Telling people their rights is a legal duty, not a courtesy.
What are section 132 rights?
Section 132 makes the hospital managers take practicable steps so a detained patient understands which section they're on, what it means, and their rights to apply to the tribunal. It must happen as soon as practicable after detention under that section starts (s132(1)).
They must also explain, as far as relevant, discharge and barring, the consent to treatment rules, the Code, 's role and correspondence (s132(2)). All of it must be given out loud and in writing (s132(3)).
What must the reading of section 132 rights include?
- Their section. Which one, what it means, the reasons for it, the essential legal and factual grounds, and the maximum length of the current period (Code 4.13 to 4.15).
- How it ends. That it can end at any time if it's not needed, won't end or renew automatically, and who can discharge them (Code 4.14, 4.21).
- Review. Their right to ask the managers for discharge, to apply to the tribunal, and to free legal advice (Code 4.21, 4.22).
- Treatment. When they can be treated without consent, when they can refuse, the 's role, and the rules where relevant (Code 4.20). See consent to treatment.
- Help and complaints. That an can help and how to get one, CQC's role, and how to complain (Code 4.13, 4.25, 4.26).
- Post. That letters can be withheld if the person they're addressed to asks (Code 4.27).
Offer a copy of the detention papers too, unless the managers, on the authors' advice, think it would harm the patient or others (Code 4.16). Reading the leaflet aloud isn't enough to count as telling them (Code 4.11).
How often should section 132 rights be read?
There's no fixed interval. Give the information when detention starts, and again whenever the section changes, for example from s2 to s3 or onto a (s132(1); Code 4.17). Then remind patients from time to time, and repeat it once someone who was very unwell has improved (Code 4.28).
The Code says consider a fresh explanation when (Code 4.29):
- The tribunal is in view. They're thinking of applying, or become eligible again.
- They ask for discharge. Or the managers refuse a request.
- Treatment rules change. For example at three months, or when they regain capacity.
- Big decisions are due. A CPA review, a major change in treatment, renewal, or recall or revocation of a CTO.
Record each time, what you covered and whether they understood. If they lack capacity to decide whether to seek a review, introduce an IMHA (Code 4.23).
Section 132 rights for CTO patients
For CTO patients the duty is in s132A. The managers must explain the effect of the CTO and the tribunal rights, out loud and in writing, as soon as practicable after it starts. That includes the conditions and when they can be recalled (Code 4.13).
On recall, the managers must tell them which provisions they're held under and how the consent to treatment rules apply (reg 6(7)). The should give oral reasons for recall beforehand where possible (Code 4.18).
What the nearest relative is told
The nearest relative gets a copy of written rights information unless the patient objects (s132(4), s132A(3)). Tell the patient this will happen, so they can say what they're happy to share (Code 4.32).
The managers must tell the nearest relative about discharge, if practicable at least seven days ahead, unless the patient or relative has asked them not to (s133). They're also told about renewal, CTO extension and transfer (reg 26; Code 4.34).
These duties aren't absolute. Don't share if the harm to the patient would outweigh the benefit, especially where the relative isn't someone they'd have chosen (Code 4.35, 4.36). See the nearest relative.
What is an IMHA?
IMHA stands for independent mental health advocate. IMHAs are specialist advocates trained to work within the Mental Health Act. The local authority commissions them, and they should be independent of anyone involved in the patient's treatment (s130A; Code 6.3).
An IMHA isn't the same as an IMCA under the , though one person can be qualified for both (Code 6.4, 6.5). Having an IMHA doesn't affect the patient's right to a lawyer or to legal aid (Code 6.14).
Who can have an IMHA?
| Qualifies | Doesn't qualify | |
|---|---|---|
| Detained patients | Anyone liable to be detained, including on s17 leave or , and Part 3 patients | Section 4 before the second recommendation, s5(2), s5(4), s135 and s136 |
| In the community | CTO, guardianship and conditionally discharged restricted patients | Patients discharged from the Act |
| Informal patients | Being considered for a s57 treatment, or under 18 and being considered for ECT or another s58A treatment | Other informal patients, for now |
Age doesn't matter (Code 6.8). Patients can decline help, or end it at any time (s130B(6); Code 6.25).
What does an IMHA do?
