If a nurse considers it appropriate to use the power to detain a patient under Section 299 (having considered all of the above criteria), they should attempt to communicate to the patient and their closest relative what is about to happen (if possible). The nurse should call the doctor on duty to arrange medical examination of the patient. The nurse should complete an NUR1 form.
The NUR1 form provides notification that the patient has been detained. It is important that the nurse outlines the reasons why detention has been necessary. The time of authorisation under Section 299 should be recorded. The detention lasts for up to two hours from that time. As soon as it is practicable after the period of detention begins, the nurse should inform a mental health officer of the detention.
When the NUR1 form is completed it should be delivered to the managers of the hospital (usually medical records office) in which the patient is detained. Local arrangements should be in place with the medical records office about who this form should be delivered to if the person is being detained outwith the usual working hours of the medical records office. Once the form is received by the managers, a copy of the form is sent to the Mental Welfare Commission within 14 days.
Under the direction of the nurse who authorised the detention, other staff may need to be involved in preventing the patient from leaving hospital. It is expected that the nurse who authorised the detention remains with the patient during the detention period.
Section 299 detention comes to an end when:
- A medical examination has been carried out within the timescale above and the patient is further detained under an Emergency Detention Certificate or a Short Term Detention Certificate.
or - A medical examination has been carried out within the timescale above and the result is that a) the patient is not further detained under the Act but b) remains in hospital on a voluntary basis or c) chooses to leave hospital.
or - After two hours detention, a medical examination has not been carried out.
The nurse’s power to detain should not be used consecutively e.g. if two hours has elapsed and no doctor has attended, it should not be used to immediately re-detain the patient. In such a situation, the nurse would need to consider whether they needed to continue to prevent the patient from leaving hospital under their common law ‘duty of care’. It would be concerning if a doctor was not able to attend during this timescale and hospital managers should be informed.
Can the Nurse’s Power to Detain be used in a Non-Psychiatric Hospital?
The Mental Health Act and Codes of Practice do not provide a clear answer to this question. The Mental Welfare Commission has sought legal guidance and it has been agreed that it is reasonable to use the ‘Nurse’s Power to Detain’ a patient in a non-psychiatric hospital, if the criteria outlined above are met.
In a non-psychiatric hospital it is recognised that there may be some difficulty in interpreting the phrase ‘medical treatment’ (as stated in the Mental Health Act). The process of carrying out an assessment by a Mental Health Nurse or Learning Disability Nurse is viewed as providing ‘care’ and therefore it does constitute ‘medical treatment’ under the Act.
Whether a patient who is in a general hospital can be recognised to be receiving treatment for a mental disorder, has to be considered on a case by case basis. For example, a person being treated following an act of deliberate self- harm may satisfy the criteria. Acquired Brain Injury is considered to be a mental illness (mental disorder) for the purpose of the Mental Health Act.