people compulsorily detained under the Act. A clinician must complete special training and demonstrate competence in their professional portfolio in order to be approved as an AC. Until the 2007 amendments , they would almost exclusively have been a consultant psychiatrist, but other professionals, such as social workers, clinical psychologists and nurse specialists, are being encouraged to take on

798-406: Is an assessment order and lasts up to 28 days; it cannot be renewed. It can be instituted following an assessment under the Act by two doctors and an AMHP. At least one of these doctors must be a Section 12 approved doctor. The other must either have had previous acquaintance with the person under assessment, or also be a Section 12 approved doctor. This latter rule can be broken in an emergency where

855-409: Is included in the 72 hours of any subsequent Section 5(2). The Care Quality Commission consider it to be extremely poor practice to allow a section 5(2) to simply "lapse". There is a clear duty on the part of the patient's RC to make a decision as to whether any further action, such as detention under section 2 for assessment or detention under section 3 for treatment should be implemented, or whether

912-501: Is punishable by imprisonment. Thus it represents an alternative to a mentally disordered person being punished by imprisonment or otherwise. It is enacted by the Crown Court or a magistrates' court on the recommendation of two approved doctors. However, the court is able to exercise discretion in this regard and can impose a prison sentence despite medical recommendations for Section 37. A person detained under Section 37 can appeal to

969-506: Is sometimes as a means to avoid the threat of detention under sections of this act by a medical doctor. These sections are implemented following an assessment of the person suspected to have a mental disorder. These assessments can be performed by various professional groups, depending upon the particular section of the Act being considered. These professional groups include AMHPs, Section 12 approved doctors, other doctors, registered mental health nurses (RMNs) and police officers. Section 2

1026-655: Is the exception to the rule, occurring in around 5% of cases, when the Tribunal judges that the conditions for detention are not met. Part II of the Act applies to any mentally disordered person who is not subject to the Criminal Justice System. The vast majority of people detained in psychiatric hospitals in England and Wales are detained under one of the civil sections of the Act. If a clinician consents, patients may choose to be treated as voluntary inpatient . This choice

1083-554: Is thought by most psychiatrists to cover schizophrenia , anorexia nervosa , major depression , bipolar disorder and other similar illnesses, learning disability and personality disorders . Most people are subject to the Act, and section 141 even makes provision for members of the House of Commons , until it was repealed by the Mental Health (Discrimination) Act 2013 . In 1983–84, the House of Lords Committee for Privileges accepted

1140-471: The Care Quality Commission . The Act was significantly amended by the Mental Health Act 2007 . A white paper proposing changes to the act was published in 2021 following an independent review of the act by Simon Wessely . It was confirmed on 17 July 2024 that a new mental health act would be legislated for in the forthcoming session of Parliament. The Madhouses Act 1774 created a Commission of

1197-517: The Care Quality Commission . The Care Quality Commission began operating on 1 April 2009 as a non-departmental public body . The Commission was a monitoring body rather than an inspectorate or regulator. Its concern was primarily the legality of detention and the protection of individuals' human rights. In addition to a visiting programme, the Commission provided important safeguards to patients who lack capacity or refuse to consent to treatment, through

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1254-748: The London County Council's Mental Deficiency Committee included being unable to keep a job, epilepsy, having had illiegitimate children, homelessness, and living in an "unsatisfactory" (i.e., impoverished) home. For example, one woman called Eliza was referred to the committee by the medical officer at a workhouse in Paddington . She'd had three illegitimate children, and was thought to be unreliable, "refusing to work unless feeling so inclined". The workhouse recommended she be institutionalised "for her own protection" so that she wouldn't "run away with men". People categorised under this Act would often be sent to

1311-580: The Royal College of Physicians with powers to grant licences to premises housing "lunatics" in London ; justices of the peace were given these powers elsewhere in England and Wales. Failure to gain a licence resulted in a hefty fine. Admission to a "madhouse" required certification signed by a doctor, and lists of detained residents became available for public inspection. This Act was later considered ineffectual and

