Section 3 of the Mental Health Act 1983 (MHA) in England and Wales provides the legal framework for detaining and treating patients with mental health issues without their consent. This is known as being ‘sectioned’ or detained under Section 3. Let’s explore what Section 3 means and entails in mental health.
What criteria must be met for Section 3?
For a patient to be detained under Section 3 MHA, the following criteria must be fulfilled:
- The patient must be suffering from a mental disorder of a nature or degree warranting detention in hospital for medical treatment.
- Detention is necessary in the interests of the patient’s health or safety or for the protection of others.
- Appropriate medical treatment is available for the patient.
The mental disorder must be of a nature or degree that warrants detention in hospital. This includes conditions like schizophrenia, severe depression, mania, and other psychiatric illnesses that require inpatient treatment. The disorder must also be linked to risks like self-harm, suicide, self-neglect or violence.
How is Section 3 applied?
For Section 3 to be applied, an application must be made by an Approved Mental Health Professional (AMHP) and accompanied by recommendations from two registered medical practitioners, one of whom must be an expert in mental health (like a psychiatrist).
The AMHP makes an application to the hospital managers, providing evidence to support the criteria for detention being met. The medical recommendations should indicate why the patient needs to be admitted and treated on an involuntary basis.
Once the application is accepted, the patient can be legally detained for up to 6 months initially. This allows the hospital to undertake assessments, provide treatment and care for the patient without requiring the patient’s consent.
What are the timeframes and renewals for Section 3?
The initial period of detention under Section 3 is up to 6 months. Towards the end of the 6 month period, the patient’s responsible clinician (usually a psychiatrist) can renew the detention for another 6 months if it is still required.
After 12 months, the section cannot be renewed any further unless under special circumstances. At this point, either the patient is discharged or detention needs to be continued under Section 37 (‘hospital order’).
The different timeframes are summarized below:
- Initial period: Up to 6 months
- First Renewal: Further 6 months (total up to 12 months)
- Second Renewal: Further 6 months only if special circumstances apply (total up to 18 months)
- Beyond 18 months: Section 37 hospital order if detention still required
What kind of treatment can patients receive under Section 3?
Under Section 3, patients can be given medical treatments for mental disorder even if they refuse, as long as it does not involve certain special treatments. The treatments include:
- Medication – Patients can be administered psychiatric medication against their will, including antidepressants, antipsychotics, mood stabilizers etc.
- Electroconvulsive Therapy (ECT) – Can be administered if approved by a Second Opinion Appointed Doctor (SOAD).
- Counseling and psychotherapy
- Nursing and specialist care
However, special treatments like psychosurgery or surgical implantation of hormones to reduce male sex drive cannot be given without patient consent.
Can patients appeal against Section 3?
Yes, patients have the right to appeal against being detained under Section 3 MHA. There are several ways a patient can appeal:
- Application to Mental Health Tribunal – Patients can apply to the tribunal within the first 14 days of detention. This can be requested again 6 months later.
- Hospital Managers Hearing – Formal request can be made to the hospital managers to review the detention.
- Judicial review – The patient can apply to the High Court if there are concerns over unlawful detention.
At the appeal, the patient’s legal team can argue why the section criteria are not met or why the detention is disproportionate. If the appeal is upheld, the patient may be discharged from Section 3.
What happens when Section 3 ends?
As Section 3 nears expiry, the patient’s responsible clinician will review if the criteria for detention still apply. There are several outcomes:
- Discharge from hospital – If the patient’s condition has stabilized enough that inpatient treatment is no longer needed.
- Remaining as a voluntary patient – If the patient agrees to remain for further treatment.
- Section 37 hospital order – If the patient still poses a risk requiring detention in hospital beyond 12 months.
- Community Treatment Order – If the patient can leave hospital but requires supervised treatment in the community.
The hospital team will arrange an appropriate care plan and discuss options with the patient prior to Section 3 expiring. This ensures continuity of care beyond the section coming to an end.
What are the safeguards for patients under Section 3?
There are various safeguards in place to protect patient rights and prevent misuse of Section 3 powers. These include:
- Informing patients of their legal status and rights
- Care planning with patient involvement
- Regular reviews of detention by hospital managers
- Scrutiny by independent psychiatrists and tribunals
- Ability to appeal to Hospital Managers or Mental Health Tribunal
- Required consultation with nearest relative
Ensuring patients can exercise their rights, receive peer advocacy support and access legal advice are also key safeguards. Hospitals must demonstrate Section 3 is applied properly and detention is regularly reviewed.
When can Section 3 be inappropriate or unethical?
Some examples of inappropriate or unethical use of Section 3 powers include:
- Detaining a patient who does not actually have a mental disorder requiring treatment
- Using mental health law to detain someone for reasons other than their health, safety or public protection
- Not providing adequate medical treatment for the patient while detained
- Failing to properly review detentions or renewals
- Detaining patients for longer than necessary
- Not allowing patients to appeal or access safeguards
Unethical detention can potentially deprive patients of liberty and amounts to discrimination and abuse. Good medical ethics, clinicians’ duty of care and the Human Rights Act 1998 help prevent misuse of mental health legislation.
Conclusion
Section 3 of the Mental Health Act 1983 provides the legal powers to detain and treat patients involuntarily for mental disorder. However, its powers should only be used appropriately, ethically and as a last resort with adequate safeguards. Proper application of Section 3 requires acting in patients’ best interests for those too unwell to consent to care themselves.
