Explains the rights you have to get your section lifted if you are being detained in hospital under the Mental Health Act, and your rights to care and support after leaving hospital.
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Hospital managers are a panel appointed specially to look at whether people should be discharged. They are independent of the hospital, Clinical Commissioning Group, Local Health Board or any organisation that runs your hospital, because they cannot be officers or employees.
You should have been given information on how to contact them when you were sectioned or put on your CTO, or you could ask an IMHA to find this out for you. This information should be available to you on your ward or at your clinic.
Hospital managers can hold a review of whether or not you should be discharged at any time. They must either consider discharging you themselves, or arrange for their power of discharge to be used by a 'managers' panel'.
They must hold a review if:
They should consider holding a review if:
The hospital managers can't discharge you if you:
See our information on sectioning to find out more about what these different sections mean.
Hospital managers can also give permission for you to be transferred into guardianship, if your local authority agrees. This will usually mean you will move to a different care setting that is not a hospital. Your responsible clinician may be given the job of discharging you into guardianship.
If you are a restricted patient or on conditional discharge, the managers can discharge you only if the Secretary of State for Justice agrees. But you still have the right to ask for the managers to hold a review of your detention. For more information see our pages on mental health and the courts.
Yes, they can discharge you in the same way as your responsible clinician.
They also have a duty to consider certain matters independently of the responsible clinician and ward staff, such as problems that may have arisen during your time under section.
But they don't have the power to:
Only your responsible clinician would be able to do these things.
Yes, they would look at the responsible clinician's barring report and reach a conclusion for themselves whether you are likely to be a danger to yourself or others if you were discharged.
They can discharge you if the reasons for your sectioning no longer apply, and should consider whether:
They are likely to look at reports from your:
This is because the managers will need to look at your past history of care and treatment and details of any future plans. This will include your care plan under the Care Plan Approach or Care and Treatment Plan, if you have one.
They will focus especially on any recent risk assessment or risk management plan, and any information that you have self-harmed in the past or used violence against anyone else.
You should be able to see the reports, unless the managers think that this is likely to cause serious harm to your physical or mental health or to someone else's. If that is their decision, they will need to give reasons.
Other people who may get a copy of the reports are your:
The managers have to consider these factors when coming to a decision about whether to discharge you, but have a discretion to discharge you anyway if they feel your individual circumstances would justify it. They should consider the least restrictive option for you getting treatment and how best to maximise your independence.
Being discharged from the section may mean you leave the hospital at that time, but this will depend on:
Although the final decision will be theirs, the managers will also look at:
The managers can discharge you in the same way as from a section, but the factors they consider will be slightly different.
There are no special forms or procedures, and you can ask them as many times as you like. However the managers may choose to hold a 'paper review' in your absence rather than a full hearing if:
If you wanted support when asking the managers to discharge you, you could speak to someone like your:
If you do not have the mental capacity to ask the managers for yourself, you could also get support from:
See our pages on the Mental Capacity Act for general information about mental capacity.
There is no set formal procedure, for example, asking questions in any particular order. But the process that the panel chooses must be fair and reasonable.
Before the meeting, the panel will look at all the relevant information, including any recent reports from your responsible clinician and other healthcare professionals involved in your care.
You should be provided with this information in good time before the meeting so that you, and your representative if you have one, have the opportunity to consider it and prepare for the meeting.
There is no set place for the meeting, but the managers will decide its location based on your best interests. If you are on a CTO or on leave from hospital, the hospital may not be the best place for you. The managers should consider other places that are more suitable, that would be practical to use.
Here is what should happen at the meeting:
The managers should support you to take part in the process as far as possible, and you should be given enough information so that you can understand the process and use it as fully as you can.
You can have extra support if you want. Managers should arrange hearings and give enough notice so that you can have someone there to support you.
This means you can have:
They must let you know the reasons for their decision as soon as they can. They should also:
If they decide to discharge you, they should give or send you an order in writing.
If they decide not to discharge you:
The managers will hold a meeting to consider what discharging you from section and allowing you to leave hospital will mean for your future care.
