Depression Treatment: Psychiatric Hospitalization
Hospital treatment
Depressive illness as we have seen is common and very varied in its severity. Sometimes hospital admission is necessary either because the ill person is unable to care for themselves and risks serious physical harm by self-neglect, or there is a risk of harm by suicide.
The majority of people who are admitted to hospital with depressive illness are admitted with their total agreement. Occasionally, depressive illness may need to be treated in hospital without consent, and they are admitted under the auspices of the Mental Health Act compulsorily. The decision is never taken lightly, and has to be made by three professionals (two doctorsand a social worker) who all agree that this step needs to be taken in the overall best interests of the person who is ill.
Quite often, after treatment has been instigated, and the person has improved enough to be able to cooperate, their status within the hospital is changed from a detained, to a voluntary patient. The length of time people need to stay in the hospital for the treatment of depression has steadily decreased over the past years. Many people who are in hospital initially, have treatment continued as a day patient (going home each day after treatment).
The step from being an inpatient to managing outside hospital can be much easier if this intermediate stage is available.
Once day care has been completed there may then be outpatient appointments that continue at lengthening intervals as progress is made.
Compulsory treatment of someone with depression
What is a Section procedure?
Most people with depression are usually treated successfully as outpatients by their doctors or by their psychiatrists. A minority of people with depression will become so unwell that they may be at risk of coming to harm from self-neglect or harming themselves.
They may be totally unwilling to go into hospital voluntarily. Under these circumstances the Mental Health Act exists to observe and treat someone with severe mental illness in hospital. The Act states that when someone is a risk to their own health or safety, or to other people because of a mental illness, they may be taken to hospital. Different ‘Sections’ of the Act refer to different circumstances, hence the term Section.
Mental Health Act procedures are only carried out as a last resort. Even very unwell people can often realise and understand that they are ill and that they should cooperate with the treatment that they are being offered. However, sometimes people with depression or other mental illnesses lose their insight to such anextent that they cannot understand that their wishes to harm themselves are irrational and should not be acted upon.
When this happens, the Act may be used. The procedure involves two doctors and an Approved Social Worker. One of the doctors should preferably have known the patient in the past (such as their doctors), and the other will have had a specialist training in psychiatry. An Approved Social Worker is there to represent the patient and family. The three individuals involved need to agree that someone is first mentally ill, and secondly in some way a risk to themselves or to other people because of their illness.
The two doctors and the social worker will usually meet at the person’s home (although the procedure can also be done elsewhere, such as in a casualty department or a police station). A mental state examination is carried out and, if the doctors and social workers agree, the legal forms are completed. Usually the patient will then be escorted to hospital by an ambulance crew and the Approved Social Worker. If there is risk of harm, then the police may be asked to provide an escort.
Section 2 of the Mental Health Act applies for 28 days (for assessment) and Section 3 of the Act applies for up to 6 months (for treatment.) Other sections of the Act can be used by the police or in hospitals.
People who are detained under the Mental Health Act are entitled to appeal to a tribunal for the Section to be discharged. Details of the appeal procedure are given to all people who have been detained under a Section of the Mental Health Act. People may be allowed home on leave while still under a Section of the Mental Health Act, once they start to improve.
Can the police take you away if you’re behaving strangely?
One of my neighbours sometimes acts in a very disturbed way in his back garden, and I’m worried that she will upset my children.
An Englishman’s home is his castle and, just because someone’s very odd, peculiar or eccentric, that doesn’t necessarily mean that they are ill, or that we can intervene in their lives, howeverhelpfully concerned we are. Someone may be quite unwell mentally but, as long as there is no risk, the health and Social Services have no statutory ability to treat them. Someone who is aggressive or even violent will not come under this Act, unless they are also ill mentally.
You can discuss your concerns with your neighbour’s doctor if you know the practice, with the local Social Services Department (contact the Emergency Desk if there seems to be a crisis) or, in an emergency, contact the police.
If someone does appear to be very disturbed in a public place, the police do have powers under the Mental Health Act to take them to a Place of Safety, usually a police station, or perhaps an Accident and Emergency Department. This is known as a Section 136 procedure.
My uncle has diabetes and really bad circulation, and the doctors say he needs surgery or he may lose his foot. He refuses to consider this. We know he’s going to go downhill if he doesn’t have this done. Can he be made to have his operation?
If he refuses, we fear the worst. No, he cannot. Medical or surgical treatment cannot be given to people against their will, however much we feel that they need it. After all, it is his health and nobody else’s. If someone is unconscious or so ill that they cannot voice an opinion, then doctors do have to make treatment decisions for people. This may be based on Common Law (and common sense). However, if your uncle is well enough to voice an opinion about his treatment, in general we have to respect his wishes, however wrongheaded we may feel he is being. The Mental Health Act can’t help us in these circumstances; it applies only to people who are mentally ill, and is for treatment of their mental illness, not physical illness.
In this sort of situation people are often scared of what’s happening to them. Rather than a head-on confrontation, you’ll get further with him by being patient and accepting how frightened he must feel. Once this is accepted and recognised, he may be able to start to think about what is the best thing to do.
If my husband is sectioned under the Mental Health Act, have I got to sign any papers?
No. The Approved Social Worker (ASW), together with the doctor and the psychiatrist will complete the paperwork without your needing to be responsible for signing anything. ASWs are very respectful of relatives’ concerns about not being put in the position of being part of a Section procedure, which could perhaps cause resentment later.
Most people who are detained compulsorily under a Section procedure usually appreciate afterwards, when they are better, that they were pretty unwell at the time, that their lives had gone well out of control, and that those involved had acted to protect their health, with their best interests at heart.
