Detention and responsibility

I was recently struck by how pernicious the word ‘sectioned’ is. A little past participle referring to putting a person under the psychiatric lock and key, instead of referring to (psychiatric) detention, it refers to a section of the Mental Health Act. So I wondered how psychiatrists themselves talk about it. And this is what I want to write about it today.

The Royal College of Psychiatrists has a webpage called ‘Being sectioned’, which I take as the ‘definitive guide to detention’ (in England and Wales). And from a linguistic point of view the document didn’t disappoint.  This is because of the extent to which the document hides responsibility for detaining a person.

But before I comment on this, I’d like to make a little point about the format – questions and answers. I dislike it, because I find it highly improbable that anyone would ask a question: “Why may I be detained?” or “Who decides that I need detaining?” In what context would you ask such a question? By inventing these questions, RCPSych seems to suggest that they are so common that the chief-shrinks must (helpfully) provide the answers to them. Incidentally, if people do ask these questions commonly, there is something wrong with psychiatry in this country!

Anyway, I might be overstating it, but FAQs belong to the customer services departments of shops or, perhaps, other institutions that you want to engage with for one reason or another.  No one wants to go a psychiatrist ask them the question: Hey, how can I get detained?

The other consequence, and more pernicious, is that the format allows the writer to focus on the questioner and not on the detaining party. In the process it also allows the writer to come up with the, quite frankly, idiotic question “Who decides that I need detaining?”. I mean – really? I don’t know many people who were ‘sectioned’, still none ever thought they ‘needed detaining’. How likely is a person to say:

I need detaining!

Let’s get real here, hey?  I will come back to this point later.


So, when I first looked at the document, I was struck how much passive voice there is in it. Just from the first few sentences:

  • Being sectioned means being admitted to hospital whether or not you agree to it.
  • You are detained under the Mental Health Act.
  • The paragraph or ‘section’ number is often used so a patient may be told they are on a section 2 or section 3.
  • The Mental Health Act is used about 50,000 times a year in England and Wales. This isn’t 50,000 people because some people may be detained several times within a year.

It’s important because passive voice has the capacity to hide the agent, the ‘doer’ of the action referred to. Compare two sentences, in active and passive voice, respectively:

  • John has hit Ben.
  • Ben has been hit.

While potentially referring to the same situation, the latter sentence hides the ‘hitter’, which might be useful from the speaker’s communicative and social goals. Indeed, there is plenty of evidence such tactics are used in media communication for persuasive reasons. And so, coming back to the excerpts from the web document, the first sentence hides who sends/admit ‘you’ to the hospital, then – who detains you, who uses the act, who tells the patient and so on and the like. In other words, the author of the document hides all those people who stand between ‘you’ and your detention. To reinforce it, when I read a sentence like:

then a magistrate can give permission for your home to be entered

I wonder why I am not being told who will be doing the entering. Of course it’s not only passive voice which can hide agency. If you take a sentence like:

The term ‘sectioned’ just means using a ‘section’ or paragraph from the Mental Health Act as the authority for your detention.

The sentence is in active voice (I shall spare you the parsing), yet, note that the verb ‘using’ hasn’t got anyone who might be doing the using or getting the authority. The sentence refers to using as if using a MHA can just happen, without the user.

And so, I started wondering precisely about this – how is responsibility for detention constructed? I looked for references to all those people who detain ‘you’. The findings are quite interesting as, it seems, no one actively does anything. Here are all the references to MH professionals in the section “Who decides I need detaining?”:

  • The process usually starts because your GP, a family member, a police officer or psychiatrist is worried about your mental health.
  • The decision is usually made (other than in an emergency) by two doctors and an Approved Mental Health Professional (AMHP).
  • One of the doctors must be specially certified as having particular experience in the assessment or treatment of mental illness.
  • If possible, one of the doctors will already know you.
  • The AMHP is usually a social worker, but could be a mental health nurse, psychologist or occupational therapist.

Have you noticed that no one actually decides? Let us look at it in some detail. The first sentence is about ‘the process’ which ‘starts’ and if you wanted to see a wonderful linguistic sleight of hand, there you are. No, the process doesn’t just start – a person starts it, for pity’s sake! The reference to people is:

GP, a family member, a police officer or psychiatrist is worried

You almost want to hold their hand, don’t you? Poor little things worrying sick about me as the process starts on its own. I am also quite uncomfortable with the fact that such a potentially life-changing decision regarding my life is made on the basis of someone ‘worrying’. I really would hope for some rational assessment here, underpinned by concern, yes, but still, a rational assessment!

The crucial sentence, the one about people deciding, is actually not about it at all. It is about a decision. The previous sentence was about a process and all of a sudden we jump to ‘the decision’. Where did that come from? And as we focus on the ‘deus-ex-machina’ decision we learn that is made. The following two sentences describe the doctors and the AMHP whose only activity seems to know you. And that’s it.

You might wonder whether it matters, after all, at least in these sentences we seem to get all the information we need. And so, yes, it does matter. Instead of writing about people doing things, RCPsych prefers to write about a depersonalised process which happens on its own. But in ‘real life’ it doesn’t. A person, worried or not, takes a decision to ‘start the process’, someone evaluates it, someone then takes the decision to detain. Simple. But in the RCPsych’s document the doctor is at best a facilitator of the process and not the pivotal part thereof.  Moreover, I suspect (and only suspect) that the form of this document results from the wish to make ‘the process’ more objective, devoid of any whims of any psychiatrists, who, I suppose, are not best loved. But it results in a text which is disingenuous and seems to hide responsibility. So how about writing something like this. Recall, finally,  the question-answer format and the questions which focus on the questioner. They allow the writer to avoid focusing on themselves!  Imagine, however, if the question were different. If the hypothetical questioner asked:

What do you do?!

Indeed, what’s wrong with saying that three people sit down, hopefully, discuss the case, and say something equivalent to:

We hereby (issue in an order to) detain …

There is no ‘process’, there are people, who, on behalf the disciplinary state, lock me up, hopefully, for good reasons. In the document the chief shrinks seem not to be willing to simply take responsibility for doing things. In fact, let me try and come up with the replacement of the section:

Usually your GP, a family member… thinks you need (extraordinary) psychiatric help and they suggest (apply) that you should be detained. Then two doctors and an AMHP consider the application on its merits, take into account both your situation and what the applicants told them and they decide whether you should be detained. They understand how important such a decision is and never take it lightly, in fact, it’s always the last resort. They always act on what they consider to be your best interest.

I wrote this in about 20 seconds and it is far from ideal, finished, complete, in brackets I suggested options. What I tried to render is responsibility for what people do. I also tried to show that it is not a ‘process’, heartless and soulless in which decisions appear and ‘are made’. I tried to show that it involves people who think and are on ‘your’ side. I also tried to show that detention is not ‘run-of-the-mill’ thing, it’s extraordinary, as it should be.  And yes, I also tried to suggest that someone cares.

Is that too much to ask?

(I’m not done with the document. I will come back to it, though perhaps not immediately.)

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