Being sectioned under the Mental Health Act

Here, people talk about their experiences of being admitted to hospital, in some cases using powers provided by the Mental Health Act 1983, or ‘being sectioned’. To be sectioned, three people (an Approved Mental Health Professional (AMHP) or nearest relative and two doctors) must agree that the person is suffering from a mental disorder and needs to be detained for assessment or treatment, either for their own safety or the safety of others. Under section 2 of the Act, someone can be detained for up to 28 days for assessment; under section 3 a person can be detained for up to 6 months for treatment; section 4 is used in emergency situations for assessment over a period of 72 hours. Most hospital patients, however, have agreed to go into hospital and have not been sectioned under the Mental Health Act; they are known as informal or voluntary patients.

Some people had been in hospital several times while others had been admitted just on one occasion; one woman had been in the mother and baby unit of a psychiatric hospital (see Reena’s story) and another spent periods of time in a mental health hostel specifically for people from Black and minority ethnic backgrounds. Most people had been informal patients on some occasions and sectioned on others; a few people could describe which section they had been on, while others couldn’t remember or said they didn’t know much about the mental health system at the time. One person emphasised that it’s important to know your rights when in hospital [see Devon below]. People had spent between 48 hours and 9 months in hospital.

Informal or voluntary admission

Some people willingly went to the doctor or hospital to ask for help when they were unwell and some had even decided to admit themselves as informal patients, including one woman pleaded with her doctor to admit her to hospital for ‘proper’ treatment (see Reena’s story). One man wanted help because he knew the way he was feeling ‘wasn’t right’, while another said one of his ‘good’ voices told him to go to hospital for treatment.

Jay took the opportunity to be an informal patient when it was offered but was very upset when…

Age at interview 42

Gender Female

Age at diagnosis 34

View profile

They said to me that there, there was a place that I could go, a women’s referral unit, and if I did, if I wasn’t going to go there voluntarily then they, they were going to section me. So of course I took, took the opportunity to put myself in, in, in somewhere voluntarily [laughing]. It seemed like a good idea. Not that I really knew an awful lot about mental health and the system that, before this happened. I just thought, ‘It’s better to go voluntarily than for someone to by law imprison you. Because to me it sounded like, ‘Well, if you don’t go, we’re going to lock you up,’ sort of thing.

So, yes, I went there. It was bizarre because they didn’t take me there. They sent a cab to get me and off I went in the cab, or was it an ambulance? I can’t even remember what it was now. I think it was an ambulance car thing. Anyway it wasn’t, I remember going there and thinking to myself that I might be, never be able to call myself normal again. And so therefore I just thought, ‘Well, all right then, I’ll just go along with it and see what happens, because I’m not mad. So it’ll be all right. And I got there [laughs] and this woman sort of took me up to a room and, after talking about whatever, I didn’t even hear any of it, I was kind of sitting there and they was going, ‘Ooh, and we’ll take you up to your room’ and took me suitcase. And this woman opened my suitcase and she was checking everything. Checking, you know, the toiletry bag, the side compartment, shaking out the clothes. And I’m looking at her and I’m thinking to myself, ‘Why on earth are you doing that? You’re making me feel like I’m a prisoner. I said to her, ‘What do you think I’m going to have in my suitcase?’

‘Well, we’ve got to make sure you haven’t got any drugs or alcohol or things that you can harm yourself with or any pills that you shouldn’t have’ and blah, blah, blah. And I just sat there and cried because I couldn’t believe that I was there. And I didn’t remember why, I’d decided it was a good idea just to come there. And I just never spoke, for days I never spoke. And I saw all these people with lots of issues and I just looked at them and think, ‘You lot are mad, but there ain’t nothing wrong with me. You lot are the mad ones, because you’re behaving mad. At least I’m just sitting quietly. You’re carrying on. And I didn’t feel part of what was going on. I didn’t, I didn’t feel alienated neither, because there was another two black women there too. So, and there wasn’t many people there. I think there was about eight of us. So, and it was all women. So I had my therapies and classes and whatever else went on in there.

Embed Print Transcript

Michael was admitted for observation but says there was no need to section him.

