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.
If your section is coming to an end because it is reaching its maximum time limit, which will depend on which section you are under, your responsible clinician must decide whether your section should be renewed. Renewal is normally possible only with some sections, such as section 3 or 37.
They must examine you in the last two months of your section and decide whether the conditions for renewing your section are met and whether you should be discharged. They should also discuss their decision with you.
Then they must do the following:
- Consult one or more professionals involved in your medical treatment.
- Explain in full their reasons in a report to the hospital managers. If they are satisfied that the conditions for renewing your section are met, they must put this in their report.
- Get agreement in writing from another professional. The professional must be involved in your care and treatment, have had recent contact with you and not be in the same profession as your responsible clinician.
If your section is not renewed, then when it reaches its maximum time limit, you should be:
- discharged and free to go, or
- placed under another section
If you think you are no longer sectioned, and are not discharged or free to go, you should
- report this yourself, or ask someone else to report this to the hospital managers as soon as possible
- report this to the Care Quality Commission as a serious incident
If you are not sectioned again, the hospital managers should make sure that a review is held within one month to:
- find out why this has happened
- find out what has been done to correct the situation
- make sure that it will not happen again in the future
Your responsible clinician should make a decision about your discharge, that considers the least restrictive option and the maximum independence available to you. They should think about whether you should be:
- discharged from your CTO into guardianship, or
- fully discharged from your CTO
If your CTO period is about to come to an end, your responsible clinician must examine you in the last two months before it reaches its maximum time limit and decide whether to discharge you or extend your CTO.
Only your responsible clinician can extend your CTO. In making this decision they should take the following steps:
- Consider whether the conditions for continuing your CTO are met, but in doing so must consult one or more professionals involved in your medical treatment.
- Consult the wider multi-disciplinary team involved in providing your care and treatment. This would include your care coordinator and anyone else involved in your care in the community.
- Consult you, your nearest relative, your IMHA or other representative, family and carers, the local authority and integrated care board (or local health board in Wales) responsible for your aftercare, and any other organisation providing key services for you. This consultation should take place during a Care Programme Approach assessment (or Care and Treatment plan review in Wales) and before the responsible clinician decides whether or not to extend the CTO.
- Consider whether extending the CTO is appropriate in your case – for example, the longer you have been on a CTO without the responsible clinician having to recall you to hospital, the more carefully they have to think about whether the conditions for extending are met or whether you should be fully discharged from your CTO.
- Submit a report to the hospital managers if they decide that the conditions for extending the CTO are met, and not to discharge you from it. They should explain their reasons in full in their report, and they must get an AMHP to agree in writing that it should be extended. They should give the AMHP enough time to interview you before they agree to the extension, but it does not need to be an AMHP who knows you already.
The responsible clinician will do this by making an order in writing. This lets the hospital authorities know that you are no longer under section, and that you should be allowed to leave hospital, and supported to do this.
The law says that there are slightly different reasons for keeping you sectioned under a section 2 or section 3. But generally speaking, your responsible clinician must reach a decision about your mental health, taking into consideration whether:
- your mental health has improved enough for you to leave hospital
- you still have a mental health problem
- you still need assessment and treatment or treatment in hospital
- your health would be at risk, or your safety or someone else's would be at risk if you were discharged from your section and/or left hospital
- there are other options available to you, such as whether it is possible for you to be treated for your mental health problem in the community, and whether appropriate treatment will still be available to you
Or, if your section has reached the maximum time allowed by the law, then the law says you should:
- be discharged
- have your section renewed, or
- be sectioned under another section. The length of time you are kept under the section may depend on which section you are under
Your responsible clinician can also discharge you for other reasons, and at any time. If the conditions for keeping you under your section or your CTO are no longer being met, they must discharge you, and they should not wait until your section or CTO has ended before discharging you.
Also, if the second professional consulted by the responsible clinician decides not to agree to your section being renewed or the AMHP decides not to agree to your CTO being extended, this does not mean your section or CTO are automatically ended. However your responsible clinician would have stronger reasons to think about discharging you.
The factors the responsible clinician will look at will be similar to when you are being discharged from section. But instead of looking at whether you are well enough to leave hospital or will be able to receive the right treatment in the community, they will look at whether they still need the power to recall you to hospital, and possibly have you brought there for treatment.
To find out more, see our information on CTOs.
If your section has reached its time limit, and it has not been renewed or replaced by another section, you should be free to go. If you think you should have been discharged but this has not happened, you should let the hospital managers know. If you need help to do this, an IMHA should be able to help you.
You will need to get permission from your responsible clinician. This is covered under section 17 of the Mental Health Act.
Responsible clinician (RC)
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 Terms
Being '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 Terms
Hospital managers (also known as Mental Health Act managers)
Hospital managers are an independent team of people in a hospital who make sure that the requirements of the Mental Health Act are properly applied. They have certain important responsibilities and can make decisions related to your detention.
In practice, most of the day-to-day decisions are taken by individuals authorised by the hospital managers to do so. This can include hospital staff. Decisions about discharge are normally delegated to a team of people who are independent of the hospital. You can apply to them to be discharged from your section and they will decide whether or not to discharge you.Visit our full listing of Legal Terms
This 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 Terms
A 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:
- a nurse
- a social worker
- another mental health worker.
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
The 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 Terms
Independent mental health advocate (IMHA)
- You have a right to an IMHA if you are:
detained in hospital under a section of the Mental Health Act, but not if you are under sections 4, 5, 135 and 136
- under Mental Health Act guardianship, conditional discharge and community treatment orders (CTOs)
- discussing having certain treatments, such as electroconvulsive therapy (ECT).
In Wales, voluntary patients can also have an IMHA.Visit our full listing of Legal Terms
Care Programme Approach (CPA)
The 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:
- a full assessment of your health and social care needs
- a care plan
- regular reviews
- a care coordinator who will be responsible for overseeing your care and support.
See our pages on leaving hospital for more information.Visit our full listing of Legal Terms
Approved mental health professional (AMHP)
AMHPs are mental health professionals who have been approved by a local social services authority to carry out duties under the Mental Health Act. They are responsible for coordinating your assessment and admission to hospital if you are sectioned.
They may be:
- social workers
- occupational therapists
Appropriate treatment or appropriate medical treatment
This means medical treatment for your mental health problem that is:
- suitable for you
- takes into account the nature and degree of your mental health problem and your individual circumstances.
Integrated care boards (ICBs)
ICBs are part of the NHS and look after the health needs of people in their area. They plan and provide services and manage the NHS budget. Membership of each board varies but usually includes healthcare professionals and local authority representatives. ICBs were introduced in 2022 to replace clinical commissioning groups (CCGs).Visit our full listing of Legal Terms
This information was published in July 2020. We will revise it in 2023.
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