Before the meeting, your responsible clinician and your multi-disciplinary care team will think about what care you might need if you were discharged, and whether these would be enough to make it no longer necessary for your section or CTO to continue. These may include:
Managers can adjourn the meeting if:
Yes, they can give permission for you to be transferred, but cannot force another hospital to give you a place, or for another Clinical Commissioning Group to give funding for your care.
They might decide to transfer you because:
The factors they will consider include:
When making their decision, they must think about what's best for you when deciding whether or not you should be transferred. This means that:
If you want to appeal against a decision not to discharge you, see our information in Getting my section lifted.
If you believe the managers have reached a decision without considering all the relevant information, or following the right procedure, you should speak to a legal adviser or mental health solicitor (see Useful contacts). They can tell you whether it's worth trying to get their decision reviewed by a court, as it is hard to bring this type of legal claim and to get legal aid for it.
The managers may refer your case if you have not applied to the tribunal yourself. This may happen if you can't apply yourself because of your illness or other health reasons. This could happen if, for example, you were detained under section 2 or 3.
They must apply on your behalf if:
The hospital managers should consider asking the Secretary of State (if you are a patient in England), or the Welsh Ministers (if you are a patient in Wales), to refer your case to the tribunal if you are unable to have your case considered by the tribunal quickly after you were first sectioned and kept in hospital, or at reasonable time intervals after that. This is because this violates your rights under the European Convention on Human Rights.
The hospital managers should normally ask for this if:
Read more about when the tribunal can discharge you.
An advocate is a person who can both listen to you and speak for you in times of need. Having an advocate can be helpful in situations where you are finding it difficult to make your views known, or to make people listen to them and take them into account.
See our pages on advocacy for more information.
Visit our full listing of Legal TermsThis means medical treatment for your mental health problem that is:
An attorney is a person over the age of 18 whom you have appointed to make decisions on your behalf about your welfare and/or your property and financial affairs. You need an attorney if you are unable to make such decisions yourself. If you do not have the capacity to appoint an attorney, the Court of Protection will appoint a deputy to perform this role.
See our pages on the Mental Capacity Act for more information.
Visit our full listing of Legal TermsThis is the report written by the responsible clinician stopping the discharge of someone under section when an application has been made by the nearest relative.
Visit our full listing of Legal TermsA care coordinator is the main point of contact and support if you need ongoing mental health care. They keep in close contact with you while you receive mental health care and monitor how that care is delivered – particularly when you’re outside of hospital. They are also responsible for carrying out an assessment to work out your health and social care needs under the care programme approach (CPA).
A care coordinator could be any mental health professional, for example:
This is decided according to what is most appropriate for your situation.
A care coordinator usually works as part of the community mental health team.
Visit our full listing of Legal Terms'Capacity' means the ability to understand information and make decisions about your life. Sometimes it can also mean the ability to communicate decisions about your life.
For example, if you do not understand the information and are unable to make a decision about your treatment, you are said to 'lack capacity' to make decisions about your treatment.
See our pages on the Mental Capacity Act for more information.
Visit our full listing of Legal TermsThe Care Programme Approach (CPA) is a way that secondary mental health services are assessed, planned, coordinated and reviewed for someone that lives in England (see: secondary care).
Secondary mental health services include the Community Mental Health Team (CMHT), Assertive Outreach Team and Early Intervention Team.
You should get:
See our pages on leaving hospital for more information.
Visit our full listing of Legal TermsCare and Treatment Planning is a way that secondary mental health services are assessed, planned, coordinated and reviewed for someone that lives in Wales. It comes from a law called the Mental Health (Wales) Measure 2010.
Secondary mental health services include the community mental health team (CMHT), assertive outreach team and early intervention team.
You should get:
See our pages on leaving hospital for more information.
Visit our full listing of Legal TermsCCGs are groups of GP practices and other healthcare professionals and bodies that are responsible for commissioning most health and care services for patients. They have replaced Primary Care Trusts (PCTs) in England.