Age at interview 49

Gender Male

Age at diagnosis 15

View profile

I was admitted to a locality mental health unit in the London of Walford [Laughter] and I at the time was admitted for observation. But actually yeah I was very pleased to be getting out of the place where I was living where I was subject to a kind of constant barrage of, of physical and verbal abuse and, and to me this was, you know, a welcome escape and it was, it didn’t take much to persuade me to, to give me a break. And I was quite happy stay on in the hospital as a voluntary patient and so there was no need to section me. And there was certainly no need to surreptitiously section me. But I think it would have been impossible to stigmatise me in the way that I’ve stigmatised if I hadn’t been section 3’d and kept in for six months without any appeal. And I think I would’ve been kept in much longer if there hadn’t been an automatic review at that point, which would have required a panel to decide that I was genuinely so ill that I had to spend an indefinite period. And even though all this went on behind my back, I was told, you know, within a very brief, given very brief marching orders that, okay we’ve got to let you go.

Embed Print Transcript

Informal patients can leave hospital when they wish, although if the doctor believes it is necessary to keep them in hospital, they can use section 5 of the Mental Health Act to detain them for 72 hours while they make an assessment. A few people said that this was a ‘weird kind of voluntary’.

Dolly was admitted as a voluntary patient but was threatened with a section when she tried to leave.

Age at interview 36

Gender Female

Age at diagnosis 21

View profile

I have been sectioned once. And three other times I have been voluntary. But it’s a weird kind of voluntary. Because they say, ‘You’re in voluntary, but if you try to leave you’re sectioned. So and I have tested that theory, and said, ‘I am leaving now. ‘Oh well we are just going to section you then. So it’s a weird, weird kind of thing, they say voluntary but you know, really no.

And what was it like when you were sectioned, what happened?

Well I think the first time I was hospitalised, I don’t really remember too much about it. I just remember going to see my community nurse, and then I just remember being driven to the hospital. It just seems quite vague. Whether I have just blocked it out or whether I just don’t remember I don’t know, but it was scary I mean, because that was the first time I was in hospital, you know. And I wanted to go home, you know.

Embed Print Transcript

Not everyone who sought help in this way was admitted to hospital. One man was given medication and sent home to his family where the crisis team visited him on a daily basis. He believed he was not sectioned (even though his parents requested it) because he was young and had support available in the community. He did, however, spend occasional periods in a respite unit at the request of his family and felt this was a helpful alternative to hospital.

Tariq says he wasn’t sectioned because he was young, vulnerable and less risk to the public and…

Age at interview 21

Gender Male

Age at diagnosis 18

View profile

So every single day for a very, very long time, I can’t even remember how many months, for every single day for several months they’d come to see me at home and I’d tell them this is how I’ve been feeling. But the thing is that even though I was talking to them my condition was worsening and it was worsening. It came to a period where, you know, they couldn’t keep me in the house but what they did do on, on occasions was to put me in the respite unit which we had in the, it was a respite unit that was part of the mental health service, but was in the community and it was a place where people can go and use the services, or use some of the provision that was available such as read books and… And it was away from the outside world, it was, you know, a lot of the time the world is a busy place and people are moving around so it was somewhere where you could go and relax and just have, you know, be with other service users and just enjoy yourself and etcetera. And I spent three or four weeks there and I did that frequently so whenever there was tension in the house, whenever I started shouting at people, in my family, that’s when it was decided, you know, you can go there.

But to be honest, you know, there’s a lot of talk that, that mental staff are very sort of, they take it to the extreme that they deliberately section people. To be honest at no point was a section considered in my case. My doctors and my nurses were some of the most compassionate, some of the most warm, some of the most kindest people that I’d ever come across because whenever my, whenever my family brought up sectioning because I, you know, for them it was a new thing that I was unwell and they were quite frightened to have me in the house and stuff, the, the, the doctors were saying no we’re not going to because we feel that we can’t, we want him to stay in the community because he’s young and we have a lot of, we have, we see a lot out there for him because, and we know that we, he has a future in front of him and we want to treat him at home. and the thing is that over time, over the last four or five, three or four years that I’ve been a patient they’ve seen me gradually recover in front of them and, and they’ve never had to section me
And why do you think you haven’t been sectioned?