1368-656: The Second Opinion Appointed Doctor Service . Its functions were: In addition, the Commission was encouraged by the Secretary of State to advise on policy matters that fall within the Commission's remit. Mental Health Act 1983 The Mental Health Act 1983 (c. 20) is an Act of the Parliament of the United Kingdom . It covers the reception, care and treatment of mentally disordered people,

1425-405: The 1959 Act did not provide clarity as to whether a legal order to detain a mentally disordered person in a hospital also empowered the hospital to impose medical treatment against the person's wishes. It had become clear by the 1970s that a specific legal framework for medical treatments such as psychiatric medications , electroconvulsive therapy and psychosurgery was needed in order to balance

1482-530: The Care and Control of the Feeble-Minded. It established the Board of Control for Lunacy and Mental Deficiency to oversee the implementation of provisions for the care and management of four classes of people, A person deemed to be an idiot or imbecile might be placed in an institution or under guardianship if the parent or guardian so petitioned, as could a person of any of the four categories under 21 years, as could

1539-539: The First-Tier Tribunal (Mental Health) outlined below. Mental Health Review Tribunals (MHRTs) hear appeals against detention under the Act. Their members are appointed by the Lord Chancellor and include a doctor , a lawyer and a lay person (i.e. neither a doctor nor a lawyer). Detained persons have the right to be represented at MHRTs by a solicitor . Discharge from hospital as a result of an MHRT hearing

1596-656: The Mental Deficiency Act 1913. The bill was passed in 1913 with only three MPs voting against it. One of them was Josiah Wedgwood , who attempted to filibuster and said of it, "It is a spirit of the Horrible Eugenic Society which is setting out to breed up the working class as though they were cattle." The new act repealed the Idiots Act 1886 and followed the recommendations of the Royal Commission on

1653-618: The Mental Health Review Tribunal after a period of six months; if they are no longer experiencing symptoms of mental disorder, the person can be discharged by the Tribunal, even if there is a strong possibility that the person might relapse and re-offend. Furthermore, a person on Section 37 alone, who may have been convicted of a serious violent crime, can be discharged in the community at any time by his or her Responsible Clinician (RC). Mental Deficiency Act 1913 The Mental Deficiency Act 1913 ( 3 & 4 Geo. 5 . c. 28)

1710-729: The Peace and lasted one year. Thereafter, detention could be renewed at regular intervals by submission of a medical report to the Lunacy Commission. The Mental Deficiency Act 1913 renamed the Lunacy Commission the "Board of Control" and increased the scope of its powers. The functions of the Board of Control were subsequently altered by the Mental Treatment Act 1930 and the National Health Service Act 1946 . The Lunacy Act 1890

1767-515: The Policing and Crime Act 2017. The Act is divided into eleven "parts" (one repealed): I Application of the Act II Compulsory admission to hospital and guardianship III Patients concerned in criminal proceedings or under sentence IV Consent to treatment 4A Treatment of community patients not recalled to hospital V Mental Health Review Tribunal VI Removal and return of patients within

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1824-570: The United Kingdom VII Management of property and affairs of patients (repealed) VIII Miscellaneous functions of Local Authorities and the Secretary of State IX Offences X Miscellaneous and supplementary Each of these parts are divided into "sections", which are numbered continuously throughout the Act. In total, there are currently 202 sections in the Act that are in force. The act lays out various procedures to detain members of

1881-413: The United Kingdom .) A section 12 approved doctor is a medically qualified doctor who has been recognised under section 12(2) of the Act. They have specific expertise in mental disorder and have additionally received training in the application of the Act. They are usually psychiatrists , although some are general practitioners (GPs) who have a special interest in psychiatry. An Approved Clinician (AC)

1938-557: The advice of the law lords that the statute would prevail against any privilege of Parliament or of peerage . An Approved Mental Health Professional (AMHP) is defined in the Act as a practitioner who has extensive knowledge and experience of working with people with mental disorders. Until the 2007 amendments , this role was restricted to social workers , but other professionals such as nurses, clinical psychologists and occupational therapists are now permitted to perform this role. AMHPs receive specialised training in mental disorder and

