Sectioning Under Mental Health Act

Sectioning Under Mental Health Act

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anonymous-user

53 months

Tuesday 20th September 2016
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Firstly OP I'm really sorry to hear of your situation, it is a truly horrible thing and only people who've had direct personal experience will understand.

Unfortunately the advice you've already had is accurate, alcohol abuse on its own is not grounds for sectioning. The suicidal thoughts, acting out and reckless behaviour could be, but because they only present when drunk it's a non-starter.

Also in a case like this sectioning could be far from the best thing. Firstly it's hugely invasive and secondly the secure units tend to be full of people with complex psychological issues (obviously) but also a very high level of substance abuse. If you are trying to get a drug addict to reform a secure mental health unit is not where you want them, unless you'd like them introduced to the full gamut of illegal drugs too.

If your relative is highly remorseful when sober then is there any form of counselling or help in place for those times to try to get to the bottom of why they drink? That is the most likely path to success, there is often something that the alchoholic may not even be able to verbalise or understand themselves which is driving their behaviour.

It's a long road with no guarentee of success. The most important thing is to keep the people closest to your relative safe, well and protected physically and mentally.

My father was a bi-polar drug addict and alchoholic, so while every case is different I can absolutely empathise.

colinevan

164 posts

102 months

Thursday 22nd September 2016
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If said situation arises again, Police can take relative to nearest hospital.

A&E can refer to a crisis team and a mental health nurse has the power to section if need be.

A nurses section is only temporary, a doctor can assess and evaluate what is going on.

If any danger to themselves or others its in the interest to be detained for evaluation.


http://www.mwcscot.org.uk/media/140960/nurse_power...





anonymous-user

53 months

Thursday 22nd September 2016
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I might have missed something, but I don't think what you've linked to would help much. From a quick read of the document isn't that just the ability to detain a patient for up to two hours so a medical examination can take place where there is immediate risk of harm and the patient is trying to leave?

Looks like a very different thing to sectioning. The key difficulty is you can't assess a mental health issue when the sufferer is intoxicated, and if they present as relatively normal when not intoxicated sectioning isn't going to happen.

colinevan

164 posts

102 months

Thursday 22nd September 2016
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It is however it's the first process of keeping someone with whom there are concerns over. The police can't keep someone so this could be used. If team were presented with facts that this person has acted this way several times before, has been reported that they have tried to take three life several times they have to act in the client's best interests.


TooLateForAName

4,727 posts

183 months

Thursday 22nd September 2016
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Police can do a section 136 and take to a place of safety.

You will not get sectioned by a medic because you are drunk.


paulmakin

653 posts

140 months

Thursday 22nd September 2016
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A registered mental health nurse has powers to hold a patient as set out within Sec 5:4 of the MHA (Nurse's Holding Power) but , specifically, section 5 is a "Report on a Hospital In-Patient" and relative would not be eligible (by virtue of not being an in-patient at a psychiatric unit).

in any event, an AE department is legally defined as an out-patient area; Sec 5 cannot be used.

regards
paul

Ali Chappussy

876 posts

144 months

Thursday 22nd September 2016
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Jasandjules said:
I am afraid sectioning is almost impossible without the agreement of the person in question.
The word 'almost' saved me saying what you wrote was total bks.

My partners daughter was sectioned 27 months ago against her wishes. Bizarrely enough, she was released back into society last Monday and now we wait anxiously to find out how she re-adjusts from being in a mental health institution to being back at home.

Tannedbaldhead

Original Poster:

2,952 posts

131 months

Thursday 22nd September 2016
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Pretty sure my relative was temporarily detained prior to being interviewed by a mental health nurse. The process was called a mental health review. Once carried out and having stated they were remorseful, not suicidal and intending to dry out and seek help to do so (all lies and all against what police, paramedics and family had reported) my relative was let go.
I understand drinking itself is not an issue but genuine suicide attempts while drunk is worthy of intervention.
Police are far from happy with the situation.

spookly

4,011 posts

94 months

Thursday 22nd September 2016
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Ali Chappussy said:
The word 'almost' saved me saying what you wrote was total bks.

