What actions should a non-Section 12 approved provider take when a patient's section has expired and they have been informal for 12 hours?

Immediate Action Required for Expired Section

The non-Section 12 approved provider must immediately contact a Section 12 approved clinician to conduct a fresh assessment of the patient, as the original section has expired and any recommendation signed by a non-approved provider is invalid under the Mental Health Act. 1

Understanding the Current Situation

The patient's legal status has fundamentally changed:

• The patient is now informal (voluntary) because the section expired before the recommendation could be properly executed 1
• The late recommendation is legally invalid because it was completed after the section expired, regardless of when it was signed 1
• A non-Section 12 approved provider cannot rectify this situation by completing paperwork retrospectively 1

Required Steps

1. Immediate Risk Assessment

Assess the patient's current clinical state and risk level:

• Is the patient currently willing to remain in hospital voluntarily? 2
• Does the patient pose immediate risk of harm to self or others? 2
• Is the patient attempting to leave or expressing intent to leave? 2
• Has the patient's mental state deteriorated in the 12 hours since becoming informal? 3

2. Contact Section 12 Approved Clinician Urgently

If the patient requires detention:

• Contact a Section 12 approved doctor immediately to conduct a fresh assessment 1
• The assessment must be conducted in person and cannot be based on the previous recommendation 2
• Two medical recommendations are required for most civil sections, with at least one from a Section 12 approved practitioner 1
• The approved clinician must make their own independent clinical judgment based on current presentation 1

3. Interim Management While Awaiting Assessment

If the patient is at immediate risk and attempting to leave:

• Staff may use common law powers to prevent a patient from leaving if there is immediate risk of serious harm 2
• This is a temporary measure only until proper assessment can occur 2
• Document all actions taken and clinical rationale in the medical record 2
• Ensure continuous observation appropriate to risk level 2

If the patient is cooperative and willing to stay:

• Explain the situation honestly to the patient 2
• Obtain the patient's agreement to remain voluntarily pending reassessment 2
• Increase observation frequency based on clinical risk 3

Critical Pitfalls to Avoid

Do not attempt to backdate or alter documentation - this is both legally invalid and professionally inappropriate 4, 5

Do not assume the previous assessment remains valid - the Section 12 approved clinician must conduct their own fresh assessment regardless of what was documented one week ago 1

Do not delay contacting appropriate clinicians - systems failures, including delays in obtaining proper authorization, are a major contributor to patient safety incidents 4, 6

Do not use restraint or seclusion without proper legal authority - if the patient is informal and not consenting, physical intervention requires either common law justification for immediate risk or proper detention under the Mental Health Act 2

Documentation Requirements

The medical record must clearly document:

• The timeline of events including when the section expired and when the patient became informal 2
• Current clinical assessment and risk formulation 2
• Actions taken to obtain Section 12 approved assessment 1
• Any interim measures implemented and their justification 2
• Patient's current legal status and their understanding of this 2

Learning Points for System Improvement

This situation represents a systems failure that should trigger review of processes to prevent recurrence 4, 6:

• Why was the recommendation completed late? 4
• What barriers prevented timely completion? 3, 4
• How can the system ensure Section 12 approved clinicians are available when needed? 1
• What safeguards can prevent similar lapses in future? 4, 6