WTF does being ‘sectioned’ actually mean?

First and foremost, I am not sectioned. But most patients on my ward are.

If you are sectioned, this means that you are kept in hospital under the Mental Health Act 1983

You should only be sectioned if:
you need to be assessed and treated for your mental health problem
your health would be at risk of getting worse if you did not get treatment
your safety or someone else’s safety would be at serious risk if you did not get treatment
your doctor thinks you need to be assessed and treated in hospital, for example if you need to be monitored very regularly because you have to take new or very powerful medication. Otherwise, you may be asked to attend a hospital out-patient clinic.

Before you can be lawfully sectioned, you will need to be assessed by health professionals, to make sure that it is necessary.

Mind

The most temporary section you can get is a Section 4.

You need to be detained under section 4 if:
you have a mental disorder
it is urgently necessary for you to be admitted to hospital and detained
and waiting for a second doctor to confirm that you need to be admitted to hospital on a section 2 would cause “undesirable delay”.

You can be sectioned by one doctor only (together with the approved mental health professional) and you can be taken to hospital in an emergency and assessed there.
Your rights are different compared to your rights under other sections. For example, you cannot be treated without your consent.
You can be detained for up to 72 hours.

Mind

This is what the nurse was referring to when I wanted to discharge myself a couple of weeks ago. She didn’t feel that I was safe, so she could have got the Duty Doctor out to put me on a Section 4 until either a second Doctor could come along, or the 72 hours came to an end, by which point I would have willingly agreed to stay in hospital.
It turns out nurses also have the power to Section someone for up to 6 hours until a Doctor arrives.

The most common type of Section (the Peep Show section) is Section 2.

You can be detained under section 2 if:
you have a mental disorder
you need to be detained for a short time for assessment and possibly medical treatment
and it is necessary for your own health or safety or for the protection of other people.

You can be detained for up to 28 days.
The section can’t normally be extended or renewed, but you may be assessed before the end of the 28 days to see if sectioning under section 3 is needed.

Mind

This is what happened to me 7 years ago. I had two Doctors and a social worker come to my home, and tell me what if I did not come willingly, they would section me.
I was still adamant that I didn’t need to be hospitalised and that I wanted to stay home with my games, my husband, and my cat. They said that either way I was going to hospital, but if I was sectioned it would be more difficult for me to be discharged, and it might affect future visa applications for holidays and stuff like that.

So I was blackmailed in to it pretty much, which shouldn’t happen, although I’m quite glad that it did.

Once I became of a sounder mind, I wondered how anyone could possibly ever be sectioned. If Doctors were basically blackmailing people this way, surely everyone would see rationally and just go willingly.
But that’s the thing with mental health isn’t it?
People aren’t thinking rationally.
Sometimes they aren’t even thinking at all.

Section 3 is the biggy, and comes when the 28 days of Section 2 are up.

You can be detained under section 3 if:
you have a mental disorder
you need to be detained for your own health or safety or for the protection of other people
and treatment can’t be given unless you are detained in hospital.

You cannot be sectioned under this section unless the doctors also agree that appropriate treatment is available for you.

You can be detained for up to 6 months.

The section can be renewed or extended by your responsible clinician:
for 6 months, the first time
then for 6 months, the second time
after that, for 12 month periods.
There is no limit to the number of times the responsible clinician can renew the section 3.

Your responsible clinician can also discharge you from your section before it comes to an end. If this happens, you are free to go home.
If your mental health gets worse again in the future, you could be sectioned and taken to hospital again on a new section.

Mind

Section 3 is for really unwell people.

Interestingly enough, my Dad’s job before he retired was to be the impartial clinician reviewing patients’ sections. That’s how he’s so familiar with the hospital that I’m in, and some of the patients too.

So yeh, I am not sectioned. I am ‘informal’, ‘voluntary’, here of my own free will.
I am not being legally detained.

You are a voluntary patient (sometimes called an ‘informal patient’) if you are having in-patient treatment in a psychiatric hospital of your own free will.
Being a voluntary patient is different to being sectioned under the Mental Health Act.
As a voluntary patient, you have the right to get treatment for your mental health problem, as well as physical health problems. You also have the right to refuse treatment you don’t want.
You can leave the hospital when you want, but you are still expected to take part in your treatment plan.Some hospitals will have rules about what you can and can’t do on the ward. But if the rules are too restrictive and unnecessary, it could breach the Human Rights Act.

