Understanding your Mental Health Act assessment

Before the AMHP service accepts a referral for assessment we expect that all attempts to help you with your mental health have been tried.

These may include:

• a recent appointment with a psychiatrist
• a visit to your GP
• an outpatient appointment with a mental health professional
• support from the Acute Mental Health Services.

We want to be sure that all least restrictive options have been attempted before initiating a Mental Health Act assessment. If possible, we would prefer that you are able to remain in the community under a supportive and safe plan. This is because the assessment is a formal procedure that can result in a legal detention in hospital. This will restrict your liberty for a period of time.

If the above examples were unsuccessful in keeping you safe and well enough to remain in the community

or

you have refused to allow staff to see you and there are high levels of concern about your health and safety or the safety of others

or

you have refused to have treatment

then a Mental Health Act assessment will be requested.

In addition to the AMHP service, we need two doctors to take part in your Mental Health Act assessment. At least one of the doctors will have had extra training called section 12 approval. This means they have specialist knowledge of mental health and the Mental Health Act.

We will always try to get a doctor who knows you but there may be times when this is not possible. But the AMHP will share all relevant information with the doctors beforehand.

If possible, one of the doctors will be a specialist in an area relevant to your situation. For example, a learning disability psychiatrist or a child/adolescent psychiatrist.

The Mental Health Act assessment team should all see you at the same time. Sometimes this is not possible. If one of the two doctors saw you in the past five days for an examination of your mental health, they can use that information to write a medical recommendation to use at the assessment.

During the assessment you can also ask to see the AMHP alone if you wish.

Who can request a Mental Health Act assessment?

Various professionals can request a Mental Health Act assessment. For example a psychiatrist, GP, care co-ordinator or a police officer. A ‘nearest relative’ can also ask the AMHP service to consider a referral. (Under section 13(4) of the Mental Health Act.) If the AMHP does not think you meet the criteria under the Act, they will let your nearest relative know why in writing.

There is more information about this on the Rethink Mental Illness - nearest relative website.

Your Mental Health Act assessment can take place in a variety of locations. This depends on who has referred you, your physical health, and whether you are already in hospital or at a place of safety. The police can use section 136(1) of the Mental Health Act in a police station — see more information below.

We will always try to assess you in a private area to uphold your confidentiality and dignity.

If you are agitated or aggressive, police may need to be present to keep you, your family or others safe during your assessment.

Your assessment may take place in:

• your home
• hospital
• a place of safety suite
• a care home or nursing home
• a community mental health team office
• a police station.

Your nearest relative, friends and significant others

You can ask for a person you know and trust to be present at your Mental Health Act assessment, if this will not cause unreasonable delay. Or you can ask to speak to the person you know and trust on the telephone.

Your 'nearest relative' is defined under section 26 of the Mental Health Act and is not the same as next of kin. We will identify who your nearest relative is by having a discussion with you and other significant people in your life. This person will play an important role in assuring that you receive appropriate treatment. If not, they can challenge your treatment with the Trust that provides your care if you are admitted to hospital.

It is good practice for us to consult and extract information about you to plan the assessment. A professional judgement will be made in section 136 judgements. But we are legally required to contact your nearest relative in the case of section 3. This is to determine if they object to you being detained under the Act.

Please tell us if you have any concerns or worries about the person deemed to be your legal nearest relative. A court can change your nearest relative if they are not deemed to be suitable. Or if there is no identified nearest relative. Examples might include:

• You have experienced abuse at the hands of your nearest relative.
• You are afraid of your nearest relative or are seriously distressed at the possibility of their involvement in your care.
• A situation where you and your nearest relative are unknown to each other.
• Your nearest relative is incapable of acting in this role due to a mental or other illness.

Embassy/consulate support

If you are from overseas, we can make a call to your country's embassy or consulate in the UK so that you can speak to them. They may sometimes be able to send a representative to see you. If not, we can arrange for a language interpreter to attend your assessment.

1. You are suffering from a mental disorder. This is the term used in the Mental Health Act. Examples include mental illness, dementia, personality disorder, learning disability accompanied by abnormally aggressive or seriously irresponsible conduct.
2. You can be detained under section 2 or the Mental Health Act if your mental disorder is of a nature or degree which warrants your detention in hospital for assessment or assessment followed by treatment for up to 28 days in the interests of your health, or your safety, or with a view to protecting others.
3. You can be detailed under section 3 only if all the following criteria applies:

• You are suffering from a mental disorder of a nature or degree which makes it appropriate for you to receive medical treatment in hospital.
• It is necessary for your health or safety or for the protection of other people that you should receive such treatment and it cannot be provided unless you are detained under section 3.
• Appropriate medical treatment is available.

