Dementia, 'sectioning' and The Mental Health Act 1983 - Alzheimer's Society podcast October 2015

This Alzheimer's Society podcast looks at what is known as 'sectioning', or the process that happens when health professionals think that a person with dementia is behaving in a way that places their health at risk or is a danger to themselves or others - they can be detained in hospital under section 2 of the Mental Health Act so that they can be assessed. This process is often known as ‘sectioning’ or 'being sectioned' and is often a challenging time for the person with dementia and their families. As the term sectioning often has negative connotations in this podcast we will be referring to the process of placing someone under a section of the Mental Health Act.
In this edition of the podcast Hannah speaks to Helpline Adviser Emma about the Mental Health Act, guardianship and after-care services.
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The term 'dementia' is used to describe the symptoms that occur when the brain is affected by specific diseases and conditions. Symptoms of dementia include loss of memory, confusion and problems with speech and understanding.
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[@mikeymarmalade]

This was explained well. Some people may be detained on a section 3 without using a 2 which wasn't mentioned. Section 117 applies to all the treatment sections and not just 3. You said s117 was "kind of the responsibility" of health and council but it "is" their responsibility!

[@alzheimerssociety]

+mikeymarmalade Thank you for your comments.
It is very true that some people may be detained on a section 3 straightaway without proceeding through a section 2, but this is quite rare. Also, this tends not to be the case for people living with dementia, which is why we didn’t think to include it.
Aftercare under section 117 is as you say, available to someone held under a variety sections of the Mental Health Act (37, 45A, 47, 48 & 32), but the sections that are mostly relevant to people living with dementia are sections 2 & 3, which is where we chose to focus the podcast.
As you mention, it would have been more accurate to emphasise that aftercare under section 117 is indeed the responsibility of the local authority and CCG.
If you would like further information please take a look at our Mental Health Act factsheet www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=117
or if you have further questions please contact our Helpline www.alzheimers.org.uk/site/scripts/documents.php?categoryID=200365 and we will be happy to speak to you about these.

[@SalWasler]

This is really well explained. Just a few minor inaccuracies (please forgive my pedantry!) - as mikeymarmelade states, a person can be detained straight onto a section 3 for treatment in some cases. This only applies when there is a well established treatment plan already in place. Also, you stated that the nearest relative must always be consulted before a section can be applied and that the nearest relative can stop the section going ahead. This is only the case for a section 3. If placing someone under a section 2, the nearest relative will be notified but has no power to stop the application going ahead. With regards to the 2 medical practitioners involved in the process, you stated that one of the doctors MUST be someone who knows the person. This is not strictly true. All efforts are made to involve a doctor who knows the person but in some circumstances it is not possible in the given time frame and 2 doctors without any prior acquaintance with the person will do the assessment. You also said that someone may want to be assigned as nearest relative - to clarify, there is no MAY, they ARE assigned, according to the list you outlined.

[@alzheimerssociety]

+Sal Wasler Thank you for your comments.
As noted above, a person may be detained under section 3 of the MHA straight away, but we tend not to see this in relation to people living with dementia. Perhaps because, as you mention next, this only applies when there is a well-established treatment plan already in place. Dementia is such an individual condition; that the treatment plan will often vary from person to person in line with their unique collection of symptoms, so treatment plans tend to be very individual.
With regards the rights of a nearest relative, our meaning here was that a nearest relative may have different powers under different sections of the MHA, but that they should always be informexd as to the decisions of the clinical team. This means that even if a person is held under section 2, the nearest relative can disagree and appeal the use of a section of the MHA. If a person is held under section 3, it is true that the nearest relative has stronger powers, as they can put a stop to the section and apply for a person’s discharge.
With regards the medical practitioners and AMHP instigating the process of detaining someone under section, it would have been more accurate to state that ‘as far as possible it should be an medical practitioner who knows the person’.
With your final point, it is true that a nearest relative will be assigned from the list of proximal relations, rather than that they ‘may’ be assigned.
If you would like further information please take a look at our Mental Health Act factsheet www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=117
or if you have further questions please contact our Helpline www.alzheimers.org.uk/site/scripts/documents.php?categoryID=200365 and we will be happy to speak to you about these.