Most mental health treatments that people receive in hospital happen on a voluntary basis. People usually agree to be in the hospital and have consented to their treatment. However, when people are very ill (e.g. there are serious concerns about their safety, or the safety of others) they can be held in hospital and given compulsory treatment there, whether or not they agree to it. In 2014/15 figure by the Care Quality Commission shows that 51% of mental health inpatients were held under a section of the Mental Health Act (sometimes called being ‘sectioned’). This page is about the people who spoke to us about their own experiences of compulsory detention and/or treatments.
People can be detained under a section of the Mental Health Act 1983 to allow medical staff to examine, assess and treat them. Even people who are voluntarily in hospital can later be detained there for further treatment without their consent if they are sectioned under the Mental Health Act. Medical professionals must usually consult with a range of professionals and a person’s nearest relative before sectioning a person, but that relative cannot always prevent their loved one being sectioned although they can challenge it at a Mental Health Tribunal. The Mental Health Act sets out when it is legal to detain and treat someone, who is authorised to do it, and what procedures should be followed. The Mental Health Act is a complex legal framework that varies between specific countries in the UK.
People are sectioned for a certain length of time, and can be ‘de-sectioned’. An assessment about whether to section someone is made based on their condition at that time. For example although Jenny wasn’t sectioned the first time she was admitted to hospital (a time when she had ECT), she was sectioned on subsequent admissions.
At the time when they were being considered for ‘sectioning’, some people knew what was happening around them, but others were too unwell to really understand. In these circumstances it was sometimes family members who most clearly remembered what the sectioning involved. Yvonne was asked if she wanted to go to the hospital for a weekend’s assessment and thought it would be somewhere to rest, like a spa. She was sectioned at the end of the weekend, and says her ‘brain had just completely shut down’ because it couldn’t cope with how she was feeling.
Catherine Z was having hallucinations and doesn’t have much recollection of being forced into an ambulance and pinned down. Her notes say she was violent and so ill she couldn’t be assessed.
Suzanne explains that when she was in hospital under a Section, she was too unwell to understand what was happening. She only realised shed been sectioned when she was de-sectioned.
Most remembered going to see a doctor and being admitted to hospital where an assessment was made. Many were relieved that there was some help available for their problems.
After Carys’s daughter was diagnosed with schizophrenia twenty years ago she was sectioned several times. On one occasion several police cars came to collect her.
Some people told us they were given the option of going into hospital voluntarily. Jane and Kathleen spoke about going in to hospital a few years ago on a voluntarily basis when they knew that being ‘sectioned’ was a possibility. Others who had been to hospital on a voluntary basis a long time ago recalled feeling threatened with a section if they tried to leave. Over twenty years ago when Tracy was a nurse she was admitted to the psychiatry department in the same group of hospitals she worked in. She wasn’t sectioned but she recalled being told that if she left the ward they would section her, even though this would not have been lawful.
David Y’s wife was a voluntary patient who was threatened with a section in the early 1990s if she left the ward. He now knows this should not have happened.
ECT and Compulsory treatment
ECT is not usually given without consent. Even if someone is detained in hospital under a section of the Mental Health Act, they can still refuse ECT most of the time. However, ECT can be given without consent in serious circumstances. This can happen for example if it is an emergency e.g. it could be life saving, or if a doctor assesses that a person is not able to make a decision for themselves. If a doctor judges that someone is too ill to make a decision about whether to have ECT, another doctor or ‘SOAD’ – Second Opinion Appointed Doctor – also needs to agree that ECT is necessary.
While many of the people we spoke to had not experienced ECT as a compulsory treatment, many people felt under some pressure to agree to ECT, or were unsure whether they could be made to undergo ECT if they refused it (see ‘Deciding whether to have ECT’). Some felt if they refused ECT they might be sectioned and given the treatment without their consent. When Beattie had ECT in 1975 she said they sort of ‘nagged’ her and she eventually agreed. When Albert had ECT in 1960, he describes being made to sign a form to consent otherwise he would be given the treatment under section. While practices have changed over time, people could still feel under pressure to agree.
Matt said although his wife seemed to think they could force her to have ECT a few years ago, that wasn’t his impression. But ultimately she was very ill and she reluctantly agreed.
Tania was in a private hospital when a doctor first recommended she should have ECT twenty years ago. Although she was a voluntary patient she signed because she thought she would be sectioned if she didn’t agree.
Many of those who had been given ECT without their consent didn’t like undergoing compulsory treatment or detention (one patient talked of doctors ‘slapping different sections on [them]’). They felt that they had lost control over what was happening to them.
Sue had been abused as a child and felt giving her ECT without her consent was wrong. To her, the ECT procedure compounded her childhood experience.
Some felt unhappy when family members consented (through power of attorney) to ECT for them or were consulted, and agreed to ECT, when they didn’t want to have it. When her husband agreed to her having ECT, Sue felt the decision was taken out of her control and blamed him: ‘at the time, I felt like even the closest thing [in] my life, my husband, has put me in this position’. Resentment could be particularly strong if family members were distant.
Yvonne didn’t want ECT and kept running away from hospital. Her estranged mother gave consent for her to have it, but Yvonne felt she shouldn’t have had a say.
Relatives were not always consulted as to whether someone had ECT. Especially where people had had ECT a long time ago, some carers spoke to us about wanting to have a say, but finding their opinion was treated as unimportant. Twenty years ago, Carys could do nothing about her adult daughter receiving ECT, even when she thought it was an ineffective treatment for her.
In hindsight some people accepted it had been necessary for them to have ECT, although they had been too distressed and unwell to consent at the time. Yvonne said twenty years on she realised ECT probably saved her life (see for more ‘Messages to others‘). As ECT is one of the only effective treatments available for when she is severely unwell, Suzanne has now written an ‘advance statement’ stating that if she is very unwell in the future, she should have ECT.
Tania now has an advance statement. She feels reassured that ECT can be carried out involuntarily when she is very unwell.
For others, ECT was not a procedure they wanted to have again and they have written an advanced statement to that effect. Yet some said they were concerned that ECT might be given to them in the future regardless of their wishes.
Sue feels being sectioned strips you really of any power. Shes asked not to have ECT in future but feels her wishes will be railroaded.
If you are clear you do not wish to receive ECT even if your life is in danger and you have already made a valid and applicable advance decision refusing ECT, or your attorney under a Lasting Power of Attorney, or a court-appointed deputy, or a Court has refused ECT on your behalf, then the ECT should not be given to you (MIND June 2016)