Section 2

[arkonline]

Hello all, thanks for this great forum. My elderly mum (80) with mixed dementia was living alone, and has recently been placed in a secure unit under a Section 2. She was becoming unable to look after herself properly and refusing any medication or medical intervention, and also refused to let the carers we organised help her. She also has a long history of depression and this was becoming heightened as the dementia progressed.

She has now been in the ward for 2 weeks, with the Section 2 set to expire on on 4th March. However, this week I have been invited to an MDT Discharge meeting (!). This has obviously freaked me out as I have absolutely no clue what will happen next.

So far she has received no treatment other than day-to-day care, but she obviously can't go home to the way things were before - the likelihood is she would refuse carers again and we'd be back to square 1. She seems to have had no medication offered to her, and as far as I can see, she's pretty much the same as she was when she went in, only now furious with me for not 'getting her out of this awful place'.

I fully expected her to move to a Section 3 for treatment, which would then give us all time to try to arrange next steps - very likely a care home I would have thought. But now it seems like they are considering putting her back out after 28 days, which seems completely mad.

My question is really - what should I do/say at the meeting? It is my understanding she can't be discharged from a Section 2 without a full care plan in place. And if there is no plan (which there isn't at present, and the likelihood of making one within the next 2 weeks seems extremely unlikely), wouldn't she then automatically have to move to a Section 3 anyway?

Any advice gratefully received.

 

[Mumlikesflowers]

Sounds like a lack of dialogue up til this point. Can you ring and ask for clarification? Did you already look at this?

https://www.dementiauk.org/wp-content/uploads/dementia-uk-mental-health-ward-admissions.pdf

I'm wondering if it's common practice for a person to come off section but still stay in hospital as a voluntary patient whilst awaiting a residential placement? I don't know where the capacity issue sits with this. It doesn't make it clear in this document unfortunately.

 

[Kevinl]

Hello and welcome to the site, it's a pity we have to meet on here all facing the same bunch of issues.
My wife's care was down to me, but, social services round here was good then, compared to some of the stuff I read on here now.
Off the record a social support worker told me that if I said "here's the house keys, I'm off to live on my boat, all hell would break loose " so I did and help ramped up a lot.
No way would I have done it but she could then escalate help. Either my wife could live alone and cope (not) or by threatening not to become part of the solution made me another problem for them.
Poker face on and threaten to disengage, ugly as it sounds they have a "duty of care" to her, you do it for love, poker face on and play them at their own game.
K

 

[SAP]

If your mum is still in hospital under section after 28days she will be placed on section 3 .
Have you had much communication from the ward she is on? Is there a social worker involved ?
Definitely ask what the care plan is and make it very clear that you won’t be taking up any slack or organising any care as your mum now requires professional input . This is what I did with my mum.

 

[Rayreadynow]

They wont put her on section 3 because that means she will become subject to section 117 which means the local authority has to pay for the social care in a care home. Section 2 can be extended if required.

 

[Kevinl]

True enough section 3 is an automatic qualifier for section 117 funding, free care does still exist.
K

 

[SAP]

This gives a bit more clarity.

https://www.mind.org.uk/information-support/legal-rights/sectioning/about-sectioning/#:~:text=How%20long%20can%20you%20be,under%20section%203%20is%20needed.

Section 2​

You can be detained under section 2 if:

• you have a mental disorder
• you need to be detained for a short time for assessment and possibly medical treatment, and
• it is necessary for your own health or safety or for the protection of other people.

How long can you be detained under section 2?​

Up to 28 days. The section can't normally be extended or renewed. But you may be assessed before the end of the 28 days to see if sectioning under section 3 is needed.

 

[arkonline]

Thanks for your thoughtful replies. Certainly not great communication so far - and all your points taken about being clear about outcomes.

In terms of the Section 2 - it is still a bit unclear to me what happens after the 28 days.

It is my understanding that unless she is discharged, she will have to either a) voluntarily remain on the ward (which is very unlikely and since she lacks capacity, probably not legal); b) go to a DOLS; or c) go to a Section 3. If they are going to consider treatment, only a Section 3 seems to allow that - unless I'm wrong?

I am adamant she requires treatment of some kind, at the very least an anti-depressant, otherwise frankly the whole Sectioning process has been a monumental waste of time.

 

[arkonline]

If your mum is still in hospital under section after 28days she will be placed on section 3 .
Have you had much communication from the ward she is on? Is there a social worker involved ?
Definitely ask what the care plan is and make it very clear that you won’t be taking up any slack or organising any care as your mum now requires professional input . This is what I did with my mum.

Thanks SAP. Is Section 3 the only option, or could they consider a DOLS?

There hasn't been a social worker involved, no. I don't know who the AMHP is, or actually who her Independent Mental Health Advocate is. I should ask about both.

