Understanding the Mental Health Act and Sectioning
Knowing what could happen
Most people who come to therapy will never experience a mental health crisis severe enough to need hospital treatment — but it’s still something worth understanding.
Knowing what could happen doesn’t make things worse; it replaces fear with clarity.
I write this not just as a therapist, but as someone who’s also stood on the other side — a carer who’s watched a loved one in crisis and had to navigate what happens when choice is replaced by necessity.
It’s a part of mental health that few talk about until they have to. So, let’s talk about it.
At a glance
- “Risk” in therapy isn’t about judgement — it’s about understanding when someone feels unsafe in themselves.
- Crisis happens when safety feels lost — sometimes suddenly, sometimes slowly over time.
- The Mental Health Act is used when someone can’t make safe decisions because of how unwell they are — it’s a legal safeguard, not a punishment.
- Short holds (24–72 hours) can happen during acute crisis; longer detentions are used when stabilisation takes more time.
- Therapy is still about choice, dignity, and working together — even when difficult or emergency steps are involved.
- No one goes through crisis alone — support continues before, during, and after.
What “Risk” Really Means in Therapy
When therapists talk about risk, we’re not talking about everyday worries or temporary distress. We mean a concern that someone may harm themselves, be harmed by others, or lose the ability to keep themselves safe.
Risk exists on a spectrum. It can be fleeting — like a thought that passes without intent. It can be situational — driven by stress, trauma, or a major life event. Or it can become persistent and overwhelming, where someone’s capacity to make safe decisions begins to slip away.
In most cases, therapy itself helps reduce risk. Having space to talk, to plan, and to name feelings can bring things down to a manageable level. Sometimes, though, the risk rises beyond what therapy can hold. That’s when other forms of help — emergency or medical — need to step in.
Confidentiality is central to therapy, but it’s never absolute. Every therapist has an ethical duty to act if someone’s life is in immediate danger. It’s not a breach of trust; it’s an act of care.
When Risk Becomes Crisis
When risk escalates, the priority shifts from exploration to safety.
A therapist may contact your GP, a crisis team, or emergency services. If someone is in immediate danger — for example, actively suicidal or severely unwell — 999 is the right call.
These steps aren’t taken lightly. They’re rare, considered, and only used when there’s genuine concern that voluntary support isn’t enough. And sometimes, those steps lead to the Mental Health Act — the legislation that allows for a person to be taken to hospital for assessment or treatment when they’re unable to do so by choice.
What the Mental Health Act Is (and Isn’t)
The Mental Health Act 1983 (amended 2007) is the UK law that allows someone to be taken into hospital for assessment or treatment when they are at serious risk and cannot safely make decisions about their care. People often call this being sectioned.
Sectioning is not a punishment. It’s used when someone’s mental health has reached a point where there is a real and immediate concern for their safety or the safety of others. The aim is stabilisation, not control.
There are different types of sections, depending on the situation:
Short emergency holds:
These are the ones that come up most often when things escalate quickly.
- Section 4 can be used in urgent situations, for up to 72 hours, when two doctors are not immediately available to carry out a full assessment. It allows someone to be brought to hospital quickly, and then reviewed as soon as possible.
- Inside hospital, there are also holding powers under Section 5(2) (used by a doctor) or Section 5(4) (used by a nurse) which can keep someone on the ward for up to 24 hours while a proper Mental Health Act assessment is arranged.
These are temporary measures — designed to keep someone safe while the full picture is understood.
Longer assessments and treatment:
- Section 2 allows up to 28 days in hospital for assessment.
- Section 3 is used when longer-term treatment is needed beyond that.
There are also specific sections used by police when someone is in distress in public, like Section 136, which brings a person to a place of safety for assessment.
The stigma around sectioning comes from how disempowering it can feel — but at its core, the Act is meant to offer protection when someone is no longer able to see risk clearly or keep themselves safe.
It doesn’t remove a person’s humanity. It shouldn’t remove their dignity. It’s simply meant to keep them alive long enough for the noise and overwhelm to settle.
The Human Reality
Being sectioned is frightening. For the person involved, it can feel like being swept into a system where control disappears. There may be confusion, anger, or total shutdown. Even when it’s done compassionately, it’s rarely experienced as such in the moment.
For families and carers, it’s an agonising mix of relief and grief — relief that help is coming, grief that it had to come this way. You can feel guilty for making the call, or helpless if you didn’t get the chance to.
