WHO Guide to Mental and Neurological Health in Primary Care
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Homepage :: Legal issues :: Assessment under the Mental Health Act England and Wales 1983 :: During the assessment

During the assessment

Except in the case of emergencies, an application for assessment (section 2-28 days) or treatment (section 3 - 6 months) must be founded on two medical recommendations from:

  • A medical practitioner approved under section 12 of the Act as having special experience in the diagnosis or treatment of mental disorder (usually a psychiatrist, often the duty consultant or specialist registrar)
  • A doctor with prior knowledge of the patient (ideally the GP)

The GP and others in the primary care team often have prior knowledge of the patient, including access to records and an existing relationship with the patient and or family which facilitates the assessment. The psychiatrist may not know the patient, but often contributes clinical experience and expertise. The ASW makes a more comprehensive assessment of the social aspects of the case and advises on the legal issues which may arise during the process. He or she sees that the patient is interviewed "in a suitable manner", ie. taking into account of the guiding principles set out in Chapter 1 of the Code of Practice to the Mental Health Act 1983 (1999).

The patient is interviewed as comfortably as possible with the following questions in mind:

  • Is there any possible evidence of mental illness?
  • Is there a risk to the health or safety of the patient or a danger to others?

If the answer to both of these questions is yes:

  • Will the patient consent to informal admission and if so, is that realistic based on past experience or aspects of the current interview?
  • Are there any community alternatives to admission? e.g. giving medication at home, CPN visits, crisis services, day hospitals.

All professionals strive to reach a consensus and if the doctors agree to make the medical recommendations for compulsory admission, the ASW makes the application to the admitting hospital managers.

Section 2 is appropriate if there is no previous history, the diagnosis is unclear or no treatment plan is in place.

Section 3 specifies the category of mental disorder and is mainly used for patients already known to the service. If the nearest relative objects to the detention, the application cannot proceed.

Last edited: 2/2/2004

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