Audit of the use of doctors' holding power under Section 5(2) of the Mental Health Act 1983.

The legal documentation and hospital case-notes of all patients detained during 1989 in Nottingham and Lincoln under Section 5(2) of the Mental Health Act 1983 (empowering the emergency detention of a voluntary inpatient who wishes to leave), were audited to establish if there were any predictors of conversion to longer-term restraint under that Act. Of the 146 Section 5(2) orders, 80 were converted to a Section 2 or 3; the conversion rate in people detained outside normal working hours and those detained within 12 hours of admission was significantly lower; and the conversion rate was significantly higher in people with a mental illness, compared with those with personality disorders, substance abuse and stress reactions. No differences existed in the overall conversion rates of people managed by senior or junior doctors, but junior doctors who did not seek the advice of a senior doctor had a significantly lower rate of conversion than those who did. These results indicate that Section 5(2) may have been inappropriately used in up to 45% of cases, and underline the need for appropriate consultation.