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In hospital under section
If you are in hospital under a section of the Mental Health Act, a nurse should have given you a rights leaflet and explained what your section means.
Anyone in hospital under section has the right to free and confidential support from an independent mental health advocate
Sometimes your section can be changed. You should always know which section you are on. Ask a nurse if you are not sure.
Nearest relative
The Mental Health Act gives rights to a patient's “nearest relative”. This could be your partner (if you have one) or a family member.
If you are unhappy with your nearest relative, or you do not want them to know about your care and treatment, please tell someone in the team looking after you.
Leaving hospital
You can leave hospital, or be “discharged”, in four ways:
Your section ends, usually because it is ended by your responsible clinician, and you are well enough to leave. If you were on section 3, you have the right to aftercare (known as section 117 aftercare) to help you meet your needs in the community.
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You are on section 3 and your responsible clinician thinks you are well enough to leave hospital under a Community Treatment Order
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You appeal against your section and either the Mental Health Tribunal or the Associate Hospital Managers agree that you are well enough to leave hospital
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Your nearest relative writes to the trust asking that you be discharged, and they agree that you are well enough to leave hospital
Patients sometimes choose to stay after their section has ended as a voluntary patient until they feel well enough to leave.
There are separate sections called forensic sections for people who come to hospital from court or prison.
Main sections of the Mental Health Act used to keep people in hospital
These are the main sections of the Mental Health Act that are used to keep people in hospital.
Emergency section – Section 4
Section 4 is used when an approved mental health professional is very concerned about your mental health and needs to act quickly so they can keep you, or others, safe.
Only one doctor is needed for a section 4. It lasts up to 72 hours and it might be followed by a section 2 or section 3.
Assessment and treatment section – Section 2
Section 2 is used to allow time to assess your mental health, and decide what treatment might help.
Two doctors and an approved mental health professional need to agree before someone is put on section 2. It lasts up to 28 days.
A senior doctor or consultant, also known as a “responsible clinician”, will be in charge of your care.
Treatment section - Section 3
Section 3 allows time for treatment to improve your mental health. Two doctors and an approved mental health professional need to agree before anyone is treated under section 3.
To start with, a section 3 lasts up to six months. If it is extended, the first extension lasts up to another six months. Any further extensions last up to a year.
A senior doctor or consultant, also known as a “responsible clinician”, will be in charge of your care.
After three months under section, if you do not want to take medication (or you are too unwell to decide) a second opinion appointed doctor (SOAD) will visit you on the ward.
These are independent doctors who check your views and wishes have been taken into account, and make sure your treatment is appropriate.
SOADs are appointed by the Care Quality Commission.
Holding sections – Sections 5(2) and 5(4)
If you are a voluntary or informal patient and there are serious concerns about your safety a holding section might be used to keep you in hospital.
A doctor can use section 5(2) to detain you for up to 72 hours while you are assessed for a section 2 or 3.
If a doctor is not available, a nurse can use section 5(4) to detain you for up to six hours. It ends when a doctor sees you.
Section 136
Some people are brought to hospital under a section 136. This is a power which a police officer can use if you were in a public place and they had concerns about your mental health.
Time off the ward - section 17
If you are in hospital under section, time off the ward needs to be agreed by your responsible clinician. This is called section 17 leave.
If you are given leave, you will be told how much you have, and if you need a nurse or someone else to go with you when you leave the ward (escorted leave).
If you do not follow these conditions, for example you do not return by an agreed time, the police may be asked to bring you back to hospital.
Forensic sections
Forensic sections of the Mental Health Act are used when court or prison authorities, advised by doctors, feel people would benefit from time in hospital to assess or treat mental health problem.
If you are admitted under a forensic section a nurse will give you a leaflet explaining the section you are under and any rights of appeal you have.
The leaflet will also explain what happens after the assessment or treatment has finished. In some cases you will leave hospital and return to court or prison.
Section 35
If you are under a Section 35 it is because a court of law has decided that you would benefit from spending time in hospital so that your mental health needs can be assessed. A Section 35 lasts for up to 28 days and can be extended but never for more than 12 weeks in total. During your time under this section the senior doctor on the ward will decide whether you have a serious mental health problem or not. In all cases you will need to go back to court.
If you were admitted under this section, a nurse will have given you a leaflet explaining the section you are under and any rights of appeal you have.
Section 36
If you are under a Section 36 it is because the Crown Court which is dealing with your case has decided that you need treatment for a serious mental health problem. A section 36 lasts for up to 28 days and can be extended but never for more than 12 weeks in total. During the time under Section 36 the senior doctor on the ward will provide treatment for you. In all cases, you will need to go back to court.
If you were admitted under this section, a nurse will have given you a leaflet explaining the section you are under and any rights of appeal you have.
Section 37 (without restrictions)
If you are under a Section 37, it is because a court of law (on the advice of two doctors) has decided that instead of going to prison, you would benefit from going to a hospital to receive treatment for a serious mental health problem. Section 37 lasts for up to six months and might be extended if the senior doctor on the ward decides that more time is needed for your treatment.
Unless you are told otherwise, this is a Section 37 without restrictions, which means that the senior doctor on the ward can end the Section 37 if he or she feels you are ready to be discharged. Before you leave hospital your needs should be assessed and an aftercare plan put together. This will be to help you to stay well in the community.
If you were admitted under this section, a nurse will have given you a leaflet explaining the section you are under and any rights of appeal you have.
Section 38
If you are under a Section 38, it means that a court of law has convicted you of a particular offence, but has not yet decided on your sentence. The reason for the delay is because two doctors have advised the court that time in hospital is needed to treat your serious mental health problem. This section lasts for up to 28 days, but can be extended, but never for more than a year in total.
In hospital, you will be looked after by a senior doctor who will see how you respond to treatment and advise the court when it decides what should happen next. The court may decide to place you under a Section 37 or send you to prison.
If you were admitted under this section, a nurse will have given you a leaflet explaining the Section you are under and any rights of appeal you have.
Section 37/41 (without restrictions)
If you are under a Section 37/41 it means that the Crown Court has decided that (on the advice of two doctors) instead of going to prison, you would benefit from going to a hospital to receive treatment for a serious mental health problem. The judge will have decided that, because of concerns about public safety, you need to be both Section 37 and also Section 41. Section 37 deals with treatment of your mental health problem.
The Section 41 (often called a Restriction Order) means the Secretary of State decides when you can be given leave and when you can leave hospital. If it is agreed that you can leave hospital, conditions will be attached to your discharge. This is called a conditional discharge and means that you could be brought back to hospital if you do not comply with these conditions.
Section 47
If you are under a Section 47 it means that you are a sentenced prisoner. On the advice of two doctors, the Secretary of State decided that you needed to spend time in hospital to have treatment for a serious mental health problem.
When the treatment finishes you will go back to prison. Most people under this section are also under Section 49 which means the Secretary of State decides when you return to prison.
If you are in hospital when your prison sentence ends it does not mean you are free to leave. This is because the Section 47 changes to what is called a 'notional' Section 37. If this happens, the doctor in charge of your care and treatment, decides when you can leave hospital.
If you were admitted under this section, a nurse will have given you a leaflet explaining the Section you are under and any rights of appeal you have.
Section 48
If you are under a Section 48 it means that you are a prisoner waiting to be sentenced. On the advice of two doctors, the Secretary of State decided that you needed to spend time in hospital to have treatment for a serious mental health problem. In most cases you will return to court for final sentencing. Most people under Section 48 are also under section 49.
If you were admitted under this section, a nurse will have given you a leaflet explaining the Section you are under and any rights of appeal you have.