My partners daughter was sectioned 27 months ago against her wishes. Bizarrely enough, she was released back into society last Monday and now we wait anxiously to find out how she re-adjusts from being in a mental health institution to being back at home.
Jesus Christ. That is a long detention. My ex-wife got sectioned well after we split. They seemed to not want to hold them any longer than necessary.


meddyg

70 posts

152 months

Thursday 22nd September 2016
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paulmakin said:
lots of sense..
This man speaks a lot of sense

As far as I am aware: To be section under the mental health act - you have to have a mental health condition, being intoxicated alone does not count. You can be detained by the police in a place of safety, but you can not be forced to have medical treatment under this act

The mental capacity act is different, this an be used to treat patients against their wishes, should they be deemed to lack capacity for certain decisions (and this is complicated as capacity is not a global state, and needs to be assessed at a particular time for a particular decision). However this act only applies whilst they lack capacity. So therefore an IV drip could be given to someone who is intoxicated, if it was medically in their best interest, and they lacked the capacity to refuse, but once they regain capacity (become sober) this act no longer applies. I've not heard of this act being used to detox from alcohol.

a DOLS only applies if in a residential / nursing home, and also has many other caveats that I wont go into here - but essentially involves medical conditions and capacity - it does not apply to alcohol abuse.

I really do feel for you, treating those with an alcohol problem is really difficult, as they can only really be treated if they agree to it. And if he presents well when sober and refuses to get help, then that is his decision, he (presumably) has capacity and therefore is now way I know of forcing treatment medically, whether there is some legal way, I don't know.

Jasandjules

69,825 posts

228 months

Thursday 22nd September 2016
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TooLateForAName said:
I agree about rehab, but the point of sectioning is that it is *against* the will of the person in question. If the person agrees to treatment then there is no need to section them.
Indeed however the police and GP advised us that we basically could not do so unless the person agreed..........

We were also advised it is nearly impossible to section someone, not least due to cutbacks..... Even someone saying they were going to kill themselves...

paulmakin

653 posts

140 months

Thursday 22nd September 2016
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Nurse's holding power under Sec 229 referenced above is not the MHA England and Wales. It's the Scottish Act and it's intention is to provide a legal framework for patients in a mental health hospital being detained for the purposes of obtaining a medical (psychiatrist) review.

i seriously doubt that any of the assessing doctors or the approved MH practitioner (AMHP) would not detain an individual liable to be detained - far too risky for them from both personal and professional standpoints if it goes belly-up. the usual process is that the assessment is convened, the medical recommendations are completed, the AMHP contacts the relevant provider unit and, once the bed is identified/located, completes the application for admission (note that, somewhat counter intuitively, only the local authority has the legal right to make a compulsory admission - based on the requisite medical recs of course)

this is when resourcing issue kicks in - bed finding can be a very lengthy process and what to do with the patient in the meantime is case-by-case. different trusts have different "solutions" but i've not encountered any in the near past that are wholly satisfactory

the only legal mechanisms for compelling people to seek treatment for addictions are with the judiciary, not health services (my caveat being my earlier quotation from the MH Act re "drunkeness alone")

paul

Edited by paulmakin on Thursday 22 September 18:52

Pothole

34,367 posts

281 months

Thursday 22nd September 2016
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Tannedbaldhead said:
Short Grain said:
In the spring of this year they suffered a work related spinal injury. There was an accusation made that the injury was due to deviation from the employer's health and safety policies and my relative was suspended pending a disciplinary investigation and hearing.

Is the accusation true or ar^e covering by the company?
Works in special needs social care. A patient they were walking with fell. Policy is to let them drop then give aid and seek help after they hit the ground. Catching them is against the rules as firstly you could hurt yourself and secondly if you fell with the patient whose to say you didn't cause the injury rather than the floor exposing the employer to litigation.
Apparently letting someone taking a seizure fall on their face is more difficult than it sounds.
Technically speaking H&S patient handling rules were breached. Relative suffered spinal injuries as a result. In their defence it's an instinctive reaction to brake the fall. I'll leave you to judge.