- Explains. Their rights, the section they're on, any conditions, their treatment and why, and the legal authority for it (s130B(1), (2)).
- Represents. Helps them use their rights, for example at review meetings or managers' hearings, or with a tribunal application (Code 6.13).
- Visits in private. Meets the patient privately, and can talk to anyone professionally involved in their treatment (s130B(3); Code 6.28).
- Sees records. With the patient's consent. If they lack capacity, the record holder should usually allow access where it's in their best interests (s130B(4); Code 6.35, 6.38).
How to get an IMHA
The managers must make sure detained patients understand that IMHA help exists and how to get it, out loud and in writing, as soon as practicable. For CTO patients it's the responsible hospital's managers, for guardianship the council, and for conditional discharge the RC (s130D; Code figure 4).
A patient can ask for an IMHA at any time, and should have private access to a phone to contact the service (Code 6.21, 6.26). An IMHA must comply with a reasonable request to visit from the nearest relative, an or the RC (s130B(5)).
If a patient lacks capacity to decide whether to have an IMHA, ask one to visit and explain (Code 6.16, 6.23). Don't request one if you know they don't want it (Code 6.24).
Can patients' letters be withheld?
Only in narrow cases. Outgoing post can be withheld if the person it's addressed to has asked in writing. Wider powers over post in and out exist only in high security hospitals. Those never cover post to or from bodies such as the tribunal, CQC, MPs, the managers, advocacy services or the patient's lawyer (s134).
CQC and complaints
CQC keeps the use of the Act under review, and visits and interviews detained, CTO and guardianship patients in private (s120). It investigates complaints about how powers and duties under the Act are used, and appoints SOADs (s120(4), s58).
Tell patients about CQC and when it's visiting, and support them to complain without fear for their care (Code 4.25, 4.54). Complaints usually start locally. Those about care under the Act can go to the provider, the commissioner or CQC, then the Parliamentary and Health Service Ombudsman (Code 4.55, 4.60). An IMHA can help (Code 4.66).
What's changing under the 2025 Act
The 2025 Act will make IMHA referral opt-out for detained patients, with advocacy services arranging to see them, and give informal inpatients in England a right to an IMHA. It will also add a duty to explain how to complain. None of this is in force yet (2025 Act ss40, 41 and Sch 3).
The rules in brief
- Information (s132). Detained patients must be told their rights, out loud and in writing, as soon as practicable, and again when things change. The nearest relative gets a copy unless the patient objects.
- IMHA. Detained, CTO, guardianship and conditionally discharged patients qualify. Not s4 before the second recommendation, s5, s135 or s136. Informal patients qualify if they're being considered for s57, or for ECT when under 18.
- Complaints and monitoring. CQC monitors how the Act is used, appoints SOADs and handles complaints about powers.
- Coming. The 2025 Act will make IMHA referral automatic for detained patients and extend it to informal inpatients in England.
Read more: MHA 1983, s132 · MHA 1983, s130C · MHA Code of Practice 2015, chapter 4: Information for patients, nearest relatives, carers and others · MHA Code of Practice 2015, chapter 6: Independent mental health advocates
Questions trainees ask
Who can have an IMHA?
Most detained, , guardianship and conditionally discharged patients. Not those on s4 before the second recommendation, s5, s135 or s136.
What does IMHA stand for in mental health?
Independent mental health advocate. An is a specialist advocate who helps patients under the Mental Health Act understand and use their rights.
What does an IMHA do?
Explains the patient's section, rights and treatment, and helps them use those rights, for example at managers' hearings or with a tribunal application. They can meet the patient in private and see records with consent.
What are section 132 rights?
The information the hospital managers must give a detained patient about their section, what it means and their right to apply to the tribunal. It must be given out loud and in writing, as soon as practicable.
How often should section 132 rights be read?
There's no fixed interval. Give them when detention starts and whenever the section changes, then remind patients from time to time and at key points such as renewal or a tribunal application.
Do CTO patients get section 132 rights?
Yes, under s132A. The managers must explain the CTO, its conditions and recall, and the right to apply to the tribunal, out loud and in writing.
Can a patient refuse an IMHA?
Yes. Nobody has to accept an IMHA's help, and a patient can end it at any time.
Test yourself
Quick-fire
Which of these patients has no right to an IMHA?
Show the answer
Section 136