Is ‘to section’ a verb we should be using? My understanding and instruction was always that we should try, if at all possible, not to refer to ‘sectioning’ someone.
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It seems a bit flippant. It seems to imply a decision made. I know these are values I am attributing to the words but I can’t escape the discomfort I feel. Then, on the other hand, it is a word that describes a process in a way that is understood.
I know that is not a rational response to reject a word out of hand but I feel quite strongly about the process and having seen regularly, the distress it causes at close quarters, trivialisation is the last thing that should ever come to mind.
This occurred to me yesterday following a discussion with a nearest relative when I was explaining about the assessment I was going to be undertaking.
Just for the record, none of the pieces of conversation below quite matched the way the ‘real’ conversation went yesterday, but they are parts of conversations I’ve had with a variety of people over the past couple of years.
It’s one of the tasks that I have as an AMHP (Approved Mental Health Professional) – and on a human level, it can be difficult. I am obliged as a part of my duties in setting up Mental Health Act Assessments to consult the relevant nearest relative in the case of an application for admission under Section 2 of the Mental Health Act and to consult and ensure that they do not object in case of an assessment under Section 3 of the Mental Health Act.
There’s that ‘section’ word again.
Depending a little on the situation and whether it might be a person’s first assessment under the Mental Health Act and how close the family member actually is, you can judge how to pace the conversation.
‘I’m going to be carrying out a Mental Health Act Assessment of your mother’ Notice the difference between ‘mental health assessment'(which could be any type of more generic assessment carried out) and ‘mental health ACT assessment’ (which is very specifically an assessment carried out in order to make a decision about compulsory detention in hospital). That’s the key difference and often it needs to be clarified.
That may be enough
‘Oh, is she going to be sectioned?’ may be a response if this has happened before.
‘Well,’ I might say ‘it’s an assessment so we don’t always know the result in advance’
Except some times it is a lot clearer than others.
That would depend on the circumstances and the lead up to the assessment.
We don’t consider Mental Health Act Assessments until all other possibilities have been expended but sometimes it might be someone we don’t know well or something might come up as a part of an assessment that we hadn’t known about in advance or it might just be a wholly inappropriate referral where some of the information given by a panicky care coordinator or family member isn’t quite what we see when we turn up on the doorstep.
Sometimes the prospect of being forcibly admitted to hospital is enough to ‘encourage’ someone who might otherwise be reluctant to engage with services.
If it is a first assessment or someone who hasn’t had any knowledge of the jargon and the way we things might work, I’ll explain in more depth the workings of the Mental Health Act and the bases by which we assess and what the implications are and may be. It depends on level of distress and what some of the precipitating factors might have been and how closely that person was involved – if it’s been possible to have some of these ‘lead-in’ conversations beforehand or not.
So this may have been discussed in great detail before this point arrives – but sometimes it would be someone who had been unknown to our services and with whom we had not had previous contact.
‘So you mean you’re going to section my mother?’
I try to reassure and often will tell the family member not to be frightened of the word itself. ‘Sectioning’. Being admitted to a psychiatric hospital for detention or rather admission, assessment and/or treatment under the Mental Health Act. It is scary. The thought of not being able to leave may be frightening but the stigma attached to ‘being sectioned’ is also frightening.
There are a lot of perceptions of what psychiatric hospitals may be like – and some may be exactly as they are perceived to be but most of the wards I admit to, I know the staff and I know the quality of the nursing care that will be administered. It’s easy to reassure someone of this but it’s hard to break through the preconceptions – understandably.
We also know the stories, we know the general perceptions of what ‘being sectioned’ might mean and the labels that might be attached.
I explain that the word holds all sorts of connotations but sometimes it is about legalities and above all it would be to ensure that we can provide the best care possible for the individual in question.
I explain that we conduct an assessment and that we do this in as humane and thoughtful a way as possible, always respecting the person and not making the situation any more distressing than it need be.
But sometimes it does need to be distressing. Sometimes the thought of ‘sectioning’ brings some of those images – as exist in general media perceptions – of someone being dragged off into the night to a hospital.
And you know, sometimes things do happen that way, I can’t deny it. Well, I don’t work at night as a rule (only if something from the day has dragged on) and there are few times when I’ve personally been involved when the police have had to actually put hands upon someone during the process. It can happen though.
Usually the police are very sensitive. We have some excellent, sensitive and extremely professional police in our borough who are, for the most part, a joy to work with.
Duty of care. It comes back to that. It would be wonderful if everything we did could be done with consent but the nature of the job is that it is not.
‘So you’re going to section XXX?’
Not necessarily, I might respond – we are going to conduct a Mental Health Act Assessment and make a decision as to whether she needs to be admitted to hospital or not.
It sometimes feels like fighting a losing battle.
‘This is the social worker. She sections people’ One of my colleagues introduced me to one of the nursing students.
‘Well, I organise Mental Health Act Assessments where they are needed and make the applications for compulsory admissions’ I try, but that’s seen as me being a bit pedantic. I’m rowing against a tide
‘Yeah, that’s what I meant, she sections people’.
When I was a student, one of my practice teachers was a (as then) ASW. It seemed a faintly mythical task to me – and more than a little scary.
It’s less mythical now of course, as I’m carrying out the same role myself, in a slightly different incarnation. But it’s still scary. There’s still a thought that this assessment, this moment is something that will have a profound impact on the course of this individuals’ life.
‘When I was sectioned.. ‘
And the shame and distress that will cause to everyone involved.
It’s easy to reassure that it is nothing to be ashamed about and that we are ultimately concerned with our duty of care towards the patient and to ensure that the best possible treatment can be administered.
Or sometimes it isn’t as easy to provide that reassurance.
That word again – sectioned.
I see why we were told to try not to use it. It has so much weight to it. So many assumptions and fears attached to it.
But we also need to say it as it is sometimes.
‘Does that mean my mother might be sectioned?’
‘Well, people do refer to it as that sometimes, yes, but it is an assessment’.
And afterwards, when I report back
‘did you section her?’
‘She was admitted under Section 2 of the Mental Health Act’
‘So you sectioned her?’
‘Yes’. Sometimes it is just best to be clear.
You would explain the reasons, the rights and responsibilities of those involved and of the nearest relative. I don’t always get it right. I try to put as much empathy into these conversations as possible.
But sometimes, often, the grief and distress, it cuts like a knife.