What is the difference between a ‘mental health assessment’, a ‘Mental Health Act assessment’ and an assessment conducted after use of s135 or s136 of the Mental Health Act 1983? – there are differences between these three things and a risk of confusion if professionals use these terms interchangeably or inaccurately, as recently did happen!
Here’s the summary of the three –
- Mental health assessment – this is an informal assessment of mental health by a clinician. Could be a force medical examiner in police custody; it could by Community Psychiatric Nurse (CPN) from a Community Mental Health Team (CMHT) visiting a person in their home; it could by members of the MH CrisisTeam in response to an out-of-hours call. It could also be something that police officers think paramedics can do! The purpose behind a generic assessment of someone’s mental health will vary from case to case: it could be a part of routine care planning; it could be a necessary precursor to formal assessment under one of the two mechanisms below.
- Section 135/6 assessment – This is a statutory process of assessment undertaken jointly by an Approved Mental Health Professional (AMHP) and a Registered Medical Practioner (RMP) whilst someone is in a place of safety having been detained by the police. This process is intended to identify whether someone may be suffering from a mental disorder, whether there are any unmet mental health or social care needs arising from it and / or whether or not someone may need to be fully assessed for admission under the Mental Health Act. It is good practice, but not a strict requirement, that the RMP in the assessment is “section 12 approved” – this means “having special experience in the diagnosis or treatment of mental disorder”.
- Mental Health Act assessment – this is the formal process of considering whether or not a person may need to be admitted to hospital under the Mental Health Act. The process will usually involved an AMHP, and two RMPs one of whom MUST be “section 12 approved”. Following assessment, they have the option of admitting the patient to hospital under the MHA, under section 2 or section 3 of the Act, or on a voluntary basis; OR they may refer the ongoing care of the person to a community-based mental health team or to their GP. In urgent circumstances the AMHP and one “section 12” RMP can apply for admission to hospital under section 4 of the Act but only where waiting for the second RMP would present ongoing risk because of the inaction.
WHAT DOES THIS MEAN?
It means it’s important to be clear, both in understanding and in communication.
Some believe police use of s136 of the Mental Health Act leads to a ‘full’ Mental Health Act assessment for consideration of admission to hospital. This is not correct, strictly speaking – it can lead to that, eventually but it’s not a requirement of s136 itself. Where the power has been used, it must lead to assessment of the person and s136(2) outlines the assessment is conducted by the AMHP and a doctor and “making any necessary arrangements for his [sic] treatment or care.” Given AMHPs and one doctor cannot, on their own, ‘section’ someone then the assessment they are doing cannot be a ‘full’ Mental Health Act assessment to determine whether someone should be admitted to hospital under s2 or s3 MHA. The s136 assessment is to determine what arrangements are necessary and the answer to that may be “full Mental Health Act assessment” or “referral to a community mental health team”, etc.. So if the AMHP and doctor take the view the person may need to be ‘sectioned’, they can call upon a second doctor who would complete their ability as a group of three to section someone – but this doesn’t mean the initial assessment under s136 MHA is a MHA assessment from the start.
They are different things, even though the one can lead to other and most people detained under section 136 do not go on to be ‘sectioned’, hence it would be rather wasteful and unnecessary to routinely bring two doctors to a Place of Safety for every assessment. That said, where an AMHP has undertaken background checks ahead of the assessment, they may realise ‘full’ MHA assessment would be necessary from the start. This could be because the person detained had been seen at home by their community team in the past few days and a ‘full’ assessment requested because of emerging concerns. Nothing prevents the AMHP arranging a ‘full’ assessment if specifics make it justified, but it’s not a statutory requirement for s136 itself and s136 assessment and MHA assessment remain two different things, for two different purposes.
In just the same way,, a generic ‘mental health assessment’ can morph in to something else, including a Mental Health Act assessment. The fact these three things are distinct kinds of assessments does not mean one cannot lead to the other and that there are no overlaps to be noticed, on occasion.
WHY DOES THIS MATTER?
In one example I recall, the police arrested a man who had gone missing, after it had been alleged he committed serious offences. Upon finding him, he was arrested and suspected he had ingested a potential overdose so he was taken to an Emergency Department where he spent time being assessed and treated for that. Eventually, he was deemed to have completed the treatment and was fit for discharge where, because of his arrest, he would be taken to the police station for ongoing investigation of the allegations. Doctors said, “but he needs a mental health assessment”.
So what are we saying he needs, precisely?
It can’t be a s135/136 assessment, because he simply isn’t detained under either of those provisions. If he just needs some kind of generic assessment to better understand his mental health, then nothing prevents this happening in the Emergency Department as part of his care, prior to discharge. Indeed, NICE guidelines suggest all of us who self-injure and present to ED in similar ways should receive a mental health assessment, not least to determine whether ongoing mental health support is required after leaving. Some areas have difficulty complying with this, for various reasons, but it remains a requirement of national guidelines nonetheless.
But could they mean he needs a Mental Health Act assessment? Well, yes – they could mean that, but it’s not what they said. They used the term “mental health assessment”. Whilst nothing prevents a MHA assessment being organised in ED for someone there, it wouldn’t normally be completed until ED had completed the patient’s treatment and if the person has completed their treatment and they are under arrest for serious allegations, nothing prevents that occurring in police custody, either. So where should it occur? – on one level it doesn’t really matter because there is no legal barrier to MHA assessment in police custody, regardless of the “place of safety” rules which are entirely irrelevant to someone under arrest for a criminal allegation. I’ve also got some sympathy for the idea that ED should not be accommodating MHA assessments for arrested criminals who no longer require ED care, but ultimately some MHA assessments do occur there, for various reasons.
The point here is just to be clear about what people are talking about when they say ‘mental health assessment’ or ‘Mental Health Act assessment’ –
- A section 135 or section 136 assessment is not a Mental Health Act assessment – although it can lead to one, if required.
- A ‘mental health assessment’ is not a Mental Health Act assessment, either – although it can also lead to one, if required.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2023
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 