Availability of section 12 approved doctors
Section 12 approved doctors are those approved by the Secretary of State under section 12(2) Mental Health Act 1983 (MHA), where they are described ‘as having special experience in the diagnosis or treatment of mental disorder’. Whenever the MHA requires the recommendations of two doctors, one of them must be section 12 approved. This includes instances of compulsory admission under section 2 (for assessment) or section 3 (for treatment) or for reception into guardianship under section 7 MHA. Every doctor who is an Approved Clinician (a role created, along with that of Responsible Clinician, by the Mental Health Act 2007 amendments to the 1983 Act), is automatically section 12 approved (s12(2A) MHA).
However, the Independent Review of the Mental Health Act 1983 (2018) identified problems in accessing section 12 doctors, as did Approved Mental Health Professionals (AMHPs) in our earlier study when discussing arranging MHA assessments. Similar comments were expressed in the focus groups held by the Care Quality Commission (2018). Furthermore, the ADASS and NHS Benchmarking (2018) survey of AMHPs found that where delays of over four hours occurred between the receipt of a referral and the assessment taking place, waiting for a section 12 doctor was the second most (28%, 74 occasions) common reason for such delays. The most common reason (39%, 102 occasions) was that it was in the best interests of the client/adult to delay the assessment.
This research is referred to in the 'Reforming the Mental Health Act' white paper, published January 2021 (p.178).
Aim of this study
To identify evidence about factors promoting and inhibiting the accessibility of section 12 doctors to participate in MHA assessments in England and Wales.
This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, through the Policy Research Unit in Health and Social Care Workforce, PR-PRU-1217-21002. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
We have conducted a literature review together with a set of interviews with managers, practitioners (including section 12 doctors and AMHPs), and other experts.
We have conducted an analysis of the national MHA Approvals Register Database.
Data from the scoping review, the analysis of the Register Database, and the interviews have been combined in the study report, a draft of which has been submitted to DHSC.
There were two main findings from the research. First is that the main problem is availability of s12 doctors to undertake MHA assessments, rather than overall numbers. This suggests a need to focus on encouraging psychiatrists and other s12 doctors to make themselves more available for doing MHA assessments. Incorporating MHA assessments as a requirement in NHS contracts may also be of value, coupled with the use of rotas, although careful consideration of the impact on workload would be needed. Second, there is currently no real way to tell how many s12 doctors are needed without better information about the numbers of MHA assessments attended by different doctors, and in what circumstances – this would help workforce planning for s12 doctors.
Note on the research team
This project was led by Dr Martin Stevens who died in March 2022.