1995-482: The application of mental health law, particularly the Mental Health Act. Training involves both academic work and apprenticeship and lasts one year. The AMHP has a key role in the organisation and application of Mental Health Act assessments and provides a valuable non-medical perspective in ensuring legal process and accountability. ( For further aspects on the role of the AMHP see also: Involuntary commitment in

2052-498: The civil sections of the Act. Section 35 and Section 36 are similar in their powers to Section 2 assessment orders and Section 3 treatment orders respectively, but are used for persons awaiting trial for a serious crime and provide courts with an alternative to remanding a mentally disordered person in prison. The order for Section 35 can be made by the Crown Court or a magistrates' court , whilst Section 36 can be enacted only by

2109-516: The establishment of a board of control which would oversee local authority efforts aimed at "the well-being of the mentally defective". Winston Churchill spoke of the need to introduce compulsory labour camps for "mental defectives" in the House of Commons in February 1911. In May 1912, a Private Members' Bill entitled the "Feeble-Minded Control Bill" was introduced in the House of Commons, which called for

2166-406: The hospital managers detain the person. The person will then be transported to hospital and the period of assessment begins. Treatment, such as medication, can be given against the person's wishes under Section 2 assessment orders, as observation of response to treatment constitutes part of the assessment process. Section 3 is a treatment order and can initially last up to six months; if renewed,

2223-463: The implementation of the Royal Commission's conclusions. It rejected sterilisation of the "feeble-minded", but had provision for registration and segregation. One of the few to raise objections to the bill was G.K. Chesterton who ridiculed the bill, calling it the "Feeble-Minded Bill, both for brevity and because the description is strictly accurate". The bill was withdrawn, but a government bill introduced on 10 June 1912 replaced it, which would become

2280-425: The management of their property and other related matters, forming part of the mental health law for the people in England and Wales . In particular, it provides the legislation by which people diagnosed with a mental disorder can be detained in a hospital or police custody and have their disorder assessed or treated against their wishes , informally known as " sectioning ". Its use is reviewed and regulated by

2337-414: The mentally disordered person. Thus a person's Nearest Relative under the Act is not necessarily their "next of kin". A mentally disordered person is not usually able to choose their Nearest Relative but under some circumstances they can apply to a County Court to have a Nearest Relative replaced. In practice, such applications are more commonly made by Social Services Departments. The Nearest Relative has

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2394-404: The next order lasts up to six months and each subsequent order lasts up to one year. It is instituted in the same manner as Section 2, following an assessment by two doctors and an AMHP. One major difference, however, is that for Section 3 treatment orders, the doctors must be clear about the diagnosis and proposed treatment plan, and be confident that "appropriate medical treatment" is available for

2451-412: The patient should be regraded to "informal" legal status. Section 135 is a magistrates ' order. It can be applied for by an AMHP in the best interests of a person who is thought to be mentally disordered, but who is refusing to allow mental health professionals into their residence for the purposes of a Mental Health Act assessment. Section 135 magistrates' orders give police officers the right to enter

2508-407: The patient. The definition of "appropriate medical treatment" is wide and may constitute basic nursing care alone. Most treatments for mental disorder can be given under Section 3 treatment orders, including injections of psychotropic medication such as antipsychotics . However, after three months of detention, either the person has to consent to their treatment or an independent doctor has to give

2565-460: The person is not known to any available doctors and two Section 12 approved doctors cannot be found. In any case, the two doctors must not be employed in the same service, to ensure independence (this 'rule' was removed in the 2007 MHA amendment). Commonly, in order to satisfy this requirement, a psychiatrist will perform a joint assessment with a general practitioner (GP). A Mental Health Act assessment can take place anywhere, but commonly occurs in

2622-607: The power to discharge the mentally disordered person from some sections of the Act. Hospital Managers represent the management of the NHS Trust or independent hospital and have the responsibility for a detained patient. On their behalf, the non-executive members of the board of the relevant National Health Service Trust and appointed lay 'Associate Managers' may hear appeals from patients against their detention, Community Treatment Order and upon those detentions being renewed and extended. Cases are heard in similar settings to those heard by

