The Mental Health Act (MHA) 1983 regulates compulsory detention and treatment of people with a mental disorder in England and Wales. Nuffield Foundation POST Fellow Susie Walker explains how and when it is used to treat children and young people under 18, and the impact of proposed reforms.
Provision under the MHA means that a person who is considered to need inpatient psychiatric care can be detained in hospital and treated without their consent, subject to a MHA assessment. This is carried out by two doctors and an Approved Mental Health Professional, typically a social worker.
The UK Government has published a draft Mental Health Bill to amend the MHA. The proposed changes focus on reducing assessment and detention and giving patients who are detained (also known as being ‘sectioned’) more choice in decisions about their care.
The MHA and children and young people
There is no minimum age limit for detention under the MHA and the criteria for detention are the same for children and young people (CYP) and adults.
It’s not possible to fully understand how many CYP are detained annually under the MHA because there are several data sources, and differences in the numbers reported. This also makes it difficult to identify any trends or changes over time.
The MHA specifies that CYP admitted to hospital should be accommodated in an environment that is suitable for their age. However, a shortage of specialist inpatient beds has contributed to CYP being detained in inappropriate settings, such as adult or general paediatric wards. In addition, CYP are more likely than adults to be admitted to an inpatient unit outside their local area.
Potential impact of the MHA reforms on children and young people
- New detention criteria to reduce the use of the MHA
- Removing autism and learning disabilities as a reason for detention under section 3. This is something charities such as the National Autistic Society have been campaigning for
- A new duty for professionals to consider explicitly the patient’s wishes and feelings
- The ability for the patient to choose a ‘Nominated Person’
- Extending the statutory right to advocacy
Many experts argue that realising benefits proposed through MHA reform will require improving access to, and experience of, CYP’s mental health services. This would include significant investment in community services, more joint working between health, social care and education, an expansion and training of the mental health workforce and reduced waiting times.
