Use of section 5(2) of the Mental Health Act on a medical admissions unit

A survey by Jackson and Warner¹ pointed to large deficiencies in doctors' knowledge about consent. Ignorance of the law on capacity to consent to medical treatment could result in inappropriate use of the Mental Health Act (1983). We have audited the use of the Mental Health Act on a medical admissions unit. The unit admits patients with a wide range of acute medical conditions including patients requiring medical management of drug overdose or alcohol withdrawal. It treats more patients with delirium and acute psychiatric problems than most other medical wards.

We reviewed the hospital notes of 14 inpatients detained under the Mental Health Act after discharge from the medical admissions unit. The original reasons for admission were overdose (10), alcohol withdrawal (3) and collapse probably due to a seizure caused by alcohol withdrawal (1).

5 patients were detained by their responsible consultant. Junior staff detained 4 patients after discussion with the responsible consultant; but 5, in contravention of the Mental Health Act, were detained by junior staff without any evidence of consultation with the responsible consultant. In 12 patients' notes the fact that the patient was unwilling to remain in hospital voluntarily was documented. In all cases the two consultants reviewing notes felt that the decision to detain under 5(2) was appropriate. Overall the documentation of the sequence of events which led to the section, the decision-making process and the mental state of the patient was poor.

The Mental Health Act is an important piece of legislation used frequently in the general hospital. Its misuse could have important medicolegal consequences for affected patients, the doctors involved and their employers. Medical staff working in inpatient specialties need to make sure their knowledge of the Act and the Code of Practice² are up to date.