Background

Patients in hospital under the Act may be described as 'detained' or 'sectioned'. The general aims of the Act are as follows:

• to provide appropriate care for the mentally disordered

• to safeguard those who are not mentally disordered against wrongful detention.

Informed use of this legislation should achieve the best possible compromise between preserving freedom and human rights, on the one hand, and protecting both patients and society, on the other hand. The Act gives no authority over those who do not suffer from mental disorder. It cannot be used to enforce treatment for physical illness, unless the physical illness is believed to be causing mental disorder. In a life-threatening situation, emergency treatment may be enforced under common law without applying the Act first.

The following summary applies to the legislation for England and Wales. Other countries have separate legislation. The Act is applied in the light of an official code of practice that gives helpful practical guidance on many of the clinical dilemmas which arise.

The Act uses the following four broad diagnostic categories of mental disorder:

• mental illness, which it does not define

• severe mental impairment: a state of arrested or incomplete development of mind that includes significant impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct

• mental impairment: as above, with the addition of the phrase, 'not amounting to severe mental impairment'

• psychopathic disorder: persistent disorder or disability of mind (whether or not including significant impairment of intelligence) that results in abnormally aggressive or seriously irresponsible conduct.

Antisocial or immoral conduct, sexual deviancy, and misuse of alcohol or drugs are explicitly excluded as grounds for detention (in contrast to the bad old days, when, for example, young women who had illegitimate children were sometimes detained on the spurious grounds of 'moral insanity'). However, mental disorders caused by substance misuse, such as alcoholic hallucinosis and amphetamine psychosis, are covered by the Act in the usual way.

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