Why? That’s a good question because, number one I think that no young person should be in a hospital, it’s a very dangerous place for a child, it can be very frightening for a child. children and young people and adults we develop in two different ways, adults are completely different from young people we have different dependency levels and etcetera so I think on that, because in hospitals it’s only those that are eighteen and over mainly or those between thirty and over, the majority of the patients are over twenty five, they’re usually in their thirties of forties. You wouldn’t put a seventeen year old onto the same ward as a forty year old whose condition is far more worse, who poses a significant threat to all the patients. So it’s better that a child is, is around the people that love them most, their family because that’s where a child should be. And even like every professional I talk to they always say that a child’s home should not be in the hospital it should be in their own home, it should be in the school where they go to school. They shouldn’t be living in a hospital that’s not the place to be. A child should be in the home, an adult can be in a hospital because an adult poses far more of a risk to, to other, to the public than a child would. A child has, you know, has limited sort of strength when it comes to the, because if you look back at the last ten years you’ll see that no young person has ever been jailed, no young person who has, who has experienced mental health diffi

Embed Print Transcript

Involuntary admission (being ‘sectioned’)

Many people described being taken to hospital against their wishes. This often, but not always, followed a suicide attempt. Some were admitted because of concerns about their safety and the safety of others, while others were admitted for observation because they were unwell: ‘they see that hospitalisation was what I wanted’. A few people mentioned being asked lots of questions during this assessment process. A few were taken to hospital by the police, including one man who was arrested for theft and then assessed at the police station. Several people said they had been unsure why they had been hospitalised, and for some, hospitalisation was unexpected, especially for those who didn’t realise there was anything wrong. One man couldn’t understand why he’d been taken to hospital by the police ‘because I had committed no crime in my life’; at first, he didn’t realise he’d been sectioned, and later wondered whether he was sectioned because he is Black.

Devon thought his hospitalisation was a mistake and talks about institutional racism.

Age at interview 49

Gender Male

Age at diagnosis 22

View profile

So stayed here’ I fell asleep actually on the bed. This is the evening time I was admitted, and it was a Wednesday night. I remember it very vividly and then I fell asleep and I woke up in the middle of the night. I got up and I went to the office again and there was a nurse sitting there with her head down like that, I think she was sleeping. I said, ‘Excuse me love. I am all right now. I think there has been a big, big mistake. I need to go now.

The next thing I know she had pressed a buzzer and four big white person ran down the corridor and got me on the floor, held me down, and injected me with tranquillizer for the first time and I was unconscious for four days. I nearly died, you know. And on the fourth day I came back conscious and they examined me.

I collapsed again that day, and I said to them, when I was on the bed. ‘Can you let my parents know what has happened to me. But they didn’t let them know. It was days before they told them.

Anyway it was at that point that I felt different in my body. My mind left me, my body was different. The way I was thinking was different, you know, like I had lost my spirit. I lost the drive. I lost myself. Due to what they gave me in the medication. It was an injection for me, they held me down and forced it upon me.

One other, most of the problems, most of the situations was, was it wasn’t so much racist it was more institutionalised racist. It’s embedded within the system. Not actual racist coming from the mouth of the people. But it’s embedded in the system, because it’s embedded from the Empire as I am saying, from that time. It’s embedded in the system from when they came over in the Wind Rush and no dogs, no Irish, no Black people. As I am saying it’s embedded within the institution from that, from that era and so it was still in the hospital system, not just in the mental health hospital, it was in the institutions in the country. The church, all institutions, the government, that is what they mean by institutionalised racism that is what it means, it doesn’t mean racism from a person. It means it’s embedded within the institutions and that is why they call it institutionalised racism. That is what it is yes, so it is embedded with them. So when the, the police came, ‘Oh you’ve been smoking dope Devon. So it is in the system, the police system, you know. Without questioning it or understanding it, it’s in the system, so you have to deal with it, because it is part of the system. In the school you can’t come to the trip, you’re a Black sambo. All these different. It’s in the system and that is what they mean by institutionalism racism which is different from racism and it’s different from prejudice. They’re the three areas, institutionalised racism is from the institution. It’s still in it now. It’s not going to come out for years yet. Because it is still in the institutions and the court system or the probation, it’s all in there. Not because of the people working there, but from the past. It’s still there. And that is what everyone’s trying to fight now. Right now everyone is trying to fight to get it away from the system and make it a new system where everyone is accepted and everyone is treated the same and fairly. Which is right, isn’t it when you think about it? It’s no one’s fault. It’s no one’s fault. It just that it’s imbedded within the system because of the way our, the world was before it’s no one’s fault now, it’s just the way it happened within the system, so that is why I don’t fight anyone now because of it. I argue and criticise and talk and debate about it. How we may change it. It’s no one’s fault. It’s not the police fault, it’s not the fault of the government. It’s the fault of the institution and the way the Empire was before it all happened. Yes.

