Section 48 Mental Health Act: urgent transfer from custody to hospital

What is section 48 of the Mental Health Act?

Section 48 lets the Justice Secretary move someone from custody to hospital when they aren't serving a sentence and urgently need treatment for mental disorder. It's done by a warrant called a transfer direction, issued through the Mental Health Casework Section (MHCS).

It matters because a prison healthcare centre isn't a hospital under the Act. Part 4 doesn't apply there, so treatment can't be given under the MHA without consent (Code 22.30). If someone on remand needs that treatment, they have to move.

Who can be transferred under section 48?

It covers people in custody who aren't serving a sentence (s48(2)):

• Remand prisoners. People remanded in custody by a magistrates' court, and others held in prison while their case goes on, usually Crown Court remands and people convicted but not yet sentenced.
• Children on remand. Since 18 February 2026, children remanded to youth detention accommodation are included.
• Civil prisoners. People committed to prison by a court for a limited term who aren't being dealt with under s47.
• Immigration detainees. People held under the Immigration Act 1971 or s62 of the Nationality, Immigration and Asylum Act 2002. Since February 2026 it also covers detention for deportation under s36 of the UK Borders Act 2007, and under the saved EEA Regulations.

Someone serving a sentence goes under section 47 instead, where there's no urgency test.

Section 48 criteria

The Justice Secretary must be satisfied, on reports from two doctors, at least one of them s12 approved (s54(1)), that the person has:

• A mental disorder of a nature or degree that makes detention in hospital for medical treatment appropriate.
• An urgent need for that treatment. This is the test that separates s48 from s47 (Reference Guide 20.3).
• Appropriate medical treatment available to them.

The Justice Secretary must also think the transfer expedient, having regard to the public interest and all the circumstances (s47(1), applied by s48(1)). A learning disability counts only with abnormally aggressive or seriously irresponsible conduct (Reference Guide 20.4).

How a section 48 transfer works: step by step

1. The prison mental health team refers to the right inpatient service. In parallel, it asks MHCS what level of security is likely to be needed.
2. It completes form H1004 and the first medical report, on the MoJ's s48 report form. Each report must give reasons for the urgent need.
3. The receiving service should acknowledge the referral within 3 days, then assess the person and write the second medical report. One of the two doctors must be s12 approved.
4. Both reports go to MHCS with H1004, the case information, a PNC printout, the order of detention and confirmation of a bed.
5. MHCS issues the warrant, or refuses and gives its reasons.
6. The person must be admitted within 14 days of the warrant, or it lapses (s47(2), applied by s48(3)).

NHS England sets two back-to-back 14-day targets: referral to first assessment, then first assessment to transfer. The whole process shouldn't take more than 28 days from referral, and the clock doesn't stop for funding disputes (NHS England, 2021).

Section 48/49: restriction directions

For remand prisoners, the Justice Secretary must add a s49 restriction direction. For civil prisoners and immigration detainees it's optional (s49(1)). It has the same effect as a restriction order (s49(2)).

So leave, transfer and discharge need the Justice Secretary's consent, and the RC must report to MHCS at least once a year (s49(3)). Leave to attend court for the trial is given in writing on admission (Code 22.36).

Treatment and rights on a section 48

• Part 4 applies. A transfer direction has the same effect as a hospital order (s47(3)), so the consent to treatment rules apply as for any detained patient.
• Information. The managers must explain the section and their tribunal rights, orally and in writing, as soon as practicable (s132).
• Advocacy. They're entitled to an IMHA (s130C; Code 6.8).
• The tribunal. They can apply in the first 6 months (s69(2)(b)). After that it's as for a hospital order: once between 6 and 12 months, then once a year (s70).
• What the tribunal can do. It can't discharge a restricted s48 patient into the community. If it finds they'd be entitled to discharge, the Justice Secretary must return them to custody, unless the tribunal recommends they stay in hospital (s74(1)(b) and (4)).
• The nearest relative can't apply to the tribunal for a restricted patient (s41(3)(b)).

How long does a section 48 last?

• Crown Court cases. The transfer direction ends when the court deals with the case, but the court can then make a hospital order or another Part 3 order (s51(2)).
• Magistrates' remands. It ends when the remand period ends, unless they're further remanded or sent to the Crown Court. The court can further remand them in their absence if they've appeared within the last 6 months (s52).
• Civil prisoners and immigration detainees. It ends when their detention would have ended anyway (s53(1)).
• No longer needing hospital. The RC, another AC or the tribunal may tell the Justice Secretary they no longer need hospital treatment, or that none will work. They can then be remitted to custody (ss51 and 53). For a magistrates' remand, the court ends the transfer on the RC's evidence (s52(5)). Civil prisoners and immigration detainees can be remitted only if they're restricted (s53(2)).
• Acquittal or discontinuance. The transfer direction ends. The RC must then discharge them or consider detention under Part 2 (Code 22.66).

Before a return to prison, hold a s117 meeting with the prison team where you can. Guidance aims to complete remission within 14 days (NHS England, 2021).

Section 47 vs section 48

Both need two doctors' reports, one from a s12 approved doctor, and admission within 14 days. Both give a tribunal application in the first 6 months (s69(2)(b)). The exam favourite: an unsentenced prisoner with an urgent need goes under s48, not s47 or s36.

Section 37 after a section 48

When the case is dealt with, the court often has to decide on a hospital order. It should always have the treating clinician's evidence (Vowles, 2015). For s37 it needs two doctors, one s12 approved, and evidence of a bed within 28 days.

If it's impracticable or inappropriate to bring them to court, the court can make a hospital order in their absence. If they're awaiting trial, it can do that without convicting them (s51(5) and (6)).

What changes under the Mental Health Act 2025

• Already in force. Since 18 February 2026, s48 reaches more kinds of immigration detention and children remanded to youth detention accommodation (2025 Act ss36(3)(b) and 38).
• A 28-day limit. New s48A will require the bodies involved to seek to ensure a decision, the direction and admission within 28 days of the first request for a medical report. DHSC expects it by December 2027.
• No excuses for shortages. A shortage of beds or staff won't count as exceptional, unless it results from other exceptional circumstances (s48A(5)).
• Remand for own protection. Adults won't be remanded in custody solely for their own protection on mental health grounds. That has no start date yet (2025 Act).

Section 48 of the Mental Capacity Act

If you searched for s48 of the Mental Capacity Act 2005, that's a different power. It lets the Court of Protection make interim orders or directions while an application is pending. There must be reason to believe the person lacks capacity in a matter within the court's powers, and acting without delay must be in their best interests.

Tips for the prison in-reach team

• Write the urgency down. The report form asks for your reasons. Say what's happening without treatment, and how fast it's getting worse.
• Call MHCS early, alongside the referral, about the security level it's likely to want.
• Don't let funding hold it up. Unknown responsibility isn't a reason to delay a transfer (NHS England, 2021).