I know that experience personally. You never forget the sound of the door closing behind someone you love.
Therapy often meets people long after that moment — once the crisis has passed but the emotional dust hasn’t settled. There can be trauma on all sides: the person who was sectioned, the family who made the call, and even the professionals who had to intervene.
Therapy’s Role Before, During, and After
Therapy doesn’t sit outside the crisis system — it connects to it.
Before a crisis, therapy can help by identifying warning signs early: changes in sleep, energy, mood, or thought patterns that suggest safety is slipping. Therapists can help clients create a crisis plan — who to call, what helps, what doesn’t, and how to stay grounded.
During a crisis, therapy might temporarily pause, or shift focus to stabilisation and support for carers. The goal isn’t insight but containment — keeping things as calm and safe as possible while emergency teams take over.
After a crisis, therapy becomes a space to process what happened. That might include exploring feelings of shame, confusion, anger, or betrayal. For some, it’s about rebuilding trust in professionals; for others, it’s about making sense of memories that feel disjointed or unreal.
The goal isn’t to avoid every crisis, but to ensure that if one happens, it isn’t faced alone.
Sometimes you just need space to accept the reality of what happened — and to recognise that you acted in their best interests. There’s no guilt required in that.
Respect and the System
It’s worth saying: the Mental Health Act sits at the extreme end of intervention, and because of that, it demands enormous care and respect from everyone involved.
The word “respect” sounds small, but it’s the hinge on which everything turns.
“Ultimately, whenever we talk about discrimination or crisis, we’re talking about a lack of respect. When respect is shown, we value the person and their differences, even when they’re unwell. It says a great deal about society that we’ve had to write laws just to remind ourselves how to treat people with dignity.”
Every section, every assessment, every form signed — they all represent a human being. When respect disappears, coercion replaces care. That’s why empathy isn’t a luxury in mental health — it’s a safeguard.
What Carers and Families Can Expect
If a loved one is sectioned, you may feel excluded at first. The process can seem opaque, and professionals often default to confidentiality even when it leaves carers in the dark. You have a right to ask for updates, to be involved where appropriate, and to seek support for yourself.
Organisations like Rethink Mental Illness, Mind, and Carers UK provide excellent guidance on understanding the system, visiting rights, and aftercare. Support is not only for the person in crisis; carers often carry trauma too.
Therapy can help carers make sense of the chaos — the guilt of “what if I’d done more,” the exhaustion, and the unspoken fear that it might happen again.
When the System Hurts
Not every experience of sectioning feels fair or humane. Sometimes, people are treated with kindness; other times, they’re retraumatised by restraint, loss of autonomy, or dismissive staff. Therapy can help make sense of that, too — holding the dual truth that help was needed, and harm still happened.
It’s okay to feel conflicted about it. Complexity doesn’t cancel validity.
The Language of Survival
When we talk about sectioning, it’s easy to slide into clinical language: “detained,” “under observation,” “treatment order.” But behind those words is the same basic story — a person at breaking point, and a society trying, however imperfectly, to hold them.
The hope is always recovery. The purpose is always safety.
The reality, though, is that everyone touched by crisis — client, family, therapist — carries its echo for a while. Therapy helps to turn that echo into something you can live with, rather than something that lives through you.
Where to Turn for Help
If you or someone you know is in crisis, you don’t have to wait for things to escalate.
You can call:
- 999 in an immediate emergency.
- NHS 111 (option 2) for urgent mental health help.
- Samaritans on 116 123, available 24/7 for anyone in distress.
- Mind, Rethink Mental Illness, or the Hub of Hope for local crisis services and mental health support.
If you’re supporting someone, remember: you also need support. It’s not selfish; it’s survival.
one end of the mental health spectrum
The Mental Health Act represents one end of the mental health spectrum — the point where autonomy meets safety. For most people, therapy never touches that end. But understanding it matters. It reminds us that mental health care isn’t just about comfort and coping; sometimes, it’s about crisis and survival.
Therapy’s job isn’t to control risk — it’s to walk alongside it with honesty, skill, and compassion. Whether you’re the person in crisis, the carer watching it unfold, or the therapist trying to keep everyone safe, one truth remains constant,
Respect and understanding are what keep us human — even when the system has to take over.
Admitting you need support, especially in difficult times, isn’t a failure. It’s a form of strength.