2679-403: The property and to take the person to a " place of safety ", which is locally defined and usually either a police station or a psychiatric hospital ward. Section 136 is a similar order that allows a police officer to take a person whom they consider to be mentally disordered to a "place of safety" as defined above. This only applies to a person found in a public place. Once a person subject to

2736-584: The public, inpatients, force them to take drugs, and perform medical procedures on them without consent. The term "mental disorder" is very loosely defined under the Act, in contrast to legislation in other countries such as Australia and Canada . Under the Act, mental disorder is defined as "any disorder or disability of mind". The concept of mental disorder as defined by the Act does not necessarily correspond to medical categories of mental disorder such as those outlined in ICD-10 or DSM-IV . However, mental disorder

2793-531: The rights of detained persons with society as a whole. The Mental Health Act 1983 was formally approved by the monarch on 9 May 1983 and came into effect on 30 September that year. It has been amended many times: notably in 1995, 2001 (via remedial order, issued on the grounds of incompatibility with the European Convention of Human Rights under the Human Rights Act 1998 section 4), 2007 and 2017 via

2850-594: The role. Once an AC takes over the care of a specific patient, they are known as the Responsible Clinician (RC) for that patient. A Nearest Relative is a relative of a mentally disordered person. There is a strict hierarchy of types of relationship that needs to be followed in order to determine a particular person's Nearest Relative: husband, wife, or civil partner; son or daughter; father or mother; brother or sister; grandparent; grandchild; uncle or aunt; nephew or niece; lastly, an unrelated person who resides with

2907-415: The same group of patients as those that may be detained under section 5(2) as outlined above. It is implemented by a first or second level Mental Health or Learning Disability Nurse . Section 5(4) lasts up to 6 hours and ends at the time the patient is seen by the doctor assessing the patient under Section 5(2), irrespective of the outcome of the doctor's assessment. Time spent by a patient under section 5(4)

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2964-657: Was an act of Parliament of the United Kingdom creating provisions for the institutional treatment of people deemed to be " feeble-minded " and "moral defectives". People deemed "mentally defective" under this Act could be locked up indefinitely in a "mental deficiency colony", despite not being diagnosed with any mental illness or disability, or committing any crime. In the late 1940s, the National Council for Civil Liberties discovered that 50,000 people were locked up under this Act, and that 30% of them had been locked up for 10-20 years already. The Act remained in effect until it

3021-464: Was compelled to provide an asylum for "pauper lunatics", who were removed from workhouses into the aforementioned asylums. The Lunacy Commission was established to monitor asylums, their admissions, treatments and discharges. Both these acts were repealed by the Lunacy Act 1890 . This introduced "reception orders", authorising detention in asylums. These orders had to be made by a specialised Justice of

3078-550: Was established with the warrant "to consider the existing methods of dealing with idiots and epileptics, and with imbecile, feeble-minded, or defective persons not certified under the Lunacy Laws... to report as to the amendments in the law or other measures which should be adopted in the matter". The Commission returned a lengthy report in 1908 which estimated that of a population of 32,527,843 British inhabitants 149,628 people (0.46%) were considered "mentally defective". It recommended

3135-534: Was repealed by the Madhouses Act 1828 , itself repealed shortly afterwards by the Madhouses Act 1832 . These Acts altered the composition of the Commission in several ways, such as including barristers in addition to doctors. The Lunacy Act 1845 and the County Asylums Act 1845 together gave mental hospitals or " asylums " the authority to detain "lunatics, idiots and persons of unsound mind". Each county

3192-407: Was repealed by the Mental Health Act 1959 , but people detained under this Act were still being discovered in institutions as late as the 1990s. The Idiots Act 1886 made the legal distinction between " idiots " and " imbeciles ". It contained educational provisions for the needs of people deemed to be in these categories. In 1904, the Royal Commission on the Care and Control of the Feeble-Minded

3249-485: Was repealed following World War II by the Mental Health Act 1959 . This Act abolished the Board of Control, and aimed to provide informal treatment for the majority of people with mental disorders, whilst providing a legal framework so that people could, if necessary, be detained in a hospital against their will. It also aimed to make local councils responsible for the care of mentally disordered people who did not require hospital admission. However, like its predecessors,

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