Embed Print Transcript

She did not realise at first that she was on a mental health ward. (Audio in Cantonese, text in…

Age at interview 60

Gender Female

Age at diagnosis 40

View profile

After I was hospitalized, and even when I arrived at the hospital, I didn’t know what ward I was in. I was actually happy about it because I thought I was finally getting the help I needed from the doctors in a hospital environment. But in reality, it wasn’t what I had imagined. Even though it was a long time ago, I remember many things vividly. I remembered when I got to the hospital, I saw how good the environment is, compared to the state of the hospitals from my homeland of China. When I saw the environment and with all the good equipment, I felt that I could get the treatment I needed. I thought the doctors would know how to help me. That was why I was happy. The nurses saw me smiling and they were surprised and wondered why I am smiling. After a few days, I felt that the patients in the ward are behaving strangely, e.g. some strip down and wander around, or some will repeatedly rummage through their own bags in the middle of the night, saying that they were about to be discharged the next day, when actually they were not. This was all very bizarre and made me think why I would end up in such ward for treatment, for an illness that I know nothing of. After one or two weeks, I realized that I was placed in a mental illness ward. Then I understood why nurses were surprised when they saw me smiling, they must have thought this was an abnormality of a mentally ill patient, when actually, I smiled because I felt that I would finally receive proper treatment.

Embed Print Transcript

Although many people didn’t want to go to hospital, some saw later that it helped them in some way (see Hanif’s story) because they got the right diagnosis (see Sara’s story), got their medication right, sorted out their accommodation, or learnt techniques to be able to manage their condition. Others, however, were glad to have avoided being sectioned.

Niabingi describes being in hospital and how it prompts her to ask “what is wrong?” and often…

Age at interview 42

Gender Female

Age at diagnosis 25

View profile

Yeah well it’s very boring, you sort of you know, you sort of sit around. While, and just sort of occupy yourself, reading, telly, I mean not reading because your concentration has gone but I just, in those days I smoked cigarettes so you just sit around smoking cigarettes, talking to people if you can talk. But I’d be mainly listening to my voices, just wandering around listening to the voices. And then at night, you get fed, three meals a day, and you watch television and take your medication. That’s basically all it was. As time has gone on it’s got a bit better. Recently not the last time I was in hospital but the time before then they started taking me out on trips you know, which are very beneficial. I did like the trips and the fresh air and everything and the little journey in town, that was very good. So you know, that was quite, quite healing, quite healing. but generally you sort of, and oh yeah and I went to a few art groups as well but never really took to the art groups, couldn’t see how you know, how, unless you know, I know some psychologists read art but you know, it didn’t really help me much, the painting and things like that it didn’t, and drawing it didn’t really help me much.

But yeah I’ve done art groups, I’ve gone on trips. Oh yeah they had video, they had video or sort of video sessions sometimes like they’d get a video or what would be a DVD now and you know, the patients would, us patients would sit down and watch a popular movie or something like that which would be good, it would be interesting you know, that would be good. games, so sometimes there would be games to play like I didn’t play any games but some of the patients would play, other patients would play chess or draughts together, and at one point in the hospital they had pool so that was very good you know, and the staff would sometimes, the nurses would sometimes play pool with you. and one occasion a nurse actually helped me and did my hair and you know, told me to get in the shower because personal hygiene is something that suffers for me when I’m ill So you know, that, that you know, that, that’s generally all you do but really it’s, a lot of the time is just sort of like you finding things that will pass the time till, you know, you get better. And there is a difference, I mean the voices stop, I start to think clearly again. They don’t go away completely but they become less forceful and less, less prominent, less loud and you know, I start to take an interest in my appearance again. Yeah.
So what is it about being in hospital that helps you to get better?
Well I think it’s the stark realisation that you’re, you’re, ’cause you’re in hospital and hospital is always this, well for me anyway, I don’t know about anybody else, I presume possibly it will be the same for everybody else but for me I associate hospital with being ill, so once I’m in there I think right this, there’s something is not well, ’cause I’m in this place where people are usually very ill and usually might even die because they’re so ill and as I start to think well then okay something is wrong, now what is wrong? Now then I start to say well they’re telling me that you know, these voices that I’m hearing are not right you know, they’re not, I’m not supposed to be hearing them so then I sort of like work on trying to not hear them. So, and you know, take the medication because usually when I’ve gone in after the first occasion it’s because I haven’t taken the medication because I don’t believe it helps because it’s got a lot of side effects you know, that, you know, I can’t, insomnia, it makes me feel sick, sometimes I dribble and sometimes I shake and all that kind of thing so you know, if I could possibly get by without it, which I have tried to do, I’d like to. But I don’t think I can now, I’ve come to the co

