See over for a good practice example Aide-memoire for doctors when documenting reasons for detention when completing a medical recommendation When documenting reasons for detention under section 2 or 3 we suggest the following: Describe the patients Mental Disorder, symptoms and behaviour and state the reasons why those symptoms and behaviour led you to your opinion that their detention in hospital was appropriate Describe how the nature or degree of the mental disorder is demonstrated Explain why in your opinion it is in the interests of the patients own health and/or safety or for the protection of others that they are detained in hospital Indicate why the patient needs to be admitted to hospital and why informal admission, or authorisation under the Deprivation of Liberty Safeguards is not appropriate Include a statement in relation to the patient’s mental capacity in relation to care and treatment proposed and admission to hospital For section 3 cases – state whether other methods of treatment and care (e.g. out-patient treatment or social services) are available and if so why management in the community is not appropriate   Appendix 7 – MHA-PGN-08 See over for a good practice example

EXAMPLE FOR THE COMPLETION OF A MEDICAL RECOMMENDATION When documenting reasons for detention we suggest five clear statements, as follows: Patient ‘A’ has ‘such and such’ a mental disorder characterised by the following symptoms…………………………………. The nature of their disorder is demonstrated by……………………………………… AND/OR the degree of their disorder is demonstrated by……………………………………………………………………………………………………………………….. Community treatment is not possible because ………………………………………………………………….and this makes 24 hour specialist hospital admission necessary. Hospital admission is necessary in the interests of ‘A’s’ health because he or she needs………………………………. in the interests of patient ‘A’s’ safety to manage the risks of………………………and for the protection of others to manage the risks of………………………………………………………………………………………………………………………………. The patient does / does not have mental capacity in relation to being accommodated for care and treatment in hospital because of their mental disorder as they are unable to …understand / retain / use of weigh / communicate in relation to this decision (include / delete as appropriate). Mental capacity may / may not be regained in the future. Informal admission is not possible because, for example:-  1. Patient A is not agreeing to admission. 2. The established nature of their mental disorder strongly indicates that they will not sustain a commitment to informal admission. 3. The patient lacks capacity but the patient's needs cannot be appropriately met by relying on the Mental Capacity Act alone; because……………………………………………………………………………………………………………… 4. The person is ineligible for authorisation under the Deprivation of Liberty Safeguards as: a. they come within the scope of the MHA b. the treatment is wholly or in part for mental disorder and they are objecting to proposed treatment c. they have mental capacity or mental capacity is fluctuating d. they have an LPA or Advance Decision refusing proposed treatment. e. they are under 18 years old. f. there is a risk to the health or safety of others (rather than the person) necessitating detention under the MHA.