An informal patient (sometimes called a voluntary patient) is a person who has consented to admission to hospital to receive treatment for their mental health problem.
An informal patient should be given information by the ward staff about their legal rights for example in relation to treatment, the right to leave the ward and how to make a complaint. This information should be provided in an language and a format that they understand.
An informal patient has the right to get treatment for their mental health problem. They also have the right to get treatment for physical health problems, just as they would in the community.
An informal patient has the right to refuse treatment, including prescribed medication. They must be given enough information about any proposed treatment to allow them to make an informed decision about whether to accept it.
Spending time away from the hospital
An informal patient has the right to leave the ward at any time, and does not need permission from the staff.
The care team will expect a patient to take part in their treatment plan, which will include therapeutic activities and talking to staff. An informal patient may negotiate periods of time away from the hospital as part of their treatment plan.
Most wards are locked; although an informal patient does not need permission to leave the hospital, they will have to let staff know that they wish to leave. Staff should ask about a patient’s plans e.g. where they are going, what are they going to do while away, what time are they going to return.
An informal patient has the right to leave hospital if they don’t want to stay. If the care team are concerned that this could put the patient, or other people at risk they may consider detention under the Mental Health Act 1983.
The threat of detention under the MHA must not be used to make an informal patient agree to take treatment or stay on the ward if they don’t want to.
A detained patient (often called a sectioned patient) is a patient who is being kept in hospital under the Mental Health Act 1983. If a patient is detained they can be kept in hospital, prevented from leaving the ward and given treatment for their mental health problems, possibly without their consent.
There are different types of sections, each has different rules about how long a person can be kept in hospital and about treatment. The patient, and in most cases their nearest relative, must be given detailed information about their legal rights under the Mental Health Act. This information must be provided in a format and language which they understand.
If a patient has been detained they normally have the right to get help from an Independent Mental Health Advocate (IMHA).
Most detained patients have the right to appeal to the Hospital Managers and the Mental Health Tribunal to challenge their detention.
Community Treatment Orders
Some patients who have been detained for treatment under the Mental Health Act are discharged from hospital on a Community Treatment Order (CTO). This means that they continue to receive treatment for their mental health problem in the community rather than in hospital. The Responsible Clinician has the power to recall the patient to hospital if they are in urgent need of treatment.
A CTO lasts for 6 months, and can be renewed for a further 6 months, and then annually.
The patient and their nearest relative, must be given detailed information about their legal rights under the Mental Health Act. This information must be provided in a format and language which they understand.
A patient on a CTO has the right to get help from an Independent Mental Health Advocate (IMHA).
CTO patients have the right to appeal to the Hospital Managers and the Mental Health Tribunal to challenge being on a CTO.
Real life experience
On more than one occasion I have been coerced into hospital under threat of section, even though the mental health act is not allowed to be used in this way. Distressed and desperate, I felt I had no choice but to agree to be taken to hospital against my will. It sounds like a contradiction but that really was the case. I was told that I shouldn’t force the issue and that things would only get worse for me if I did. I felt utterly powerless, and in that moment I had fewer rights than I would have had if the due process for a mental health section had occurred. The coercion continued on the ward, where I was officially an informal patient, but was being told that if I tried to leave the ward I would be sectioned. I felt in an impossible position where I didn’t really know where I stood. It was not a tenable position to remain in, and when I asserted my rights as an informal patient, I was sectioned anyway. I think it would have been preferable to have been sectioned right from the start so at least I would have known exactly where I stood and would have been afforded the rights a sectioned patient is entitled to. Being held under the mental health act was not something I would have chosen but it was necessary at that time to keep me safe, however, being held under the threat of a section was definitely a worse place to be. I have also experienced being sectioned where there was no messing around, and though unpleasant and scary, at least I knew what was what.