High rate of Section 4 admissions: clinical implications and possible explanation

Abstract

The Mental Health Commissioners recommend that whenever possible two doctors should be involved in the decision to admit a patient to hospital under the Mental Health Act (1983). That is, Sections 2 and 3 of the Act should always be used in preference to Section 4, where only one doctor is required. It further recommends that the use of Section 4 should be confined to emergencies when it is only possible to secure the attendance of one doctor.

Emergency admissions for assessment at All Saints Hospital

“…The small (0.54) percentage of admissions under the emergency order compares well with all other pub lished studies, which report rates of 0.8-1.6%, and our figure of 2.63% of all sections is many times lower than any other study (7.54-30% Winterson & Barraclough, 1984,1985Webster et al, 1987;Puri & Bermingham, 1990).This can readily be explained by the nature of our catchment area. ASH is an inner city psychiatric hospital and as a consequence has a substantial population of chronically ill patients who, typically, relapse with limited insight and re quire enforced treatment or supervision in hospital.…”