The use of section 5(2) of the Mental Health Act 1983: an audit

Section 5(2) of the Mental Health Act 1983 (MHA) deals with the compulsory detainment of a mentally unwell inpatient in hospital for a period of 72 hours. During this time the Responsible Medical Officer (RMO) must review the patient and either increase the duration of compulsory stay by converting it to a section 2/section 3, or discharge the patient if appropriate or make the patient's stay informal. Section 5(2) can be implemented by either the RMO or his deputy (duty doctor). An audit of the use of section 5(2) MHA within a psychiatric hospital was carried out between October 2000 and September 2001. The medical case notes of those patients identified were used to obtain data on patient demographics, date of implementation of section 5(2), date of reassessment after section 5(2) and outcome of the assessment. We also looked at reasons for the use of section 5(2), and the documentation standards. Section 5(2) was implemented 55 times during this period. Nearly 83% of cases were in the age group 21 to 60 years. Most were implemented out of working hours. Seventy-five per cent of the patients were assessed within the next 48 hours by the RMO. Forty-one per cent of the patients who were placed under 5(2) were re-graded to informal, 32% were put under section 3 of MHA and 27% placed under section 2 of MHA. When compared with similar studies, this study showed a higher conversion rate from section 5(2) to section 2/3 suggesting that section 5(2) may have been used appropriately (Table I). Many current areas of practice do not meet with standards recommended by the Code of Practice as suggested in a cross sectional survey on the use of section 5(2) (Jacob and Freer, 2005). Higher conversion rates of section 5(2) to a further section may indicate appropriate use of Section 5(2), and also increasing psychiatric inpatient morbidity.