Sectioning and the ‘Bournewood Gap’

I was seeing a patient the other day.  A fairly young bloke, he’d had a bit of stress at work, and subsequently what he’d called a nervous breakdown, and what I’d call an acute stress reaction.  He’d gone to this local A&E and had been seen by the psychiatrist on call and had spend a few days in hospital. 

The next thing he said struck me:

‘I didn’t think that I needed to come into hospital, but they told me that they thought that I did and if I didn’t come in voluntarily then they would think about making me come in’

This sort of thing happens all the time.  No one likes to bring a patient into hospital against their will (sectioning).  It doesn’t feel like a nice thing to do and psychiatrists like to think that they’re nice people.  A lot of patients would rather not be sectioned either, as this is seen as a very stigmatising thing by a lot of people you might meet.  So people come into the ward ‘informally’ i.e. not under section.

So, what’s the problem with that?  I’m not saying that all patients who are admitted to a psychiatric ward should be under section.  There is a place for informal admissions.  However if a patient is being informally admitted then a question should be asked: if this patient tries to leave will we let them?  If the answer to this is ‘no’ then a section should be considered. 

To my mind if an informal patient will be sectioned if they try to leave then they’re actually not there informally at all, but under a defacto section.  Worse still,  being under defacto section means that there is no legal protection; if you are on a section you are entitled by law to reviews of your status under the Mental Health Act, if you are an informal patient you receive no such protection. 

There have been similar, but not identical, concerns the context of patients with learning difficulties as a result of the Crown vs. HL. This case involved Bournewood Hospital in Surrey where the hospital’s authority to keep a person in hospital and give treatment, when they have neither actively consented nor refused, was challenged. 

Because of this case a situation where there is an issue of the rights of mental health inpatients who lack the capacity to make decisions for themselves and therefore cannot consent to their treatment has come to be known as the "Bournewood Gap".  Many such patients are given hospital treatment informally because they accept hospitalisation and treatment ‘compliantly’.  You can read more about the mental health charity Mind’s concerns about this here

 

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