Under section 136(1) of the Mental Health Act 1983, if a police officer believes that you "appear to be suffering from a mental disorder and to be in need of immediate care or control," they can remove you to a place of safety.

A police officer cannot use section 136 in any house, flat or room that you live. This also extends to the garden and outhouses or a private dwelling.

Police officers usually consult a health care professional before placing someone under section 136.

Section 136(1) can last up to 24 hours, but a doctor can grant an extension for a further 12 hours under section 136(b). The extension cannot be authorised because of a bed delay.

Southern Health Foundation Trust currently has four place of safety suites:

• Elmleigh, Havant
• Antelope House, Southampton
• The Orchards, Portsmouth
• Parklands, Basingstoke.

If you are under 18 years of age you will stay at Parklands or, if this suite is occupied, then you will stay at Elmleigh.

Surrey and Borders Partnership Trust has two designated place of safety suites at Farnham Road Hospital, Guildford, Surrey.

At all times, the AMHP co-ordinating the Mental Health Act assessment will seek your co-operation. Sometimes this is not possible because you refuse to engage with us and there are concerns for your health, your safety and/or the safety of others. In these cases, we will apply to the magistrate's court for a warrant under section 135(1) of the Mental Health Act.

This allows the AMHP, one or two doctors and a police officer to enter your home by force if you still refuse to have any form of contact. We can then remove you to a place of safety to continue the assessment.

We will only take these steps when there is enough evidence that all possible attempts to engage with you have failed.

The assessment can take place in your home if you agree and the professionals believe that the risk to yourself or others is low.

We will provide you with a copy of the warrant once signed by the police officer present.

A section 135(1) warrant lasts up to 24 hours but on occasions a doctor can grant an extension for a further 12 hours.

The AMHP and doctors must always consider alternative ways of providing your care and treatment when deciding whether it is necessary to detain you.

There is no obligation for the AMHP to make an application even if we have two medical recommendations from the doctors. If we decide not to make that application, this will be supported by an alternative care and treatment plan. For example, intensive support from mental health services that will aid and monitor your recovery in the community.

Possible outcomes of your assessment are:

1. No admission or formal admission under the Mental Health Act. Mental Health Services may offer you a community support package.
2. Discharge from any section you are on and you become an informal patient in hospital. The AMHP and doctors will assess your capacity to understand what this means. They will also assess your capacity to agree to further assessment or treatment and care.

When we have decided whether to make an application or not, we will tell you and give our reasons. We will let you know which hospital you will be admitted to, if this is the outcome. If not, we will discuss with you a suggested community support plan.

We will also inform your nearest relative. (See above for more information.)

We may also inform the following people so they can support your treatment/care plan:

• the doctors involved in your assessment if they were not present at the interview
• your care co-ordinator
• your GP
• your significant other, if you request this.

If you are detained under the Mental Health Act, you have the right to appeal against the section in place. Shortly after your admission you will be notified of your rights under section 132 of the Mental Health Act. This will enable you to start the appeal process.

You also have the right to have an Independent Mental Health Advocate. We can arrange this at your assessment. Or the ward staff can organise this.

If admitted to hospital you will always have the right to:

• ask for an advocate
• have section 132 information shared with you by nursing or medical staff
• request an appeal.

Your pets and property

We will make arrangements to secure your home and property. We will also make arrangements for the care of any pets you have. We may need to reclaim any costs that these incur, particularly if there are ongoing costs.

Hospital discharge

Throughout your hospital admission the care team will consult you about your assessment and treatment. You will also be fully involved with your discharge plan. This should be co-ordinated through the Care Programme Approach. You can find a more detailed fact sheet on the Rethink Mental Illness website.

If detained under the Mental Health Act you may be entitled to section 117 aftercare. This is a legal duty placed on the National Health Service (NHS) and adult social care services to provide free help and support after you leave hospital. This will come into effect upon your discharge.

Contacts

• Approved Mental Health Professional (AMHP) Hub — Tel: 0300 555 1386
• Hampshire County Council Out of Hours Service — Tel: 0300 555 1373
• Antelope House — Tel: 023 8083 5500
• Elmleigh Hospital — Tel: 023 9268 2820
• Farnham Road Hospital — Tel: 0300 555 5222
• Melbury Lodge — Tel: 01962 897700
• The Orchards — Tel: 0300 123 6620
• Parklands Hospital — Tel: 01256 817718

Complaints

• Hampshire County Council — Email: [email protected]
• Solent NHS Trust — Tel: 0800 013 2319
• Southern Health NHS Foundation Trust — Tel: 023 8231 1200
• Surrey and Borders Partnership NHS Foundation Trust — Tel: 01372 216202