The communication has been okay in terms of day-to-day stuff, but I haven't really had much guidance about treatment / care - the consultant psych was on holiday during her first 10 days, so I presume that's why. Which makes the idea of a discharge meeting all the more ludicrous!

All good suggestions
- insist on hearing what the care / treatment plan is
- ask what they're thinking will happen after discharge
- ask when they think discharge will be
- and be very clear that the responsibility is no longer mine.

 

[arkonline]

Hello and welcome to the site, it's a pity we have to meet on here all facing the same bunch of issues.
My wife's care was down to me, but, social services round here was good then, compared to some of the stuff I read on here now.
Off the record a social support worker told me that if I said "here's the house keys, I'm off to live on my boat, all hell would break loose " so I did and help ramped up a lot.
No way would I have done it but she could then escalate help. Either my wife could live alone and cope (not) or by threatening not to become part of the solution made me another problem for them.
Poker face on and threaten to disengage, ugly as it sounds they have a "duty of care" to her, you do it for love, poker face on and play them at their own game.
K

Hi Kevin - it is a shame, isn't it? Still, reassuring to know so many are in the same boat.

Yes. I think I need to be much clearer about not handling the care post Section. I've already taken 2 months off work, and it just can't carry on like that.

Will start practicing my poker face now

 

[SAP]

Yes they could consider DOLS but this should be with in the 28 days. It would also mean that they plan to keep her in hospital or in residential care and would also mean that they consider her to lack mental capacity.

 

[Kevinl]

We don't live in some tinpot dictatorship where the state can snatch a citizen in a free country and lock them up, there has to be a legal framework.
The police can arrest you but they have to tell you "you have the right to remain silent..." And all the rest.
Sections of the Mental Health Act (sectioned) or a DoLSO (dols) can be used but a legal framework for detaining someone when it is or maybe has to be in place, it's a free country. K

 

[arkonline]

Sounds like a lack of dialogue up til this point. Can you ring and ask for clarification? Did you already look at this?

I'm wondering if it's common practice for a person to come off section but still stay in hospital as a voluntary patient whilst awaiting a residential placement? I don't know where the capacity issue sits with this. It doesn't make it clear in this document unfortunately.

Thanks for the pdf. I have talked to them about it in an informal way, but I only met the consultant psychiatrist for the first time last Friday, so really I feel we haven't even started yet - which is why the idea of discharge seems so mad.

I believe it's theoretically possible to remain on the ward voluntarily after sectioning, but given that she was sectioned and thus deemed to lack the capacity to make best interest decisions for herself, I'm not sure how she can now suddenly regain capacity - she has dementia, after all!

I think the decision if she does have to stay in is whether they use Section 3 or DOLS - but again, it's all so unclear I don't understand how they arrive at that decision. As far as I can understand it, treatment requires a Section - it is not possible to treat on a DOLS, it seems.

 

[arkonline]

They wont put her on section 3 because that means she will become subject to section 117 which means the local authority has to pay for the social care in a care home. Section 2 can be extended if required.

I didn't know that Section 2 can be extended - do you have a link for this?

 

[arkonline]

Yes they could consider DOLS but this should be with in the 28 days. It would also mean that they plan to keep her in hospital or in residential care and would also mean that they consider her to lack mental capacity.

Do you know the criteria for making the decision? As far as I understand it, treatment requires a Section (2 or 3); DOLS does not allow treatment, only detention.

Is this right?

 

[SAP]

There you have me I’m afraid. In my mums case she required specific provisions and so went on to a section 3 until a placement was found for her. She is now under a DOLs with 117 aftercare in a home where she has been for just over a year. I should also add that she was not on a hospital ward as such but a mental health unit run by the Mental Health Services for Older People.

I’ve found this thread from several years ago, might help.

Section 3 or DoLS?

Mum's Section 2 detention period is coming to the end of its 28 day limit and I have been called to go to an assessment meeting on Friday about whether she goes onto Section 3 or DoLS. Has anyone got any experience of this kind of meeting or knows/understands the consequences of one over the other?

forum.alzheimers.org.uk

 

[Rayreadynow]

My understanding is that you cannot be sectioned under the Mental Health Act 1983 and DoLS at the same time...its one or the other.

 

[Kevinl]

Section 3 to section 117, free care for life (currently).
DoLSO (dols) if you like is just to make sure they can't do a runner, it is after all a free country. K

 

[SAP]

Just done a bit of a refresher course. The difference is whether a person can be treated under the MHA or the MCA . Sectioning comes under the Mental Health Act, DoLS comes under the Mental Capacity Act.

 

[arkonline]

Just done a bit of a refresher course. The difference is whether a person can be treated under the MHA or the MCA . Sectioning comes under the Mental Health Act, DoLS comes under the Mental Capacity Act.

Ah, that's useful - I didn't know that.