mental health act 1983 mental health act 1983 the mental health act 1983 (c. 20) is an act of the parliament of the united kingdom. it covers the reception, care and treatment of mentally disordered people, the management of their property and other related matters, forming part of the mental health law for the people in england and wales. in particular, it provides the legislation by which people diagnosed with a mental disorder can be detained in a hospital or police custody and have their disorder assessed or treated against their wishes, informally known as "sectioning". its use is reviewed and regulated by the care quality commission. the act was significantly amended by the mental health act 2007. a white paper proposing changes to the act was published in 2021 following an independent review of the act by simon wessely. mental health act 1983act of parliamentparliament of the united kingdomlong titlean act to consolidate the law relating to mentally disordered people.citation1983 c. 20territorial extent england and wales (full); northern ireland and scotland (parts of the act)datesroyal assent9 may 1983commencement30 september 1983other legislationamendsmental health act 1959status: amendedtext of statute as originally enactedtext of the mental health act 1983 as in force today (including any amendments) within the united kingdom, from legislation.gov.uk. history the madhouses act 1774 created a commission of the royal college of physicians with powers to grant licences to premises housing "lunatics" in london; justices of the peace were given these powers elsewhere in england and wales. failure to gain a licence resulted in a hefty fine. admission to a "madhouse" required certification signed by a doctor, and lists of detained residents became available for public inspection. this act was later considered ineffectual and was repealed by the madhouses act 1828, itself repealed shortly afterwards by the madhouses act 1832. these acts altered the composition of the commission in several ways, such as including barristers in addition to doctors. the lunacy act 1845 and the county asylums act 1845 together gave mental hospitals or "asylums" the authority to detain "lunatics, idiots and persons of unsound mind". each county was compelled to provide an asylum for "pauper lunatics", who were removed from workhouses into the aforementioned asylums. the lunacy commission was established to monitor asylums, their admissions, treatments and discharges. both these acts were repealed by the lunacy act 1890. this introduced "reception orders", authorising detention in asylums. these orders had to be made by a specialised justice of the peace and lasted one year. thereafter, detention could be renewed at regular intervals by submission of a medical report to the lunacy commission. the mental deficiency act 1913 renamed the lunacy commission the "board of control" and increased the scope of its powers. the functions of the board of control were subsequently altered by the mental treatment act 1930 and the national health service act 1946. the lunacy act 1890 was repealed following world war ii by the mental health act 1959. this act abolished the board of control, and aimed to provide informal treatment for the majority of people with mental disorders, whilst providing a legal framework so that people could, if necessary, be detained in a hospital against their will. it also aimed to make local councils responsible for the care of mentally disordered people who did not require hospital admission. however, like its predecessors, the 1959 act did not provide clarity as to whether a legal order to detain a mentally disordered person in a hospital also empowered the hospital to impose medical treatment against the person's wishes. it had become clear by the 1970s that a specific legal framework for medical treatments such as psychiatric medications, electroconvulsive therapy and psychosurgery was needed in order to balance the rights of detained persons with society as a whole. the mental health act 1983 was formally approved by the monarch on 9 may 1983 and came into effect on 30 september that year. it has been amended many times: notably in 1995, 2001 (via remedial order, issued on the grounds of incompatibility with the european convention of human rights under the human rights act 1998 section 4), 2007 and 2017 via the policing and crime act 2017. overview the act is divided into eleven "parts" (one repealed): i application of the act ii compulsory admission to hospital and guardianship iii patients concerned in criminal proceedings or under sentence iv consent to treatment 4a treatment of community patients not recalled to hospital v mental health review tribunal vi removal and return of patients within the united kingdom vii management of property and affairs of patients (repealed) viii miscellaneous functions of local authorities and the secretary of state ix offences x miscellaneous and supplementary each of these parts are divided into "sections", which are numbered continuously throughout the act. in total, there are currently 202 sections in the act that are in force. legal processes, detention of people, and involuntary treatment the act lays out various procedures to detain members of the public, inpatients, force them to take drugs, and perform medical procedures on them without consent. legal processes to detain people under the act action applies to changes status to proposed by approved by threat of section 2 by responsible clinician free individual voluntary inpatient approved clinician no one section 5(4) voluntary inpatient 72-hour hold nurse no one section 5(2) voluntary inpatient section 2 inpatient any medical doctor no one section 2 free individual section 2 inpatient responsible clinician doctor and amhp (conditions) voluntary inpatient approved clinician request to be discharged section 2 free individual patient responsible clinician threat of section 3 by responsible clinician section 2 inpatient voluntary inpatient responsible clinician responsible clinician section 3 voluntary inpatient section 3 inpatient responsible clinician doctor and amhp (conditions) section 2 inpatient period of detention under the act detention period applies to action proposed by approved by 72-hour detention voluntary inpatient section 5(4) nurse no one 72-hour detention voluntary inpatient section 5(2) any doctor no one 28 days detention free individual section 2 responsible clinician doctor and amhp (conditions) 6 month detention voluntary inpatient section 3 responsible