Nigel Turner's HyperGUIDE to the Mental Health Act

Medical Recommendations

General Requirements concerning Recommendations

Two Medical Recommendations are required for a person to be admitted to hospital for assessment under Section 2, for treatment under Section 3, or to be received into Guardianship under Section 7. Admission to hospital in an emergency may take place under Section 4 which requires only one Medical Recommendation. The Recommendations have to be in a format required by Regulations made under the Act. The people making the Recommendations must personally examine the patient.

Where two Medical Recommendations are required:

• one Recommendation must be made by an approved doctor in accordance with Section 12, and
• one Recommendation must be made by a doctor who has "previous acquaintance" with the person. This may apply to the Section 12 doctor, but if not, then the second Recommendation must be by a doctor who has previous acquaintance, if at all practicable.

Time Limits and Joint Recommendations

The doctors who examine the patient may do so together or separately, but if separately then there must be no more than five days between each doctor's examination. The Recommendations must be signed on or before the day of the application.

Types of Mental Disorder

The Act defines 4 types of mental disorder. The doctors who give the two Medical Recommendations must agree that the person has the same form of mental disorder. In other words, the Medical Recommendations must cite one type of mental disorder in common, even if one or both applications give more than one form of mental disorder. For example, if one Recommendation says the person has mental illness and mental impairment, and the other Recommendation says severe mental impairment and mental illness, this is in order, as both doctors agree that the person has mental illness.

Restrictions on who can make Medical Recommendations

In the case of admission to hospital (as opposed to Guardianship), it is in order for one Recommendation to be made by a doctor from the hospital where the person is to be admitted, unless the person is to be admitted as a private patient. Where one Recommendation is made by a doctor from the admitting hospital, the second Recommendation cannot be made by a doctor from the same hospital unless all of the following conditions are met:

• one of the two doctors works for less than half of his/her health service contract at the hospital in question, and
• neither of the doctors works under the direction of the other, and
• obtaining a second Recommendation from a doctor other than one from the same hospital would result in delay involving serious risk to the health and safety of the patient.

There are also restrictions which ensure that anyone making a Medical Recommendation is not:

• the applicant her/himself (as might possibly happen if the application is being made by the nearest relative and that relative happened to be a doctor)
• a professional partner of the person making the other Medical Recommendation, nor of the applicant
• going to receive payment for the maintenance of the patient (but this does not prevent a fee being paid to a doctor to conduct the examination to consider whether a Recommendation should be made)
• (in the case of Guardianship) the person to be the Guardian
• a close relative of the patient or of any of the above people.