Section 5(2) MHA 1983: results of a three-year rapid cycle clinical audit.

The aim of this paper was to establish whether section 5(2) of the Mental Health Act 1983 was being used appropriately in an inpatient psychiatric unit in the UK. A clinical audit was conducted over three consecutive years. Peer review of decisions to use section 5(2) on the hospital's adult and old age wards was conducted by junior medical staff. Ninety-eight per cent of the uses of section 5(2) were felt to be appropriate and most were reviewed within 72 hours. Very few patients (5%) were placed on this section again during their admission. The number placed on section 5(4) prior to section 5(2) increased from 2% to 12%. The proportion reviewed within the first 24 hours of detention nearly doubled over the audit period and fewer patients subsequently went on to sections 2 or 3 by the third year. There was no evidence of inappropriate use of section 5(2). Changes in the shift system for junior medical staff may have inadvertently led to a more frequent use of section 5(4). The use of further formal detention after section 5(2) declined, although this decline was not statistically significant.