clinician doctor and amhp (conditions) section 2 inpatient 1 year detention section 3 inpatient section 3 responsible clinician doctor and amhp analysis definition of mental disorder the term "mental disorder" is very loosely defined under the act, in contrast to legislation in other countries such as australia and canada. under the act, mental disorder is defined as "any disorder or disability of mind". the concept of mental disorder as defined by the act does not necessarily correspond to medical categories of mental disorder such as those outlined in icd-10 or dsm-iv. however, mental disorder is thought by most psychiatrists to cover schizophrenia, anorexia nervosa, major depression, bipolar disorder and other similar illnesses, learning disability and personality disorders. subjects most people are subject to the act, and section 141 even makes provision for members of the house of commons, until it was repealed by the mental health (discrimination) act 2013. in 1983–84, the house of lords committee for privileges accepted the advice of the law lords that the statute would prevail against any privilege of parliament or of peerage. approved mental health professionals an approved mental health professional (amhp) is defined in the act as a practitioner who has extensive knowledge and experience of working with people with mental disorders. until the 2007 amendments, this role was restricted to social workers, but other professionals such as nurses, clinical psychologists and occupational therapists are now permitted to perform this role. amhps receive specialised training in mental disorder and the application of mental health law, particularly the mental health act. training involves both academic work and apprenticeship and lasts one year. the amhp has a key role in the organisation and application of mental health act assessments and provides a valuable non-medical perspective in ensuring legal process and accountability. (for further aspects on the role of the amhp see also: involuntary commitment in the united kingdom.) section 12 approved doctors a section 12 approved doctor is a medically qualified doctor who has been recognised under section 12(2) of the act. they have specific expertise in mental disorder and have additionally received training in the application of the act. they are usually psychiatrists, although some are general practitioners (gps) who have a special interest in psychiatry. approved clinicians and responsible clinicians an approved clinician (ac) is a healthcare professional who is competent to become responsible for the treatment of mentally disordered people compulsorily detained under the act. a clinician must complete special training and demonstrate competence in their professional portfolio in order to be approved as an ac. until the 2007 amendments, they would almost exclusively have been a consultant psychiatrist, but other professionals, such as social workers, clinical psychologists and nurse specialists, are being encouraged to take on the role. once an ac takes over the care of a specific patient, they are known as the responsible clinician (rc) for that patient. nearest relatives a nearest relative is a relative of a mentally disordered person. there is a strict hierarchy of types of relationship that needs to be followed in order to determine a particular person's nearest relative: husband, wife, or civil partner; son or daughter; father or mother; brother or sister; grandparent; grandchild; uncle or aunt; nephew or niece; lastly, an unrelated person who resides with the mentally disordered person. thus a person's nearest relative under the act is not necessarily their "next of kin". a mentally disordered person is not usually able to choose their nearest relative but under some circumstances they can apply to a county court to have a nearest relative replaced. in practice, such applications are more commonly made by social services departments. the nearest relative has the power to discharge the mentally disordered person from some sections of the act. hospital managers hospital managers represent the management of the nhs trust or independent hospital and have the responsibility for a detained patient. on their behalf, the non-executive members of the board of the relevant national health service trust and appointed lay 'associate managers' may hear appeals from patients against their detention, community treatment order and upon those detentions being renewed and extended. cases are heard in similar settings to those heard by the first-tier tribunal (mental health) outlined below. first-tier tribunal (mental health) mental health review tribunals (mhrts) hear appeals against detention under the act. their members are appointed by the lord chancellor and include a doctor, a lawyer and a lay person (i.e. neither a doctor nor a lawyer). detained persons have the right to be represented at mhrts by a solicitor. discharge from hospital as a result of an mhrt hearing is the exception to the rule, occurring in around 5% of cases, when the tribunal judges that the conditions for detention are not met. civil sections part ii of the act applies to any mentally disordered person who is not subject to the criminal justice system. the vast majority of people detained in psychiatric hospitals in england and wales are detained under one of the civil sections of the act. if a clinician consents, patients may choose to be treated as voluntary inpatient. this choice is sometimes as a means to avoid the threat of detention under sections of this act by a medical doctor. these sections are implemented following an assessment of the person suspected to have a mental disorder. these assessments can be performed by various professional groups, depending upon the particular section of the act being considered. these professional groups include amhps, section 12 approved doctors, other doctors, registered mental health nurses (rmns) and police officers. assessment orders section 2 is an assessment order and lasts up to 28 days; it cannot be renewed. it can be instituted following an assessment under the act by two doctors and an amhp. at least one of these doctors must be a section 12 approved doctor. the other must either have had previous acquaintance with the person under assessment, or also be a section 12 approved doctor. this latter rule can be broken in an emergency where the person is not known to any available doctors and two section 12 approved doctors cannot be found. in any case, the two doctors must not be employed in the