About the Mental Health Act & being detained under it
(the legal bit )

The Mental Health Act 2001

The Mental Health Act is the law that relates to mental health care and treatment in Ireland. It applies both to adults (aged 18 and over) and young people.

There are some specific bits of the Act that only apply to young people although these bits are mostly relevant to you only if you have been diagnosed with a mental disorder. It sets down what must and mustn’t happen if someone is diagnosed as having a mental disorder.

There is also a Code of Practice that sets out what should happen if a young person is admitted to hospital. The Code of Practice is not something that doctors and your team must follow, but they must have a very good reason not to.

The Act is set out in sections that deal with specific things, and these sections are numbered. So, for example, Section 3 sets out what is meant by a mental disorder.

What do they mean when they talk about a mental disorder?

This is when you have:

A mental illness

– this is a state of mind which affects the person’s thinking, perceiving, emotions or judgement to the extent that they require care or medical treatment in their own interest or in the interest of other people. Examples of this may be when a person is very depressed or anxious to a point that makes them think, behave and feel so differently from what is usual that it causes others to be so concerned for their welfare and those around them that medical treatment is thought to be necessary.

OR

Severe dementia

– this usually involves some physical changes in the brain that badly effects a persons ability to think, remember and understand things. It only really happens to older adults.

OR

Significant intellectual disability

– this is where a person’s mind does not fully develop and the problems with their mind affects them to such a degree that they struggle to get on with other people and do things that may be considered to be very reckless or possibly harmful to themselves or others.

AND

- A doctor must also have concerns that because of the mental illness, disability or dementia, there is a serious likelihood that you may cause immediate and serious harm to yourself or to other persons or your ability to think and act sensibly is so impaired that if you are not admitted to hospital it would be likely to lead to your condition getting much worse or unless you were in hospital you could not be given the right treatment, and it is likely that if you went into hospital your condition would get much better.

In the previous text some of the key words are ‘serious’, ‘severe’, and ‘significant’. So if you have a mild bout of depression (a few days of feeling very low) or if you have a slight learning disability it is very unlikely you will be detained under the Mental Health Act. It is only when you begin to get really unwell, or people feel that you could do something, because of your mental state, that might harm you or someone else that professionals will start to consider whether it may be in your best interests to be detained under the Act.

It is worth knowing that very few young people are detained in hospital. Even if you are detained, you still have a lot of the rights (as described earlier in the toolkit).

Section 4 says that all decisions around care and treatment (including being detained) must be made in the person’s best interests. It also says a person must be consulted about any proposal to give treatment, and it says that a person’s rights must be respected.

Section 23 sets out what has to happen if as a voluntary patient you try to leave hospital, or your parent tries to discharge you, but the doctor or nurse considers you should stay in hospital because you have a mental disorder.

Section 25 is a very important section as it talks about what must happen for a young person to be detained under the Act. It states that if a young person is thought to be suffering from a mental disorder and needs treatment in hospital that they’re unlikely to get if an order is not made, then the Health Service Executive may go to the District Court and ask for an order allowing them to detain the young person.

However, the young person must have been examined by a consultant psychiatrist who has diagnosed that the young person has a mental disorder, unless there are good reasons why that cannot be done. In the situation where a young person’s parents do not allow the psychiatrist to carry out an examination, but there is a reasonable cause to believe that the young person has a mental disorder, the Court may authorise the consultant psychiatrist to carry out an examination, and go back to the Court if he or she is satisfied that the young person does indeed have a mental disorder. The young person may be detained whilst this examination is done and whilst the Court is considering the results of the examination.

If, after receiving the consultant psychiatrist’s report, the Court is satisfied that the young person has a mental disorder and needs to be in hospital to be treated, it can then order that the young person is detained for up to 21 days. This does not mean that the young person must be detained for 21 days, only that they cannot be detained for longer than that without going back to Court.

If the Court does order a further period of detention then it can only be for a specific period up to a maximum of 3 months but it does not have to be for the full 3 months. For example, the consultant psychiatrist may ask the Court to detain you for a further 14 days. Any further authorisation will be for specific periods up to a maximum of 6 months.

The Court must have considered the welfare of the young person as the most important factor when making a decision about whether a young person should be detained or not. The Court must also try to take the young person’s wishes into consideration.

While I’m detained in hospital does that mean I must stay there until I’m discharged?

No.

Section 26 gives your doctor the right to allow you to leave hospital for a specified period. This may be for an hour or a few days. It depends on how well you are, and whether the doctor thinks it would be good for you to spend some time away from the unit. This permission has to be in writing and can only be given by the doctor in charge of your care.

The doctor might put some conditions on the permission to leave the unit. This might be that you can only go out accompanied by a member of staff or your family or only go to certain places.