Section 4: emergency admission for assessment
Section 4 is used when it is ‘of urgent necessity’ for the patient to be admitted and detained under section 2 (s4(2)). It is rarely used.
|Routes to discharge||In practice: Responsible Clinician only|
|Tribunal eligibility||At any time (in practice, a hearing could only take place if the s4 is converted to s2)
No application by nearest relative
|Types of discharge||Immediate, unconditional discharge|
It is similar to s2 except:
- Only one medical recommendation is required (as opposed to two for s2) (s4(3)).
- It lasts for a maximum of 72 hours, as opposed to 28 days (s4(4)).
- The applicant (usually AMHP) must have seen the patient in the previous 24 hours (rather than 14 days) (s4(5)) and certify that getting the second doctor would ‘involve undesirable delay’ (s4(2)).
- The patient is not subject to the Part 4 ‘Consent to Treatment’ provisions.
- In the past there was some debate over whether a Tribunal application can be made, but both Jones and the Reference Guide state that it is possible. The logic is that the s66(1)(a) application right applies to an ‘application for admission for assessment’, which wording is also used in s4.
The Code of Practice states (at paragraphs 15.6 and 15.8) that:
Section 4 should be used only in a genuine emergency, where the patient’s need for urgent assessment outweighs the desirability of waiting for a second doctor. … To be satisfied that an emergency has arisen, the person making the application and the doctor making the supporting recommendation should have evidence of
- an immediate and significant risk of mental or physical harm to the patient or to others
- danger of serious harm to property, or
- a need for the use of restrictive interventions on a patient
A second medical opinion should be sought as soon as possible. A second medical recommendation converts s4 to a s2 (s4(4)) which is treated as beginning when the s4 began (including in relation to the 14-day Tribunal eligibility period).