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8.4 Mental Health Act Assessments including Section 136 referrals

The Mental Health Act 1983 is the law in England and Wales that allows people with a ‘mental disorder’ to be admitted to hospital, detained and treated without their consent either for their own health and safety or to protect other people. Substantial amendments were made to the Act in 2007. People can be admitted, detained and treated under different sections of the Mental Health Act. For example, Section 2 is used to admit someone for assessment whereas Section 3 is used to admit someone for treatment; Section 4 is used if there is an emergency. The Act can also be used to place individuals on Community Treatment Orders (CTOs) following a period of compulsory treatment in hospital.

Mental Health Act Assessments

In South Gloucestershire the number of mental health act assessments more than doubled from 243 in 2011 to 563 in 2014 (a 132% increase). Outcomes from the assessments performed in April 2015 are shown in Table 8.6.

Table 8.6 Outcomes from the Mental Health Act Assessments performed in April 2015

Outcomes of Assessment Number
Community Treatment Order 1
Community Treatment Order Renewal 3
Guardianship meeting/Guardianship 2
Informal 3
Not Admitted 1
Not Detained 13
To be treated under Deprivation of Liberty Safeguards 1
Section 2 17
Section 3 11

Section 136 referrals

Section 136 of the Mental Health Act allows the police to remove a person with mental illness from a public place to a “Place of Safety”58 either for their own protection or for the protection of others for the following purposes :

  • enabling the individual to be examined by a registered medical practitioner and to be interviewed by an approved mental health professional (AMHP) and
  • allowing necessary arrangements to be made for the individual’s care or treatment

Currently, the maximum length of detention is 72 hours. Following a Section 136 referral people may then be placed on Section 2 or 3 of the Mental Health Act, admitted to hospital as an informal or voluntary patient, or discharged.

In 2013, the multi-agency mental health act group chaired by the Royal College of Psychiatrists examined best practice with regard to Section 136 and made the following recommendations:

  1. The custody suite should be used in exceptional circumstances only
  2. A vehicle supplied by the ambulance provider should be able to attend promptly so that it is used for conveyance unless the person is too disturbed
  3. The AMHP and doctor approved under Section 12(2) of the Mental Health Act should attend within 3 h in all cases where there are not
    good clinical grounds to delay assessment
  4. The first doctor to perform a Mental Health Act assessment should be approved under Section 12(2) of the Act
  5. A monitoring form should be agreed locally to meet all the national requirements and should be completed in all cases
  6. Commissioners should ensure that there is a multi-agency group meeting to develop, implement and quality assure the agreed policy. This group should review the monitoring data. It should also consider how the need for use of Section 136 might be reduced

In South Gloucestershire there were 32 Section 136 admissions from the 3rd February 2014 to the 29th April 2014 of which:

  • Twenty (62.5%) were male and twelve (37.5%) were female
  • Most people (84.4%) were of White British ethnicity
  • More than half (56.3%) were aged 26 to 45 years. Four were aged 18 to 25 years, 8 were aged 46 to 64 years and two persons were 65 years or older
  • All persons were transferred to the place of safety via police vehicle
  • Twenty six persons had one or more repeat admissions; the majority (22) had one repeat admission
  • Twenty three (71.9%) admissions were out of hours (between 6 pm and 9 am); nine (28.1%) of admissions were in hours (9 am to 6 pm)
  • Six individuals (18.8%) waited 0-4 hours for assessment, seven (21.9%) waited 4-9 hours, four (12.5%) waited 9-12 hours and 15 (46.9%) waited for more than 12 hours until assessment
  • Fourteen (43.8%) individuals had no mental health follow up with no letter sent, eight (12.5%) were discharged to the AWP team, four (12.5%) were detained under section 2 for assessment and treatment in hospital, three (9.4%) had no mental health follow up with a letter to the GP and two (6.3%) were admitted informally
  • Seventeen individuals (53.1%) stayed longer than 12 hours, six (18.8%) stayed 4-9 hours, 5 (15.6%) stayed 9-12 hours and four(12.5%) stayed less than 4 hours
  • Intoxication was the main reason for admissions over 9 hours (36.4% of these admissions)

Using older data from 2012/2013:

  • there has been a decrease in Section 136 detentions from 71 in July 2012 to 23 in November 2013
  • the most common reason for detention over 10 hours was due to Emergency Duty Team delay followed by delay after assessment and under the influence of drink or drugs
  • the most common reasons why someone would be taken to custody and not hospital were due to being uncooperative/aggressive and because the hospital was full
  • the average time from Approved Mental Health Practitioner (AMHP) requested to assessment was 5hrs and 52 minutes

 

58 A Place of Safety can be a hospital, police station or some other designated place.