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Mental health

Mental health

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.

Safeguards

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".

Who's who in mental health care

If the person you're looking after has mental health problems, a variety of healthcare professionals who specialise in mental health may be involved in their treatment.

Psychiatrist

Psychiatrists are qualified medical doctors who specialise in mental health problems. They have overall responsibility for diagnosing a mental heath condition and prescribing treatment. They may work in hospitals or community mental health centres, and they work closely with other professionals, such as GPs, psychologists and social workers.

Psychologists

Psychologists are extensively trained senior members of any team of mental health professionals, but they're not qualified medical doctors. There are different types of psychologists, such as clinical psychologists and counselling psychologists.

Counsellors and psychotherapists

Counsellors use talking treatments to help people manage their mental health problems. They sometimes offer group or family therapy. Psychotherapists have a similar approach, but their training is different and they may offer more intensive or longer-term treatment.

Community mental health nurses or community psychiatric nurses

These are registered nurses who are trained in mental health and can give long-term support to those living in the community. They're also able to give some types of medication.

Community mental health team

Community mental health teams can be made up of several different professionals, including social workers, community mental health nurses, occupational therapists, psychologists and counsellors. They provide regular support or emergency intervention for people living in the community (with family, friends or in supported accommodation).

Care co-ordinator

The care of the person you're looking after may be managed using a Care Programme Approach. If so, there's likely to be a care co-ordinator who liaises with other professionals to care for the patient.

Mental health professionals and the Mental Health Act

There are some mental health professionals who have specific duties and powers under the Mental Health Act. These are outlined below.

Approved mental health professionals

Approved mental health professionals may be social workers or a range of other professionals. Under the Mental Health Act, they're involved in deciding whether compulsory admission to hospital is necessary and what the alternatives may be.

Approved clinician and responsible clinician

An approved clinician is a mental health professional who has certain duties and powers under the Mental Health Act. A responsible clinician is the approved clinician who has overall responsibility for an individual patient's case.

For example, they may be able to make decisions if a patient needs emergency treatment but doesn't have the capacity to give consent to it or refuses treatment. Certain types of treatment, such as electroconvulsive therapy (ECT), can only be given if an approved clinician is managing the case.

Mental Health Act commissioner

A Mental Health Act commissioner is given the power to interview people who are compulsorily detained in hospital. They investigate complaints and can appoint a panel to give a second opinion if there are concerns about the consent needed for treatment.

Nearest relative

Under the Mental Health Act, the person acting as the nearest relative has certain powers and rights in connection with the patient's admission to and detention in hospital. A relative or established partner who lives with and is the patient's carer take precedence over other relatives. If the patient is living with or being cared for by any person on the list, this person is the nearest relative.

The Mental Health Act defines the nearest relative as someone over 18 who is a:

  • husband, wife or civil partner (including a person with whom the patient has been living for not less than six months)
  • son or daughter
  • father or mother
  • brother or sister
  • grandparent
  • grandchild
  • uncle or aunt
  • nephew or niece

Supporting someone through mental illness

Phil’s brother Simon has a mental illness. The brothers explain how mutual support has helped them to cope with the illness

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Page last reviewed: 19/08/2013

Next review due: 19/08/2015

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