If you are caring for someone who has mental health problems, you should familiarise yourself with the legal and ethical issues round the treatment of their condition.
The Mental Health Act of 1983 and the Mental Health Act of 2007 set out various legal rights that apply to people with severe mental health problems. They also contain the powers that, in extreme cases, allow some people with mental health problems to be compulsorily detained in a psychiatric hospital.
Voluntary admission to hospital
In the majority of cases, patients will be admitted to psychiatric hospital on a voluntary basis. They have exactly the same rights as anyone going into hospital for any treatment, and they can leave whenever they want.
Compulsory admission to hospital
In other cases, people can be detained in a psychiatric hospital for certain periods of time. For example, the Mental Health Act 1983 authorises patients to be detained for assessment or treatment. The purpose of this law is to ensure that people with serious mental disorders that put their health and safety at risk (or the health and safety of other people) receive appropriate assessment and treatment.
When a person is compulsorily detained in hospital, it's sometimes referred to as being “sectioned”. The decision to detain an individual is made under a particular section of the Mental Health Act 1983.
Section two, for example, allows a person to be detained for a maximum period of 28 days so they can be assessed. Section three allows a person to be detained so they can receive treatment. The maximum period of detention in this case is six months, but more time may be authorised.
Other sections of the Mental Health Act deal with the powers to compulsorily detain people who have severe mental disorders and have committed a criminal offence.
Compulsory detention if there's appropriate medical treatment
The law states that when someone is detained in hospital for a long period of time, it must be demonstrated that medical treatment appropriate to the patient's mental disorder is available.
Supervised community treatment
This has been introduced for patients who have been compulsorily detained in hospital. It allows some of them to be discharged earlier than would otherwise be possible, subject to them being supervised within the community.
The law makes it clear that there are maximum periods of detention, depending on the reason behind the patient's detention. The law also sets out how patients can be discharged and who can make that decision. In some cases, you may be the “nearest relative” (see Who's who, below), and you'll have powers to apply for the person you're looking after to be discharged from psychiatric hospital. The person you're looking after will also be able to apply for discharge after certain periods of detention in hospital.
Mental health tribunals
These are independent bodies that make decisions when a patient, or someone acting on their behalf, has applied for their discharge from hospital. When making their decision, the tribunal is required to balance the freedom of the individual with the protection of the public and the best interests of the patient.
The tribunal can decide to discharge a patient immediately or, for example, recommend a leave of absence from hospital or a supervised discharge. Hearings are usually conducted in private at the hospital where the patient is detained.
In some cases, a further appeal can be made to an administrative appeals chamber.
Consent to treatment
A patient can only be forced to have medical treatment if they're compulsorily detained in hospital under the Mental Health Act. Under those circumstances, there may be a maximum period of three months during which they can be forced to have medication. There are also special legal safeguards concerning surgery on the brain (psychosurgery) or electroconvulsive therapy (ECT).
The Mental Health Act Commission offers another safeguard for patients who lack the capacity, or refuse, to consent to treatment, through the “second opinion appointed doctor service”.