You would only be sectioned if the care team is worried about the risks to yourself or others if you leave the ward.

ADVANTAGES
You have greater control and say on your life. For some people this is very important and can improve wellbeing.
You have more freedom. You are able to leave the ward when you want, within reason. You should also have less restrictions placed on you, like having your mail checked on the ward or having access to your possessions.
You can refuse treatment, including medication. This means that you can have more discussions with your care team, which leads to better understanding and you are more likely to take the medication.
You are less likely to experience discrimination. People who are detained under the Mental Health Act are more likely to be discriminated against at work or when taking out insurance. The Equality Act could protect you from discrimination in some situations. See our information on disability discrimination to find out more.
It is less likely to show up on a DBS check. If you are taken to a place of safety under section 136 of the Mental Health Act, it may show up on a DBS check when you’re applying for a job because the police have been involved. So this could affect your ability to find a job, especially if you work with children or vulnerable adults. See our information on DBS checks to find out more. If you go voluntarily, the police are less likely to be involved.
You are more likely to be allowed in foreign countries. If you want to travel to a country that needs a visa, some of the application forms will ask you about mental health problems. You are more likely to be allowed in the country if you have not been sectioned.

DISADVANTAGES
You do not have the right to get section 117 aftercare. This means that you do not always get the same level of support in the community as you would if you were sectioned, and that you may have to pay for some services. Because you do not have the same rights to aftercare, sometimes the discharge planning is not as detailed as it would be if you were under section.
There is no right to review. This is different to if you are sectioned, where you would have the right to challenge your detention by applying for a mental health tribunal. To find out more see our information on sectioning.
It can sometimes be difficult to get a bed in hospital. There is currently a shortage of hospital beds which means that in some areas you cannot be admitted unless you are sectioned.(In England only)
You don’t have the right to an independent mental health advocate (IMHA). IMHAs are only available if you are sectioned. But there may be other advocacy services available in your area.

You can temporarily leave the ward if you are a voluntary patient. But you will be expected to take part in your treatment plan, which could include therapeutic activities and talking to staff. So this means that you will need to spend some time on the ward.
You should talk to your care team about how much time they expect you to spend on the ward to make sure that you agree. You may want to go out for an hour, a day, or overnight, so it’s important to be clear about how much time you want to spend on the ward.
You will also need to let ward staff know about your plans so that they know where you are. This is for health and safety reasons, for example if there is a fire drill.
Your ward may be locked, so you should be told who you can speak to if you want to leave, and must be able to leave at any time you want to. You have the right to leave the hospital if you don’t want to stay. Your care team must tell you if they believe leaving hospital could put you or others at risk, or if they’re considering stopping you by detaining you under the Mental Health Act.
Health professionals can’t threaten to section you to make you agree to treatment or to stay on the ward if you don’t want to.

You may be entitled to support in the community after you leave hospital, so it’s important to speak to your care team so that they can assess your needs.
If the care team is worried about the risks to yourself or others if you leave the ward, they may decide to section you.
If that happens, your doctor may keep you on the ward for up to 72 hours while they decide whether you need to be detained and kept in hospital. If a doctor isn’t available, a nurse can stop you from leaving the ward for up to six hours until one can be reached.
Health professionals can’t threaten to detain you under the Mental Health Act to make you agree to stay in hospital.

You can only be detained if two doctors and an approved mental health professional (AMHP) agree that:
you need to be assessed and/or treated for your mental health problem in hospital
your health would be at risk of getting worse, or wouldn’t get better, if you don’t get treatment
your safety or someone else’s safety would be at risk if you don’t get treatment.

When you are discharged, if you need support from different people, you should be given community care under the Care Programme Approach (CPA) in England, or the Care and Treatment Planning (CTP) in Wales.
Under the CPA or CTP, your needs should be assessed by your care team. You will be given a care coordinator who is often a social worker or a nurse. You should be involved in this assessment.
As a result of this assessment, a care plan should be written explaining how issues around your care and treatment will be addressed. You should be given a copy of your care plan and this should be regularly reviewed.

Mind

So there you have it.
The main thing I have to be wary of is my aftercare on discharge, as there is no real legal obligation to fulfill that. But that’s what I can and can’t do, and how I have ended up here.
I am aware of how fortunate I am to have got a bed. Although I am almost certain that if I hadn’t been able to get one I would have been either Sectioned or dead within the week.