Edited by Tannedbaldhead on Monday 19th September 20:47
Nothing for us to judge. The rules may be hideous, but they are in place and well known.

Tannedbaldhead

Original Poster:

2,952 posts

131 months

Thursday 22nd September 2016
quotequote all
Pothole said:
Tannedbaldhead said:
Short Grain said:
In the spring of this year they suffered a work related spinal injury. There was an accusation made that the injury was due to deviation from the employer's health and safety policies and my relative was suspended pending a disciplinary investigation and hearing.

Is the accusation true or ar^e covering by the company?
Works in special needs social care. A patient they were walking with fell. Policy is to let them drop then give aid and seek help after they hit the ground. Catching them is against the rules as firstly you could hurt yourself and secondly if you fell with the patient whose to say you didn't cause the injury rather than the floor exposing the employer to litigation.
Apparently letting someone taking a seizure fall on their face is more difficult than it sounds.
Technically speaking H&S patient handling rules were breached. Relative suffered spinal injuries as a result. In their defence it's an instinctive reaction to brake the fall. I'll leave you to judge.


Edited by Tannedbaldhead on Monday 19th September 20:47
Nothing for us to judge. The rules may be hideous, but they are in place and well known.
Apparently catching patients is an involuntary reaction. It's very difficult not to.

anonymous-user

53 months

Friday 23rd September 2016
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Tannedbaldhead said:
Pretty sure my relative was temporarily detained prior to being interviewed by a mental health nurse. The process was called a mental health review. Once carried out and having stated they were remorseful, not suicidal and intending to dry out and seek help to do so (all lies and all against what police, paramedics and family had reported) my relative was let go.
I understand drinking itself is not an issue but genuine suicide attempts while drunk is worthy of intervention.
Police are far from happy with the situation.
Tension between the police and mental health services always runs high, in my experience. The police feel they are constantly having to deal with mental health issues because of resourcing issues, the mental health pros feel that the police don't understand the constraints under which they have to operate. They're probably both right.

When you say your relative's statement was all lies do you mean that he's suicidal when sober, or are they only lying about intending to dry out and seek help for the alcohol abuse?

If your family can build enough evidence that they are a danger to themselves or others when sober then it may be possible to get something done in terms of sectioning, but I can't emphasise enough that sectioning really is the last resort and can be counter-productive.

My experience of secure mental health units is that they're not very secure and not very therapeutic either, but maybe there are some that are better than the ones I've experience of.

How engaged with the relevant health services are your relative's family and friends? If your relative is remorseful when sober then it might be possible to get someone close to them to attend a GP appointment with them so that the family concerns can be discussed - that can open a lot of doors.

Certainly I know I found once I was able to do that it was recorded in the notes that consent had been given by my father for me to be involved and it became much easier to discuss things with the various people involved in my father's care.

Might be worth a try if it's not been done already, assuming it's possible to get your relative to agree?

Ali Chappussy

876 posts

144 months

Friday 23rd September 2016
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spookly said:
Jesus Christ. That is a long detention. My ex-wife got sectioned well after we split. They seemed to not want to hold them any longer than necessary.
Yep, it is. Early signs are that she's not coping at all and we are all quite worried about the next few weeks.

andy118run

866 posts

205 months

Friday 23rd September 2016
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charltjr said:
Tension between the police and mental health services always runs high, in my experience. The police feel they are constantly having to deal with mental health issues because of resourcing issues, the mental health pros feel that the police don't understand the constraints under which they have to operate. They're probably both right.

When you say your relative's statement was all lies do you mean that he's suicidal when sober, or are they only lying about intending to dry out and seek help for the alcohol abuse?

If your family can build enough evidence that they are a danger to themselves or others when sober then it may be possible to get something done in terms of sectioning, but I can't emphasise enough that sectioning really is the last resort and can be counter-productive.

