• If the person needs to be admitted to hospital, every attempt should be made to persuade them to go voluntarily.
• If the person refuses to go to hospital, compulsory admission may be necessary if the person:
• Requires assessment and/or treatment in a hospital, and
• Needs to be admitted in the interests of their own health or safety, and/or for the protection of other people.
• Compulsory admission is arranged using the appropriate section (usually section 2) of the Mental Health Act (MHA):
• Section 2 allows for compulsory admission for up to 28 days.
• It requires an application from an Approved Mental Health Professional (AMHP, formerly an Approved Social Worker), or, rarely, the person's nearest relative, and recommendations from two doctors, one of whom is section 12-approved (usually a psychiatrist) and one who has previous acquaintance with the individual (usually the person's GP if at all practicable).
• Ideally the person should be examined jointly by the two doctors with the AMHP also present. Where this is not possible, each doctor may carry out a separate examination. If the AMHP is not present it is essential that at least one of the doctors discusses the person with the AMHP.
• Section 4 is used in exceptional cases to permit compulsory admission for up to 72 hours if there is 'urgent necessity', and 'undesirable delay' would occur while trying to arrange admission under section 2.
• It requires an application from an AMHP (or, rarely, the person's nearest relative) and just one medical recommendation, preferably from a doctor with previous acquaintance (usually the GP).
• Section 136 may be used by police to take someone from a public place to a place of safety and enable the person to be examined by a registered medical practitioner and interviewed by an Approved Social Worker. The person's GP, where known, may be informed.

• Details of guidance and forms for the most common sections of the Mental Health Act can be accessed from the Department of Health website, as well as details of amendments made in the Mental Health Act 2007.
• The Mental Health Act 2007 made a number of amendments to the Mental Health Act 1983. Changes relevant to compulsory detention of individuals with bipolar disorder include:
• Broadening of the range of practitioners who can take on the functions formerly performed by the Approved Social Worker to include nurses, occupational therapists, and psychologists (who are now referred to as Approved Mental Health Professionals, or AMHPs).
• A requirement that young people 16 or 17 years of age refusing admission to hospital for mental health treatment cannot be detained on the basis of their parents' consent, but will need to be formally detained under the Mental Health Act.
• A doctor with previous acquaintance of a patient is 'one who knows the patient personally in his or her professional capacity'. If you are a GP receiving a request for a medical examination under the Act and the person is well-known to one of your GP colleagues within the practice but not to you, the guidance states, 'GPs will need to consider on a case-by-case basis what knowledge they have of the patient, and how useful that knowledge is to the decision-making process'.
• For admission under section 2, where there is no obvious person to provide the second medical recommendation (for example, because the person is not registered with a GP or is not known to local mental health services) another section 12-approved doctor is usually asked to assess the individual. However, in cases where this is not practicable, any registered medical practitioner may provide the second recommendation as long as they do not work in the same hospital as the doctor providing the first recommendation.
• Where someone has been compulsorily admitted under an emergency section 4, this section is usually converted to a section 2 (usually requiring further involvement of the GP).

These recommendations are based on Department of Health guidance for GPs on use of the Mental Health Act 1983 [DH, 2001], amendments made in the Mental Health Act 2007 [DH, 2007a; HMSO, 2007; DH, 2008], and a clinical review, Mental health and the law [Barker, 1997].