Section 5(4) of the Mental Health Act 1983: a review of local policy and guidance in England and Wales

Published date14 March 2016
Date14 March 2016
AuthorRussell Ashmore,Neil Carver
Section 5(4) of the Mental Health
Act 1983: a review of local policy and
guidance in England and Wales
Russell Ashmore and Neil Carver
Russell Ashmore and
Neil Carver are Senior Lecturers
(Mental Health Nursing) at the
Department of Nursing and
Midwifery, Sheffield Hallam
University, Sheffield, UK.
Purpose The purpose of this paper is to review policy or guidance on the implementation of Section 5(4)
written by NHS mental health trusts in England and health boards in Wales.
Design/methodology/approach A Freedom of Information request was submitted to all trusts in England
(n ¼57) and health boards in Wales (n¼7) asking them to provide a copy of any policy or guidance on the
implementation of Section 5(4). Documents were analysed using content analysis. Specific attention was
given to any deviations from the national Mental Health Act Codes of Practice.
Findings In total, 41 (67.2 per cent) organisations had a policy on the implementation of Section 5(4). There
was a high level of consistency between local guidance and the Mental Health Act Codes of Practice. There
were however; different interpretations of the guidance and errors that could lead to misuse of the section.
Some policies contained useful guidance that could be adopted by future versions of the national Codes
of Practice.
Research limitations/implications The research has demonstrated the value of examining the
relationship between national and local guidance. Further research should be undertaken on the frequency
and reasons for any reuse of the section.
Practical implications Greater attention should be given to considering the necessity of local policy, given
the existence of national Codes of Practice.
Originality/value This is the only research examining the policy framework for the implementation
of Section 5(4).
Keywords Best practice, Mental Health Act, Policy, In-patient, Nursesholding power, Section 5(4)
Paper type Research paper
In England and Wales the Mental Health Act 1983 (hereafter the Act) (Department of
Health (DH), 2007) is the legislative framework governing the admission, detention
and treatment of people with a mental disorder. The Health and Social Care
Information Centre (2014) reported that in the period 2013-2014 the Act was used
53,176 times to detain people in hospital. In 34,806 of cases, detentions were made on
admission to hospital. In a further 14,087 of cases detentions were made following informal
admission to hospital. A person who is admitted to hospital informally is; Someone who
is being treated for a mental disorder and is not detained under the Act(Department of
Health (DH), 2008a, p. 361). The term patientis used throughout t he Act and this usage is
followed in this paper .I t does not imply it is preferred to other ter ms, for example service user
or client.
Received 21 May 2015
Revised 3 July 2015
Accepted 22 July 2015
The authors would like to
acknowledge Richard Jones
(Consultant for and behalf of Blake
Morgan, Cardiff and Honorary
Professor of Law at Cardiff
University) and Mat Kinton,
National Mental Health Act Policy
Adviser, Care Quality Commission
for their responses to the queries.
DOI 10.1108/MHRJ-05-2015-0017 VOL. 21 NO. 1 2016, pp. 37-47, © Emerald Group Publishing Limited, ISSN 1361-9322
PAG E 37

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