My experience of secure mental health units is that they're not very secure and not very therapeutic either, but maybe there are some that are better than the ones I've experience of.

How engaged with the relevant health services are your relative's family and friends? If your relative is remorseful when sober then it might be possible to get someone close to them to attend a GP appointment with them so that the family concerns can be discussed - that can open a lot of doors.

Certainly I know I found once I was able to do that it was recorded in the notes that consent had been given by my father for me to be involved and it became much easier to discuss things with the various people involved in my father's care.

Might be worth a try if it's not been done already, assuming it's possible to get your relative to agree?
I've worked as a nurse in inpatient services for 12 years. Currently in a medium secure unit - our security is equivalent to a Cat b prison so people never really go Awol, apart from failing to return from leave.

I also did 7 years on a normal acute admission ward in London. Awols would be pretty much a daily occurrence, much to the frustration of police, relatives and even the staff. However, these places are really not designed to be 'secure' as they admit a mixture of detained and informal patients, none really requiring a great level of security (those that do would get referred on accordingly).

So, bit of an aside from the topic in question, but I do agree that these places are rarely therapeutic and your typical acute ward is not really 'secure' either.

FlyingMeeces

9,932 posts

210 months

Wednesday 28th September 2016
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Tannedbaldhead said:
Apparently catching patients is an involuntary reaction. It's very difficult not to.
It is, which is why people working in relevant fields are specifically told and trained not to. It sounds like the only potential argument there is that the training was perhaps insufficient if s/he was not able to suppress their instinctive reaction.

I don't fall any more because I can no longer stand or walk, but a few years back I did - if I fell and hit the deck I'd have bruises, but if I fell and someone grabbed me, we'd automatically be looking at a hospital stay and potentially surgery as my joints dislocate easily under much less force than for those without my condition. I similarly had to learn not to try to save myself after a very nasty one when I slipped on the stairs and grabbed the bannister - must be getting on for 15 years ago and I can still remember the pain.

When your rellie is in the sober/contrite phase of the cycle can they be persuaded to commit in some way to rehab - I mean not verbally but actually get an admission process underway or something?

Sounds like an utter nightmare, I'm really sorry.

(Deprivation of Liberty safeguards can apply at home but only under really, really specific conditions which definitely are not in place for the OP - an example of when it does apply is the use of a secure 'safe space' at home for someone with eg autism and severe intellectual impairment to be able to be safe and unsupervised overnight.

anonymous-user

53 months

Friday 30th September 2016
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From a different angle your relative needs a break from the issues. There's the job issue and the 'spinal injury'. Can't do much about the former at the moment but the latter? What is it?? Doctors and prescriptions are useless for these types of injuries and the last thing he/she needs is more pills so:

GET THEM TO A CHIROPRACTOR

There's a very good chance that with between 1 and 3 visits the 'spinal injury' will be sorted so therefore no doctors, no pills, no pain.

Having said that is this an injury that's handy to have given the accusation at work? There are a great many people out there who don't want their 'spinal injury' to be sorted until other issues are concluded - and then they seem to make a quick recovery. It's it a diagnosed spinal injury or a hurty back - there's a big difference!!!!




spookly

4,011 posts

94 months

Friday 30th September 2016
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Ali Chappussy said:
spookly said:
Jesus Christ. That is a long detention. My ex-wife got sectioned well after we split. They seemed to not want to hold them any longer than necessary.
Yep, it is. Early signs are that she's not coping at all and we are all quite worried about the next few weeks.
Well, good luck with it.

My ex was re-sectioned several times over the following years. Last time was now a couple of years ago. She is still on a cocktail of drugs (sleeping pills, anti-psychotics, SSRIs). While she is now not a danger to herself or anyone else she isn't the person she once was. Put on a *lot* of weight, is still quite paranoid, not very logical either, can't sleep without pills, often says quite inappropriate things, and can flip between friendly and angry in a second.... I suspect she'd be worse without the medication. And she has now decided she wants to start weaning herself off the drugs.