I train AMHPs and have become increasingly involved in discussions about how paragraphs 14.26 to 14.29 of the MHA Code should be applied when deciding whether Section 2 or Section 3 should be used as the initial admission section.
Even where the nature and degree of a person’s mental disorder are established, and there is a clear treatment plan, Section 2 is increasingly being used for the following reasons:
Where no bed has been identified at the time of the medical examination(s), the doctor(s) may be unable to state in the recommendation where appropriate medical treatment would be available for Section 3. Even if the doctor lists all psychiatric hospitals within a Trust, the recommendation cannot be used if an out-of-area bed is later identified.
Because of lengthy delays in the County Court system, some local authority legal services are advising AMHPs to use Section 2 as the admission section, on the basis that the Court is unlikely to hold a Section 29(3)(c) hearing within a reasonable or safe timescale.
Are these cogent reasons for an AMHP to depart from the Code?
I’ve only been qualified a little over a year so happy to be corrected (please do if needed for my learning) but my understanding is that the AMHP role is not an administrative function - we’re not here to remedy operational issues which both points seem to be… So my instinct would be to say those aren’t cogent reasons!
Previously an AMHP for ten years, always referred to Section 3 (2) (c), which asks why Section 131 cannot be considered, or Section 2, and in some circumstances, a DoL.
(c)it is necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment and it cannot be provided unless he is detained under this section[
However, the wrong(s) run far deeper than the text of the law or issues about bed shortages.
The deeper wrong is that the state has created a statutory framework, imposed duties of integrity on the professionals who operate it, then allowed the infrastructure to decay to the point where those duties cannot be met honestly or lawfully. The professionals are then left holding the liability for a system that made compliance impossible.
It is a betrayal of the people required to operate the law and a betrayal of vulnerable citizens in a ‘free and democratic society’.
What am I talking about?
If a doctor recommends Section 3, they must state on a statutory form that appropriate treatment is available at a named hospital. No bed means that such as statement is false. Signing it would itself be a probity issue.
If they recommend Section 2 knowing full well that Section 3 criteria are met, they are completing a statutory form that does not reflect their genuine clinical judgement about the appropriate section.
Either way, the doctor is being placed in a position where honest completion of the paperwork is impossible. The system has made integrity and compliance mutually exclusive.
That is institutional and systemic failure at its most conspicuous. It is the doctor’s name on the form, and it is the doctor who would face scrutiny if challenged. The GMC holds individual doctors to account. It does not audit the system that made compliance impossible.
But then again the GMC does not have ‘eyes’ into systemic failures like these. They just wait there like a Venus flytrap. The probability of getting caught is low. Many roll the dice. A very informed colleague once said to me, ‘The patient is incidental’. The more dinosaurian I become, the more I see how right he was.