The Nurse's Holding power: patterns of use in mental health

Abstract

Implementation of the nurse's holding power (Section 5(4) of the Mental Health Act 1983) is an important, yet poorly researched aspect of mental health nursing practice. Data collected from the Mental Health Act records of all patients detained under Section 5(4) in one trust from 1983 to 1997 suggest that detainees generally came from the acute mental health services, were female, were detained by male registered mental nurses and were held for an average of 2 hours and 24 minutes before being placed on another section of the Mental Health Act. The use of Section 5(4) seems to be influenced by the time of day, but not the day of the week, or month of the year. Peaks of Section 5(4) usage corresponded to such factors as the changeover of shifts, the absence of medical staff, visiting time and medicine rounds. The importance of these findings for clinical practice is discussed.

Section 5(4) (The nurse's holding power): patterns of use in one mental health trust (1983-2006)

“…Attempts to explore the holding power in more detail have focused on a number of areas including: nurses' attitudes and opinions of the holding power (Hussain & Varadaraj 1983, Dimond 1989, Carver & Ashmore 2000); nurses' knowledge of the section (Ward 1991, Ashmore 1992a, 1998a); and the ethical implications of de facto detentions (Ashmore & Carver 2000). However, the majority of papers have reported on attempts to identify the factors associated with the implementation of the section (for example see Ashmore 1992b, 1998b, Lovell et al. 1998, and Shivram 2006); the main findings are summarized below.…”

“…For example, Lovell et al. (1998) have reported an average of 1.8 applications per annum and Ashmore (1998b) a figure of 38.1 per annum. The majority of holding powers are applied in acute adult inpatient settings with the remainder distributed across a range of clinical services including: rehabilitation services, care of the older adult, liaison, forensic and intensive care services (Ashmore 1998b, Shivram 2006).…”

“…An increase in the application of the holding power has been associated with: nurses undertaking clinical activities, for example attending multi‐professional team meetings, writing nursing notes and dispensing medication; the changeover of nursing shifts; visiting times; and the absence of medical staff. There are few applications of Section 5(4) during the night and a number of papers suggest this may be because patients are more likely to be sleeping during this period, therefore allowing nurses to dedicate their time to those patients who require more attention (Ashmore 1992b, 1998b, Lovell et al. 1998, Shivram 2006).…”

“…With the exception of Lovell et al. (1998), all studies (Ashmore 1992b, 1995, 1998b, Salib 1998, Pym et al. 1999, Ajetunmobi 2001, Shivram 2006) report that more female patients (range 44–61.7%) than male patients (range 38.3–56%) are detained under the holding power.…”

Advanced ‘prescribing’ of nurses’ emergency holding powers under New Zealand mental health legislation

“…Most of the located literature focused on an analysis of the use of Section 5(4) of the Mental Health Act 1983 in England and Wales. This Section of the legislation gives registered nurses holding powers similar to that of Section 111 in the New Zealand legislation (Ashmore 1992; Ashmore 1998; Dimond 1989; Houlihan 2000; Lovell et al 1998; Pym et al 1999). However, no mention is made in this literature of the ‘prescribing’ of nurse holding powers by medical practitioners.…”