Audit of the use of nurses' holding power under section 5(4) of the Mental Health Act 1983.

Emergency detention of psychiatric patients by doctors under s. 5(2) of the Mental Health Act 1983 is not always preceded by the use of nurses' holding power under s. 5(4). In this review of patients in North Cheshire, all applications of s. 5(4), allowing the emergency detention of voluntary in-patients by registered psychiatric nurses for a maximum period of six hours, were reviewed to examine the extent of its use and to assess its effect on s. 5(2) outcome. Of the 877 detentions under s. 5(2) implemented during the 11-year review period, 140 (16%) were preceded by s. 5(4). There was no significant difference in age, sex, clinical diagnosis, day of the week, reason for detention and length of hospital stay before section application between those who had s. 5(4) applied before 5(2) and those who did not. The latter were less likely to be converted to other sections (53%) compared to a much higher rate of 80% if s. 5(4) preceded s. 5(2). The review has also found that time of section application and length of hospital stay prior to detention may have influenced the use of nurses' holding power. It suggests that s. 5(4) may be a useful predictor of s. 5(2) outcome.