title: A critical review of patients under Section 5(2) of the Mental Health Act of 1983.
abstract: BACKGROUND
  Patients who suffer from mental illness within the definition of the Mental Health Act of 1983 and present a risk to themselves, to other people or at risk of self neglect or deterioration, can be detained under section. Section 5(2) applies for patients who are already admitted to hospital and express their wish to leave against medical advice. It requires the recommendation of one medical practitioner. It gives the power to detain them for 72 hours in hospital for further assessment. To safeguard malpractice of this section, trusts have developed policies and procedures which define good medical practice within the legal framework of the MHA 1983.
  
  
  OBJECTIVE
  To evaluate current medical practice and insure that it complies with trust's policies and procedures and applies good medical practice.
  
  
  METHODS
  Medical case notes of patients admitted from 1.1.07-30.6.07 and were detained under Section 5(2) were reviewed. A special form was devised to collect information from the notes. It included age, sex, marital status, occupation, diagnosis, history of violence, history of drug and alcohol abuse and circumstances of their detention were obtained.
  
  
  RESULTS
  44 patients were identified. 40% were men, 65% above the age of 50 years; 52% were sectioned after hours or at the weekends. Measures to persuade patients to stay as informal patients were taken by 16%. 55% were sectioned by the on-call doctor. 68.5% exhibited threatening behaviour. 30% had self neglect, 13% were a risk to others, 26% had a deliberate self harm risk. 60% had moderate to severe suicidal risk and ideation. 68% did not have mental health capacity to give consent for admission. 60% had been assessed in the first 24 hours of their section. 60% were converted to Section 2,3 of the Mental Health Act. 25% stayed as informal patients and 7% were discharged.
  
  
  CONCLUSIONS
  Female patients were more likely to be put on Section 5(2), which was against expectation. Older people were more likely to be put on section 5(2), which was again against expectation. Majority of patients were a risk to themselves and only 13% were a risk to other people. Nearly two-thirds were assessed within 24 hrs from the section, which we commend our services on. 60% needed to be transferred to different sections which indicates that 40% of the sample could have been managed more efficiently without warranting section 5(2).
  
  
  CONCLUSIONS
  Section 5(2) is a useful legal framework when it is used efficiently. This study has shown that current clinical practice could be improved by applying the least restrictive measures by giving patients more choice and empowering them in clinical decision making.
authors.affiliation: Mental Health Unit, Basildon Hospital, Basildon, Essex SS16 5NL, UK, hellme.najim@sept.nhs.uk.
authors.forename: Hellme
authors.initials: H
authors.lastname: Najim
authors.forename: Raja
authors.initials: R
authors.lastname: Shaik
mesh_terms: D000328:Adult; D000367:Age Factors; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D010351:Patient Discharge / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012737:Sex Factors