What are the differences between informal and sectioned mental health patients
Following my last post on We still lock up mental health inpatients here, a reader asked “What are the differences between informal and sectioned mental health patients?” Hence this post.
Did you know that while you might be admitted to a mental health ward as an informal (voluntary) patient, you can still be sectioned against your wishes? Find out why here.
But first, let’s take answer the question about the differences between informal and sectioned mental health patients.
What is an informal patient?
Most people with mental health problems are able to get treatment and support at home, sometimes with the help of their GP. But there may be times when you need to go to hospital to get treatment. You are a voluntary patient (informal patient) if you are having inpatient treatment in a psychiatric hospital of your own free will (Mind.org.uk).
What is a sectioned patient?
You can be sectioned under the Mental Health Act, 1983 (MHA) if you pose a risk to your own or others health or safety, or if you are refusing treatment. You can be detained in hospital where you’re not prepared to go in as a voluntary patient (informally). If you are a patient under section, you lose certain rights, including the right to leave hospital freely.
What is the Mental Health Act?
The Mental Health Act (MHA) 1983 is the law in England and Wales which was updated in 2007. The NHS writes “the MHA is the main piece of legislation that covers the assessment, treatment and rights of people with a mental health disorder. People detained under the Mental Health Act need urgent treatment for a mental health disorder and are at risk of harm to themselves or others.”
The MHA is designed to give health professionals the powers, in certain circumstances, to detain, assess and treat people with mental health disorders in the interests of their health and safety or for public safety (Kings Fund).
The MHA is divided up into lots of different sections
The main ones are (Mind):
Section 2: admission for assessment
(and possibly assessment followed by treatment) – you can be detained under section 2 if:
- you have a mental health disorder
- you need to be detained for a short time for assessment and possibly medical treatment, and
- it is necessary for your own health or safety or for the protection of other people.
You can be detained for up to 28 days. The section can’t normally be extended or renewed, but you may be assessed before the end of the 28 days to see if sectioning under section 3 is needed.
Section 3: admission for treatment
– you can be detained under section 3 if:
- you have a mental health disorder
- you need to be detained for your own health or safety or for the protection of other people, and
- treatment can’t be given unless you are detained in hospital.
You cannot be sectioned under this section unless the doctors also agree that appropriate treatment is available for you. You be detained for up to 6 months. The section can be renewed or extended by your responsible clinician:
- for 6 months, the first time
- then for 6 months, the second time
- after that, for 12 month periods. There is no limit to the number of times the responsible clinician can renew the section 3.
Your responsible clinician can also discharge you from your section before it comes to an end. If this happens, you are free to go home. If your mental health gets worse again in the future, you could be sectioned and taken to hospital again on a new section.
Section 4: Emergency admission for assessment
– you need to be detained under section 4 if:
- you have a mental health disorder
- it is urgently necessary for you to be admitted to hospital and detained, and
- waiting for a second doctor to confirm that you need to be admitted to hospital on a section 2 would cause “undesirable delay”.
You can be sectioned by one doctor only (together with the approved mental health professional) and you can be taken to hospital in an emergency and assessed there. A second medical opinion should be sought as soon as possible. A second medical recommendation converts s4 to a s2 (s4(4)) which is treated as beginning when the s4 began.
Your rights are different compared to your rights under other sections. For example, you cannot be treated without your consent. You can be detained for up to 72 hours.
Section 5: Holding powers
– you can be detained on the ward temporarily if a doctor or nurse suspects your are not fit to leave, either for your own or others safety. This includes two separate powers:
- Doctor: One doctor; when inpatient; 72 hours.
- Nurse: One nurse of specified level; when inpatient; 6 hours.
Differences in informal and sectioned patients’ leave
Sectioned patients might be granted leave which is normally restricted and has certain conditions. This could be something like 1-2 hours leave between certain hours and they might have to remain within the hospital grounds. They might only have escorted leave with a mental health professional. A nurse would have to check this patient’s leave status and assess their mood and mental state prior to agreeing to any leave.
Informal patients should be able to come and go from the ward as they please, but this alleged right can be denied. Although classed as an informal (voluntary) patient, if staff believe there’s risk to self or others, or if you’re refusing treatment, you may be asked to stay on the ward. If you refuse, both the doctors and the nursing staff have the power to detain you under Section 5 of the MHA (see above).
Voluntary still have to ask to go out and a nurse would check their leave status and assess whether they were fit to leave.
So, in both cases, staff have to follow care plans addressing each individual’s section status, leave status and assess all patients before letting them go out.
Final thoughts
Most acute mental health inpatient wards in London have around twenty patients, both voluntary and sectioned, and where I worked, the majority were detained. And now you know, yes you can be detained against your wishes, even if you are a voluntary patient.
The unfortunate thing on many ‘open’ wards for all patients, but particularly for those who are voluntary, is that the doors are mainly kept locked. See Why we still lock up our mental health patients here.
For nurses or other mental health professional reading this; If you’re escorting a patient outside of the hospital grounds, please — take your ID badge off. Let the patient enjoy their leave with dignity. Who wants to look like they’re being escorted or controlled?
Unfortunately, I’ve seen to many staff wearing their badges smiling at the patient sympathetically in front of staff in the local cafe. It’s like they’re letting them know I’m here with a patient. Meaning if the patient appears to be behaving oddly, they’re a patient, not my friend. I think it looks like a them and us situation and it’s not fair, or kind.
And please, always try engage the patient in conversation, however difficult it feels for you. Imagine how difficult it is for a patient who’s maybe low, sad, feeling sedated or tired. I’ve had staff tell me “I don’t know what to say to them.” Ffs! Ask if they’d like to talk? Ask questions about where they went to school, did they enjoy it, do they have sibling and so on. Talk about the weather, if you have to! It’s not bloody rocket science.
Over to you
I hope this answers the question; “What’s the difference between informal and sectioned patients?” If not, please let me know if you have any other questions. As always, I look forward to your thoughts about the differences or perhaps the fact that voluntary patients have to ask to be let out?
