To Section – as a verb

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.

8 thoughts on “To Section – as a verb

  1. Agree with what you are saying. I am an ASW in NI. In Northern Ireland we don’t usually talk about sectioning as our Mental Health Order is divided in to Articles not Sections. However social workers (and others ) do of course use shorthand which as descripters often devalues the activity undertaken. We refer to ‘signing the forms’ , ‘signing in’, ‘going to do a detention’ ( when the ASW have not yet met the potential patient, never mind having not yet decided what to do), ‘detained admission’ ( when in NI it is a GP and ASW who make an application for admission for assessment and a psychiatrist at hospital decides whether person will be admitted – the ASW and GP really authorize a ‘detained conveyance’). It is often others including other professionals who use the language. However all to often social workers (including sometimes ASW’s) use these ‘shorthands’ which devalue or own professional activity and the people who we may deprive of their liberty

  2. We weren’t allowed to talk of “sectioning” as a verb, when I trained. It was said (no idea how true it was) that if you said that in your exams you’d almost certainly fail.

    As you say, it suggests a flippant, casual approach to a process that is formal, serious and professional. There’s an implied lack of courtesy and decorum when instead of, “I think we should progress an assessment to consider detention under the Mental Health Act 1983,” to, “Let’s see her to section her.”

    To this day, despite sounding overly officious, the training’s stayed with me and I won’t (and can’t!) talk of “sectioning” someone. Now I’m passing my foibles on to my junior doctors too.

    Does it matter? I’m really not sure. But it matters to me, so I maintain my eccentricity 🙂

  3. I still vividly remember my mental health/social work instructor stating that a person is not a schizophrenic, but a person suffering from or deal with schizophrenia. Now with my professional life in a hospital (dealing with physically ill children) I do my best to refrain from referring to the ALL (acute lymphoblastic leukaemia) in this room or the gastrochesis (kind of a super hernia) kid in that room. Not to mention the freak (parent) in the third room 🙂

  4. Just to clarify, is “sectioning” when someone is admitted to hospital involuntarily? I’m guessing so, since what you describe sounds a lot like what we Canadian mental health workers call “forming”.

  5. I’m not sure about this one. I agree it sounds more professional not to use ‘to section’ but my experience doing advocacy is that it’s very accessible to inpatients to speak about being sectioned. Everyone understands what it means.

  6. Interesting discussion. There are of course plenty of occasions when, for example, local government officers, magistrates or others apply a particular section of a particular law to some person/case to require or compel them to do something, but as a verb, ‘to section’ does seem to have this particular mental health connotation – certainly in the public mind.

    Thinking about it further, I’ve just checked the psychiatry books on my shelves; they talk about ‘detaining someone under Section 2’ and even going right back to books from the 1950s, ‘section’ isn’t used as a verb. I remember that my father, who was a mental health social worker for many years, used to just talk about ‘taking someone to hospital’ or ‘having them admitted to hospital’ – and he started work in 1946, when the 1890/1922 Lunacy Acts (as modified by the 1930 Mental Treatment Act) were still in force.

    So I’d hazard a guess that ‘sectioning’ someone in all probability isn’t terminology that’s been commonly used in social work or psychiatry, or if so it’s been ‘backroom’ talk – very likely it’s more used by the patients, their family, and in popular culture?

  7. Sorry, forgot the 1891 Lunacy Act as well (the consolidation act). Actually I haven’t immediately been able to find the full text of the act though the British Journal of Psychiatry in 1891 (volume 37, it appears – I had no idea it had been running since the mid-1850!) seems to have several critical articles about the operation of the Lunacy Acts….

  8. Thanks for all the responses!

    Nigel – thanks for that, I didn’t know the process in NI so it’s always interesting to see how things are different. I would love to investigate further about the ways that the law changes in different parts of the UK..

    Shrink – I have no doubt it’s about how things are trained into us. It was also really strongly and repeatedly emphasised with us that we should never refer to ‘sectioning’. I find it really hard now to think in those terms but I do think that language is very important in developing value bases.

    Carolyn – Yes, equally we are told never to refer or describe someone by their diagnosis (unless we have to cluster them .. oh, don’t worry about that, it would take too long to explain.. I’ll probably write a post about clustering.. ).

    Nectarine – yes, that’s exactly what it is.

    Spinks – I don’t think anyone would have a problem with people defining their detention as they feel most comfortable but personally, I feel that I had a responsibility to show more respect to the word and the system. Like The Shrink says above, it’s something that I feel very uncomfortable saying but that doesn’t mean everyone, particularly those who are subject to these orders can’t self-identify and describe.

    jonvagg -thanks for that contribution – very interesting. I didn’t look back that far so thanks for your research as well. I never really considered the roots of why it is described as ‘sectioning’ although maybe it was shorthand that passed into common usage. It probably emerged as a term from outside the professional sphere though, as you say. It makes much more sense.

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