Embed Print Transcript

Tariq says that he’s glad he wasn’t sectioned because he believes it could have damaged his…

Age at interview 21

Gender Male

Age at diagnosis 18

View profile

So I think that being supported in the community has been beneficial for me and it’s also helped, it hasn’t tarnished my records because once you’re sectioned it actually bars you from taking up certain positions in society because from what I understand, from what I’ve learnt is that if, once you’re sectioned you’re not allowed to do voluntary jobs that may require you to work with the public, you may be barred from becoming I don’t know a professional in some areas you know, you can’t even become an academic, academic if you’re sectioned.

But if you’ve experienced mental health difficulties but you’re not sectioned you can, that’s the big difference. And for example there was a famous guy in the United States and I’ve forgotten his name, John, he was a US professor who suffered mental health difficulties, there was a film done about him called the Beautiful Mind, Professor John Nash. John Nash was a professor who suffered very serious mental health but he was never sectioned. Although the film was a bit exaggerated and it didn’t give an accurate depiction of his life he took medication but he was allowed to stay as a professor but what they did say to him was that if, if he was sectioned and then couldn’t continue his career and that’s what his, what people should differentiate that, people that experience mental health difficulties can go onto become success, successful but people that are sectioned it may be far more difficult for them because they, people that are sectioned it’s far more difficult for them to access services and for people to sort of, because of the legal processes in this country it’s quite difficult to sort of, I don’t now I’m not sure how I can word it but I don’t know how to word it so I’m not going to continue on that bit. but I think people that do experience mental health difficulties but are not sectioned do far more better than people that are sectioned. Winston Churchill, as I was saying, he suffered depression he was never sectioned, Abraham Lincoln was never sectioned many of the, you know,

Beethoven, the famous classical, he, he was, he suffered from mental health, what’s that guy’s name, the guy who inspired Mahatma Ghandi, Tolstoy, he suffered from mental health, he mentioned in one of his books that he suffered from mental health difficulties. Many of the most significant figures in the 20th century and even before suffered mental health difficulties. So, but the majority of them were not sectioned, I don’t think any of them were, they were, they took medication, they suffered from depression but they were never sectioned and they’ve gone onto to do very well for themselves so I think that I’ve actually benefited by not being sectioned.

Embed Print Transcript

Many people described wanting to leave the hospital, including one woman who said: ‘I still wouldn’t stay in hospital and get the help needed because I just didn’t trust people’. A few even managed to escape, and lived on the streets until they were brought back to hospital, in one case by the police. Everyone has the right to appeal against detention to a Mental Health Review Tribunal, and some did so.

Niabingi was concerned about losing her place in a hostel and appealed to a Mental Health Review…

Age at interview 42

Gender Female

Age at diagnosis 25

View profile

But anyway so I went into hospital andwas there, I think about six, at least, at least six months, hated hospital for you know, you know, hated hospital, couldn’t escape and started the process of a tribunal because I wanted, well I got into, I think I was there for about six, eight months or something but after about four months I said, Oh I really want to leave this place and I was afraid that my, my bed at the hostel would go and I didn’t want you know, to be homeless again. And well not homeless again but you know, you know, so I was sure that I’d find you know, somewhere to live but I just, you know, that was nice and clean and everything and you know, the people there, living there were good, it was you know, somewhere nice. anyway started a tribunal to get out of hospital and then, and won that, or semi won that, they had an agreement, the doctors agreed that I agreed with the doctors that I wouldn’t leave immediately but they had, they said they were going to let me go in a few weeks’ time anyway so if I agreed to sort of just waiting till that time I would definitely be released. So I agreed and they stuck to their word so I got released and went back to the hostel.

Embed Print Transcript

Some people chose to remain in hospital as an informal patient after a 6 month review of their case. This included one man who was keen to get back to the community but also wanted to get better’ ‘I couldn’t leave, I was in a state, so I said, ‘I’ll stay voluntary for a while”.

See also ‘Being in hospital for mental health problems’ for more about what people felt their hospital stay was like.