Hi I would appreciate any legal knowledge as to how long a patient can be detained in a medical hospital if there is no space available in a psychiatric unit? My daughter (adult) has been placed on a section 2 and has been told she is number 16 in the waiting list for a psychiatric bed in Notts where we live. There is another patient in her ward who has been waiting for over 3 weeks.
Thank you
Is this a full section or a recommendation ?
Section 2 following a MHAA
The Section lasts for 28 days then has to reviewed
It saves the hospital using a DOLS but a DOLS should only be used if the patient is still not medically optimised and has not deemed to have capacity and is refusing treatment
In our trust we do not have a licence to fully section patients on a General Hospital ward it is only a recommendation once a Mental Health bed has been identified then a full Section 2 will be completed by the AMHP
Thank you.
I was aware it’s 28 days but have been told there’s no psychiatric bed available so it may be weeks before she is able to move to one. Is this acceptable practice?
Its totally not acceptable practice but a lack of resources is the problem especially in our area
Patients have been known to be waiting in our trust for upto 3 months until a Mental Health bed is identified
My only advice is to keep pressure on this Trust by speaking to the Director of Nursing and involve CQC
Essentially indefinitely as long as the team are satisfied that detention remains appropriate and necessary (and in the case of a Section 3 being made, that appropriate treatment exists there).
Your daughter is able to apply to the Mental Health Tribunal within the first 14 days of her Section 2 if she wishes to appeal against her detention. She would also be entitled to free legal representation to assist her with this. A normal hospital may not have the usual list of solicitors but local ones can be found online to call for advice. Alternatively, she can ask for an “Independent Mental Health Advocate” (but she may have to wait a few days to see one) who can help her submit an appeal and find a solicitor .
1 Like
Just re-read post properly
Indefinitely yes
But your daughter should have a responsible clinician in charge of treatment who is an approved clinician and therefore treating mental health
Thank you for taking the time to reply and give advice.
As stated above, Section 2, is up to 28 days. The Section can be “re-graded” to Section 3, up to six months, and then renewed, at 6 months, then 12 months onwards. But for this to happen, the criteria for treatment needs to be met. Now, in your daughters case, as mentioned above, there will need to be active involvement from a Responsible Clinician, alongside regular involvement from other MH professionals.
A Section 3 is different, it is concerned more with treatment, not a 2, which is assessment and treatment.
After a couple of weeks under the Section 2, I would expect that the RC will now have a better idea on the mental disorder and associated treatment that is required to treat the mental disorder, In moving to a Section 3, the RC, another doctor and an Approved Mental Health Professional will need to conduct another MHA assessment. Two medical recommendations will need to be completed setting out the reason that further detention is required, and that there are no other alternatives to the detention. Those alternatives could be home treatment, an agreement that the patient will make themselves available to professionals, agree to treatment plan in their home. There is also another option, that the patient agrees to remain in hospital for an agreed period of time and agree to the treatment. In these circumstances a Section 3 will not be required.
There are occasions where treatment in a General Hospital is more appropriate, such as Eating Disorders, where you may need closer monitoring by medical staff. In these cases the primary focus is on the health condition, but there is a concern that a mental disorder is the risk factor. In effect you are treating the symptoms, re-feeding, and the underlying cause with psychotropic medication. Medical staff are on hand, along with dieticians etc. This forms the treatment, and if the patient declines this treatment, then this will give authority to detain and treat under a Section 2/3.
Now there will come a time where the patient may respond to the treatment, gains an understanding of the risks and the need for intervention. Once the patient obtains this understanding, and can then make decisions, and no longer objects to the intervention, then this can weaken the need for detention and treatment.
The RC, and the second Doctor may still insist that further treatment is required and this can only be provided in a hospital. For example, if there is a history of the patient stopping the treatment, seeking discharge against medical advice.
The AMHP will need to speak with you and obtain your views especially if you have been identified as the Nearest Relative. If you are the NR, you can object to the AMHP making the application for Section 3. The application authorises the detention and treatment. Whilst the MHA does not set out what a NR objection is, as each case will be different, there will need for the AMHP to set out the rationale for the need for treatment, and why this treatment can only be provided in a hospital and under detention. Whilst the objection does not have to be reasonable or sensible, I believe where a NR sets out a clear and rational alternative to detention, that can obtain the same outcomes, this will weaken the need for detention.
Hope this helps.
Many thanks for taking the time to explain this so clearly. It is appreciated.