A day-by-day account of what happens when you get sectioned under the Mental Health Act, as told by former mental health nurse Steve Bown. From 2024 to 2025, there were 52,731 new detentions reported under the Mental Health Act. The legislation is designed to regulate the assessment, treatment and rights of people with a mental health condition in the UK. But over the years, the Act has come under intense scrutiny, with critics citing a lack of autonomy and freedom for those sectioned, as well as ‘shameful racial inequalities’. With detentions slowly climbing, the mental health charity Mind called for reform, demanding a bill that ‘strengthens the rights of people at their most unwell.’ In December 2025, that goal was achieved. While it did not include all the recommendations requested by charities and independent bodies, Mind did say it would ‘bring in some positive reforms.’ Today, the goal is that the Mental Health Act — which ultimately allows a patient to be held for an unlimited time — is only used when absolutely necessary. For those who are detained, and their family and friends, this can be an incredibly scary experience.
What is Section 2 of the Mental Health Act?
The section most commonly discussed in relation to the Act is Section 2 – a legal framework that allows for a person to be compulsorily admitted to hospital for an assessment, and if necessary, medical treatment. You can be detained for up to 28 days under Section 2 if you meet the following criteria: you have a mental disorder; you need to be detained for a short time for assessment and possibly medical treatment; detaining you is necessary for your own health or safety, or to protect other people.
Day 1: Crisis Team Assessment
There are many different ways onto a ward, but going through a crisis team is probably the most common. ‘Somebody in a mental health crisis will be referred to the team by either the police, the local community, or a family member – and that crisis is associated with significantly increased risk, either to themselves or others,’ says Steve. ‘And these risks can be either deliberate or non-deliberate.’ Examples can include things like suicidal intent, exhibiting violent or severe impulsive behaviour, episodes of psychosis or extreme mania. Once someone has been referred, a crisis practitioner will visit this person in their home or in the local community. ‘Within that assessment, you get a sense of active suicidality or risk to others, or significant risk of someone destroying their social existence – this can mean things like developing delusional thoughts that they’re a millionaire, taking out a huge bank loan and buying nothing but scratch cards, or behaving psychotically among neighbours, friends, or family.’ In short, the crisis team are looking for whether or not they can maintain ‘reasonable standards of behaviour’ or if they need to be detained. In Steve’s experience, crisis practitioners will try their best to create a ‘hospital approach in the person’s home.’ However, that’s not always possible. If the expert believes there’s an immediate severe risk, they’ll then make a referral for a Mental Health Act assessment.
Day 2: Mental Health Act Assessment Team
A Mental Health Act assessment team will be established, consisting of a mental health professional and two doctors. At least one of those doctors has to be Section 12 approved, meaning they can make mental health assessments. Steve explains: ‘This will be both a medical and social assessment. This will be to decide: “Are there any less restrictive approaches that we could use to effectively manage the client’s mental health disorder?”.’ For example, if there are other care settings they can go into, or if there is strong family support, these things will play a role in whether or not detention is necessary. Factors that can come into this, Steve notes, are things such as: ‘The nature of the condition, chance of relapse, and severity of presentation.’ If the team decides the best course is to section the client (and all three must agree), then an application for detention is made. Steve adds that while things may differ regionally, the turnaround process for the assessment and application stages is relatively quick – typically within the course of a day or so.
How Long Can People Be Detained?
How long you’re detained will depend on which section you’re sectioned under. Under Section 2, you can be detained for up to 28 days. Normally, this section can’t be extended or renewed. But doctors might assess you again before the end of the 28 days to see if you should be put under Section 3. Under Section 3, you can be detained for up to 6 months. After 6 months, a clinician can renew or extend your Section 3. The first extension can last up to 6 months more. The second extension can last up to another 6 months. After this, each further extension can last up to 12 months each time. There’s no limit to how many times your clinician can renew a Section 3.
Day 3: Detention in Hospital
When it’s agreed someone will be detained, that client then needs to come to hospital. Sometimes the police will be involved if there is high risk, but Steve added that he’s seen family members or trusted social workers and carers walk clients into hospital as well. Once someone arrives, Steve notes that there are not many administrative hoops left. From the perspective of a nurse, Steve adds: ‘We’re aware this is such a dehumanising process. So, if you can, you pretty much want to clear the next three hours of your diary. In that time it’s a case of “let’s get you onto the ward, let’s get you your own room, your own bit of privacy, a cup of coffee and a sandwich”.’ The admission process will then include a nurse and a medic accepting the client, signing a form to state that the individual is now in the hospital’s care. Then, Steve continues, once the client is given some time to breathe and potentially calm down, there will be a holistic assessment. ‘You’ll want to find out what the presenting complaint is and what that person’s understanding of that is. You’re also going to want to figure out how that plays into someone’s broader psychological and social experience.’ Using the example of someone with suicidal thoughts, Steve says it will be during this holistic assessment that a nurse and doctor will try to understand where those thoughts might be coming from – for example, social stresses, loss of job, loss of role, significant psychological stresses, etc. Separately, there will be a ‘risk assessment,’ this will be more about safety on the ward, how medication may be managed by staff, and how they will approach certain risks either to or from the client. That risk assessment will then influence how much privacy a client is given, with some needing observations every 15 minutes. Once again, due to how damaging this experience is, Steve said that there is a strong emphasis on ‘maintaining social function.’ So, in the past, he’s regularly seen clients take escorted leave off grounds to the local shops within the first 24 hours or so of detention.
Day 4: Treatment
Once someone is as settled as possible, treatment can begin. Now, Steve emphasises that while medication is important, ‘the importance of talking therapies should be noted’, such as Cognitive Behavioural Interventions and Dialectical Behaviour Approaches. Steve also says medics consider not just the symptoms of the illness, but how being mentally unwell can be damaging in terms of a patient’s social life and their own psychology. Professionals will often use the CHIME model, which stands for Connectedness, Hope and Optimism, Identity, Meaning in Life, and Empowerment. This framework, Steve emphasises, prepares the client to return to the community. The identity element of this recovery method, for example, encourages the client to develop and envision a new identity that is not solely defined by their mental health diagnosis, challenges, or past. A number of forums recommend shifting perspective from ‘I am X’ to ‘I am a person who lives with X’.
Day 5: Appeal
Each client’s treatment is different, so the following days and weeks in treatment will vary. However, one important aspect of being detained is the appeal process. ‘There are two forms of appeal. One is an appeal to a Mental Health Act tribunal, an independent body. They can discharge someone from the section immediately. The individual will be provided with a solicitor, free of charge. And the client’s nurse has to support them in that appeal process.’ The appeal must be made within the first two weeks of detention, with the hearing then scheduled within seven working days. The second form of appeal is ‘to the hospital managers,’ which Steve describes as ‘a little more toothless.’ ‘It tends to be less about a clinical issue and more about the hospital managers doing a general check and balance of whether people need to be detained. However, they tend to be much more deferential to clinical opinion.’ Throughout the assessment, detention, and appeal process, Steve emphasises that ‘the real job of wards is to work from a position of coercion towards a position of collaboration.’ ‘The key issue here is one of building a therapeutic relationship and trust with the client in the initial hours. I suggest to my students the need to “set the tone” of the relationship with the client. One of empathy and compassion as the key factors to be provided.’
