same service, to ensure independence (this 'rule' was removed in the 2007 mha amendment). commonly, in order to satisfy this requirement, a psychiatrist will perform a joint assessment with a general practitioner (gp). a mental health act assessment can take place anywhere, but commonly occurs in a hospital, at a police station, or in a person's home. if the two doctors agree that the person has a mental disorder and ought to be detained in hospital in the interest of the patient's own health or safety, or for the protection of others, they complete a medical recommendation form and give this to the amhp. if the amhp agrees that there is no viable alternative to detaining the person in hospital, they will complete an application form requesting that the hospital managers detain the person. the person will then be transported to hospital and the period of assessment begins. treatment, such as medication, can be given against the person's wishes under section 2 assessment orders, as observation of response to treatment constitutes part of the assessment process. treatment orders section 3 is a treatment order and can initially last up to six months; if renewed, the next order lasts up to six months and each subsequent order lasts up to one year. it is instituted in the same manner as section 2, following an assessment by two doctors and an amhp. one major difference, however, is that for section 3 treatment orders, the doctors must be clear about the diagnosis and proposed treatment plan, and be confident that "appropriate medical treatment" is available for the patient. the definition of "appropriate medical treatment" is wide and may constitute basic nursing care alone. most treatments for mental disorder can be given under section 3 treatment orders, including injections of psychotropic medication such as antipsychotics. however, after three months of detention, either the person has to consent to their treatment or an independent doctor has to give a second opinion to confirm that the treatment being given remains in the person's best interests. a similar safeguard is used for electroconvulsive therapy (ect), although the rc can authorise two ect treatments in the event of an emergency for people detained under section 3 treatment orders. ect may not be given to a refusing patient who has the capacity to refuse it, and may only be given to an incapacitated patient where it does not conflict with any advance directive, decision of a donor or deputy, or decision of the court of protection. leave and discharge absence or "leave" from hospital can be granted by the rc for a patient detained under either a section 2 assessment order or section 3 treatment order, and the rc will ultimately be responsible for discharging a patient under such an order. following discharge from a section 3 treatment order, the person remains subject to the after-care provisions of section 117 indefinitely. these provisions include a formal discharge planning meeting, and provision of personal care if necessary. emergency orders section 4 is an emergency order that lasts up to 72 hours. it is implemented by just one doctor and an amhp, in an emergency in which there is not time to summon a second suitable doctor in order to implement a section 2 assessment order or section 3 treatment order. once in hospital, a further medical recommendation from a second doctor would convert the order from a section 4 emergency order to a section 2 assessment order. section 4 emergency orders are not commonly used. holding powers section 5(2) is a doctor's holding power. it can only be used to detain in hospital a person who has consented to admission on an informal basis (i.e. not detained under the act) but then changed their mind and wishes to leave. it can be implemented following a (usually brief) assessment by the rc or his deputy, which, in effect, means any hospital doctor, including psychiatrists but also those based on medical or surgical wards. it lasts up to 72 hours, during which time a further assessment may result in either discharge from the section or detention under section 2 for assessment or section 3 for treatment. section 5(4) is a nurse's holding power. it can be applied to the same group of patients as those that may be detained under section 5(2) as outlined above. it is implemented by a first or second level mental health or learning disability nurse. section 5(4) lasts up to 6 hours and ends at the time the patient is seen by the doctor assessing the patient under section 5(2), irrespective of the outcome of the doctor's assessment. time spent by a patient under section 5(4) is included in the 72 hours of any subsequent section 5(2). the care quality commission consider it to be extremely poor practice to allow a section 5(2) to simply "lapse". there is a clear duty on the part of the patient's rc to make a decision as to whether any further action, such as detention under section 2 for assessment or detention under section 3 for treatment should be implemented, or whether the patient should be regraded to "informal" legal status. magistrates' and police officers' orders section 135 is a magistrates' order. it can be applied for by an amhp in the best interests of a person who is thought to be mentally disordered, but who is refusing to allow mental health professionals into their residence for the purposes of a mental health act assessment. section 135 magistrates' orders give police officers the right to enter the property and to take the person to a "place of safety", which is locally defined and usually either a police station or a psychiatric hospital ward. section 136 is a similar order that allows a police officer to take a person whom they consider to be mentally disordered to a "place of safety" as defined above. this only applies to a person found in a public place. once a person subject to a section 135 magistrates' order or section 136 police officers' order is at a place of safety, they are further assessed and, in some cases, a section 2 assessment order or section 3 treatment order implemented. informal patients section 