Visit our full listing of Legal TermsIf you have been sectioned and treated in hospital under certain sections, your responsible clinician can put you on a CTO. This means that you can be discharged from the section and leave hospital, but you might have to meet certain conditions such as living in a certain place, or going somewhere for medical treatment. Sometimes, if you don't follow the conditions or you become unwell, you can be returned to hospital.
See our pages on CTOs for more information.
Visit our full listing of Legal TermsThis is where you are discharged from hospital but will have to follow some conditions, such as living at a particular place or meeting healthcare professionals. If you break these conditions, you can be recalled to hospital.
You can only be put under a conditional discharge if you have been:
The Court of Protection makes decisions and appoints deputies to act on your behalf if you are unable to make decisions about your personal health, finance or welfare.
See our pages on the Mental Capacity Act for more information.
Visit our full listing of Legal TermsIf you are in a hospital or care home, your liberty can normally only be taken away if health professionals use the procedures called the Deprivation of Liberty Safeguards. This protects you from having your liberty taken away without good reason.
See our pages on the Mental Capacity Act for more information.
Visit our full listing of Legal TermsA deputy is a person the Court of Protection appoints to make decisions for you once you have lost capacity to make them yourself. A deputy usually makes decisions about finances and property. The court can appoint a deputy to take healthcare and personal care decisions, though this is relatively rare.
Visit our full listing of Legal TermsThis is where someone called a 'guardian' is appointed instead of being sectioned and kept in hospital. Your guardian could be a person or a local authority.
You can only be placed under guardianship if it's necessary for your welfare or to protect other people. Your guardian has the power to make certain decisions about you and to make conditions that you will be asked to keep to, such as where you live.
Guardianship lasts for up to six months and can be renewed: initially for a further six months, and then for a year at a time. You can appeal to the Mental Health Tribunal once in each of these periods.
Visit our full listing of Legal TermsAn IMHA is an advocate specially trained to help you find out your rights under the Mental Health Act 1983 and help you while you are detained. They can listen to what you want and speak for you.
In Wales, voluntary patients can also have an IMHA.
See our pages on IMHAs (England) and IMHAs (Wales) for more information.
Visit our full listing of Legal TermsAn IMCA is a specially trained advocate who can help you if you do not have the capacity to make particular decisions. NHS bodies or local authorities must take an IMCA's views into account when making decisions that affect you if you have lost capacity. They are normally appointed by the local authority in England, and by local health boards or other NHS bodies in Wales. They must be independent people of integrity and good character with appropriate experience and training.
See our page on IMCAs for more information.
Visit our full listing of Legal TermsThese are organisations in the health service in Wales that have been set up to develop and provide health services based on the needs of the local community.
Visit our full listing of Legal TermsThis tells health professionals how they should follow the Mental Health Act. It is not law, so it cannot be enforced by going to court, but health professionals should follow it unless there is a good reason not to.
The Code covers some areas not specifically mentioned in the Mental Health Act, such as visiting rights and the use of seclusion.
If a health professional doesn’t follow the Code, you can make a complaint.
Visit our full listing of Legal TermsThe nearest relative is a family member who has certain responsibilities and powers if you are detained in hospital under the Mental Health Act. These include the right to information and to discharge in some situations.
The law sets out a list to decide who will be your nearest relative. This can sometimes be changed.
See our pages on the nearest relative for more information.
Visit our full listing of Legal TermsThis is the mental health professional in charge of your care and treatment while you are sectioned under the Mental Health Act.
Certain decisions, such as applying for someone who is sectioned to go onto a community treatment order (CTO), can only be taken by the responsible clinician.
All responsible clinicians must be approved clinicians. They do not have to be a doctor, but in practice many of them are.
Visit our full listing of Legal TermsBeing 'sectioned' means that you are kept in hospital under the Mental Health Act. There are different types of sections, each with different rules to keep you in hospital. The length of time that you can be kept in hospital depends on which section you are detained under.
See our pages on sectioning for more information.
Visit our full listing of Legal TermsThis information was published in July 2020. We will revise it in 2023.
References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.