Sectioning and community treatment orders: when can an individual be deprived of their liberty under the Mental Health Act 1983?

Sectioning is the detention of an individual who is suffering from a mental condition in order to protect them or others from harm, to assess them and/or to administer treatment.

The Mental Health Act 1983 (MHA) authorises medical professionals to transport and admit individuals suffering from a mental health disorder to hospital and to detain them there provided that the detention is necessary and is either in the interests of the patient's health and safety or is done with a view to protecting others.  This can include detaining the patient so that a medical assessment can be carried out.  A patient may also be admitted to hospital for treatment if the 'nature or degree' of their condition means it is appropriate that they are treated in hospital and the detention is necessary both to enable the treatment to be carried out and to ensure the patient's and/or others' safety.  

In both cases, two medical professionals must agree the detention is necessary and that the legal test has been met.  In emergency cases, an individual can be detained on the recommendation of one professional.  But in such cases the detention must be limited to 72 hours.

The MHA also grants police officers certain powers to take individuals who appear to have a mental disorder to a place of safety for a limited period to enable a mental health assessment to be carried out.

The most commonly used detention sections are section 2 and 3 MHA. Section 2 allows a person to be detained in a hospital for assessment and treatment of a mental disorder for up to 28 days. This type of section cannot be renewed.  Section 3 allows for detention for an initial period of up to 6 months but can be renewed for further periods.  A section 3 order is commonly referred to as a 'Treatment Order'.

Community Treatment Orders (CTO) allow patients to be discharged into the community, subject to certain conditions such as who they can contact and requirements to attend regular check-ups.   A CTO may be used when the treatment can be administered in the community, but where it is considered necessary that the patient continues to be supervised and for the medical professionals to retain the power to recall the patient to hospital if required.

It is also for a previously sectioned patient to stay in a secure hospital on a voluntary basis.

The MHA establishes various safeguards, including the role of the nearest relative, a person defined in a strict order of priority starting with spouses, then children, parents and so on. Their role is important as it provides a family member with certain rights and responsibilities, including the right to be consulted and informed about the detained person's care and the right to object to detention under section 3. 

The MHA establishes a tribunal which reviews decisions to section an individual.  The tribunal checks that the legal test has been met and can make recommendations as to the treatment of the individual.  The individual can make representations to the tribunal to show, for example, that it is not necessary to detain them (for instance, where the individual understands their illness, demonstrates that they can and will access treatment and has somewhere suitable to live) and that the legal test has not been met.  If the legal test is not made out, the tribunal will order that the individual is discharged.  

A patient who has been sectioned section 3 and who, following the discharge of  their section, still needs care arising from their mental health condition may be eligible to receive this care free of charge under s117 MHA. 

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