131 allows for patients to be voluntarily admitted as an inpatient, and voluntarily remain after other sections cease to apply. voluntary inpatients may be prevented from leaving by a nurse under section 5(2) or any physician under section 5(4) for 72 hours before being assessed for commitment through section 3 or section 2. criminal sections part iii and other various criminal sections of the act apply to sentenced prisoners and persons subject to proceedings of the criminal justice system. although they are invariably implemented by a court, often upon the recommendations of one or more psychiatrists, some of these sections largely mirror the civil sections of the act. pre-trial orders section 35 and section 36 are similar in their powers to section 2 assessment orders and section 3 treatment orders respectively, but are used for persons awaiting trial for a serious crime and provide courts with an alternative to remanding a mentally disordered person in prison. the order for section 35 can be made by the crown court or a magistrates' court, whilst section 36 can be enacted only by a crown court. courts can enact either of these sections on the medical recommendation of one section 12 approved doctor. both these sections are rarely used in practice. post-trial orders section 37 is a treatment order, similar in many regards to the civil treatment order under section 3, and is fairly frequently used. it is applied to persons recently convicted of a serious crime (other than murder), which is punishable by imprisonment. thus it represents an alternative to a mentally disordered person being punished by imprisonment or otherwise. it is enacted by the crown court or a magistrates' court on the recommendation of two approved doctors. however, the court is able to exercise discretion in this regard and can impose a prison sentence despite medical recommendations for section 37. a person detained under section 37 can appeal to the mental health review tribunal after a period of six months; if they are no longer experiencing symptoms of mental disorder, the person can be discharged by the tribunal, even if there is a strong possibility that the person might relapse and re-offend. furthermore, a person on section 37 alone, who may have been convicted of a serious violent crime, can be discharged in the community at any time by his or her responsible clinician (rc). for these reasons, people who either are deemed by the court to pose a particularly high risk to other people if released, have a pronounced history of dangerous behaviour, or have committed a particularly serious offence, usually have section 41 used in conjunction with section 37. section 41 imposes "restrictions" upon the terms of section 37. in summary, this means that the home office and, ultimately, the home secretary, rather than the rc, decides when the person can leave hospital, either temporarily ("leave") or permanently ("discharge"). indeed, most people are ultimately given a "conditional discharge", which sets a statutory framework for psychiatric follow-up in the community upon release and provides for recall into hospital if, for instance, a person disengages from mental health services. only a crown court can impose section 41, but a judge can do so without a doctor's recommendation. although persons on section 41 can appeal against their detention to the mental health review tribunal, their cases are heard by a special tribunal, chaired by a high court judge. since the 2007 amendments have been implemented, section 41 is universally imposed without limit of time. section 38 is an interim order, used in similar circumstances to section 37, when it is likely, but not wholly clear, that a section 37 will be appropriate. transfer orders it is noteworthy that the act only provides for enforced treatment of mental disorder in a hospital. as a prison is not defined as a "hospital" by the act, no prisoner can be treated against his or her wishes under the act in prison, even in a prison healthcare wing. instead, sections 47 and 48 provide for prisoners to be transferred to a hospital for treatment of a mental disorder. section 47 applies to sentenced prisoners, whilst section 48 applies to those on remand and those convicted but awaiting sentence; it provides for temporary treatment out of prison. section 48 can be used only for prisoners in need of urgent treatment for mental illness or severe mental impairment, whilst section 47 can be used to treat any category of mental disorder. the home office is required to approve applications for these sections and decides what level of security in hospital is necessary for a particular prisoner. section 49 provides for "restrictions" to section 47, in the same way that section 41 provides for "restrictions" to section 37. physical illness the act provides the legal framework for the assessment and treatment of mental disorders. it does not provide for the assessment or treatment of physical illnesses. there has been substantial case law to confirm this interpretation. thus, a person who has a mental illness as well as an unrelated physical illness for which he is refusing treatment, cannot be treated for his physical illness against his wishes under the act. in such cases, however, it might be deemed that the person lacks the mental capacity to consent to treatment of the physical illness, in which case treatment could be given, in the person's best interests, under the mental capacity act 2005. however, if the physical illness is causing the mental disorder, or if the physical illness is a direct consequence of the mental disorder, treatment of the physical illness is permitted under the act. a common example of this is a person who has a short-lived confused state as a result of a physical illness such as an infection or a heart attack, but who is refusing assessment or treatment of the underlying condition. it is legal to treat such a physical illness under section 2 of the mental health act, on the grounds that treatment of the physical illness will alleviate symptoms of the mental disorder. however, this is