Section 5(2) Mental Health Act: the doctor's holding power and how to complete Form H1

It's two in the morning. A nurse rings to say an informal patient on the acute ward has packed a bag and wants to leave, and the team are worried about him. You're the doctor on call. This is where the section 5(2) Mental Health Act holding power comes in, and it's one of the few legal powers you'll use in your own name as a new trainee.

I've written this for foundation doctors and core trainees doing their first psychiatry on-calls. By the end you'll know who can use section 5(2), on which patients, how to complete Form H1 so it holds up, and what has to happen in the 72 hours after. I'll also cover the nurse's power under section 5(4), and what the Mental Health Act 2025 does and doesn't change.

This is the law in England as it stood in October 2026. Wales has the same section 5, but its own regulations, forms and Code of Practice: the report there goes on Form HO 12, not H1

Section 5(2) Mental Health Act basics: what the holding power does

Section 5(2) lets the doctor or approved clinician in charge of an in-patient's treatment hold that patient in hospital for up to 72 hours. It isn't a treatment section. It has one job: to keep the patient on the ward while an assessment for detention under section 2 or 3 is arranged.

Four things follow, and I'd know them cold:

• It's a bridge, not a destination. It only makes sense if you think an application under section 2 or 3 ought to be made.

• The clock starts when the report is furnished to the hospital managers. Not when you decide, and not when you sign.

• It gives no power to treat. Part 4 of the Act, which allows treatment without consent, doesn't apply. The patient is in the same position as any informal patient: treatment needs their consent, or the Mental Capacity Act if they lack capacity.

• It can't be renewed. It can be used again on a later occasion if a new situation arises.

Who can use it: the nominated deputy rule

The power belongs to the registered medical practitioner or approved clinician in charge of the patient's treatment. That person may nominate one deputy to act in their absence. The deputy must be a doctor or approved clinician on the staff of the same hospital.

In most hospitals, the nominated deputy out of hours is the doctor on call. The Code allows nomination by job title, and its own example is the junior doctor on call for particular wards. Only one person can hold the role for a patient at any time, and it must be clear who that is. That's how a core trainee or foundation doctor comes to hold the power.

The rules that catch people:

• One deputy at a time. If the on-call doctor is the nominee tonight, the ward's day doctor isn't also a deputy.

• No chains. A nominated deputy can't nominate somebody else.

• No instructions in advance. A consultant can ask the ward to call the deputy if a patient tries to leave. They can't tell the deputy to use section 5(2), and nobody can complete the form ahead of time. The judgement is yours.

• Get advice. If you're not an approved clinician or a section 12 approved doctor, the Code expects you to seek advice where possible. On call, that means the consultant on call, or a registrar who is section 12 approved.

Which patients it covers

The patient must be receiving in-patient treatment and must not already be liable to be detained. That includes informal patients on any ward, medical and surgical wards included. It also includes patients in hospital under a Deprivation of Liberty Safeguards authorisation.

It doesn't cover:

• anyone in the emergency department, or any out-patient;

• a patient already on section 2, 3 or 4, or on a community treatment order;

• someone held in hospital as a place of safety under section 135 or 136.

Step by step: the call to the ward

On the phone

Find out what's happening and how urgent it is. Is the patient trying to leave right now? Why were they admitted, and what are the risks? Ask the nurse to keep talking with them and to encourage them to wait for you.

If the nurse is a mental health or learning disability nurse, they can use section 5(4) if the patient won't wait. Then go. Don't make this decision over the phone.

With the patient

Skim the notes and the latest risk assessment on the way in if you can. Then see the patient yourself. The Code says you should use the power only after examining the patient personally. Start by listening.

"Hi, I'm Dr Shah, the doctor on call tonight. The nurses tell me you want to go home. Can you tell me what's happened?"

"If you left now, where would you go? What would you do?"

Do a focused mental state examination and a risk assessment. Ask about intent, plans and what changed today. Get collateral from the nursing team and the notes.

Then try the less restrictive options. In my experience, many patients agree to stay until morning once they've been heard properly. Sometimes the reason for leaving is fixable: a missed phone call, a pet at home, a row with another patient. Sometimes it's enough to know they'll see their team first thing.

Decide, and ring your senior

Ask yourself two questions. Does it appear that an application under section 2 or 3 ought to be made? And would it be unsafe or impracticable to set that up without holding the patient meanwhile? If both answers are yes, section 5(2) is the right tool.

I'd ring the registrar or consultant before signing, unless the patient is already heading for the door. Then ring them straight after.

Tell the patient

Be honest and plain:

"I'm worried about what might happen if you leave tonight. I'm using a part of the Mental Health Act called section 5(2). It means you need to stay on the ward for now, for up to 72 hours, while we arrange an assessment of whether you need to stay longer. The nurses will give you information about your rights, and you can ask me anything."

The hospital managers must give the patient information about their position and rights under section 132. Make sure the nurse in charge knows that needs doing.

How to complete Form H1

In England, the report goes on Form H1, which is set by the Mental Health (Hospital, Guardianship and Treatment) (England) Regulations 2008. Amendments that came into force on 1 December 2020 added electronic sending to the form. If the copy on your ward has no electronic option, it's an old one.

Part 1 is yours:

1. The hospital. The name and address of the hospital where the patient is now an in-patient.

2. Your name. Printed in full.

3. Who you are. Delete (a) or (b). Option (a) is the person in charge of treatment and (b) is their nominee. Within it, delete doctor or non-medical approved clinician. If you're the on-call nominee, you're (b), as a registered medical practitioner.

4. The patient's name. In full, checked against the wristband and the notes.

5. Reasons. Why informal care is no longer enough. This is the part people read.

6. How you're furnishing it. Internal mail, with the time. Electronic communication, if your hospital managers have agreed to accept it that way. Or by hand to someone authorised to receive it. Delete the ways you didn't use.

7. Signature and date. An electronic signature counts.

Part 2 is completed by whoever receives the form on behalf of the managers. It records how and when it arrived.

Timing matters, because the 72 hours start at furnishing. A report sent by internal mail counts as served the moment it goes into the system. One sent electronically counts as served immediately after it's sent.

Tap to enlarge

Writing the reasons

Informal in-patient since [date], admitted with [presentation or working diagnosis].

Tonight: [what happened, in one or two lines].

On examination: [the mental state findings that matter].

Risk if they leave now: [to self, to others, to health], because [specific evidence].

Less restrictive options tried: [what you offered and how they responded].

I think an assessment for detention under section [2 or 3] is needed, and it is not

safe to allow them to leave while it is arranged.

What goes in the notes

The form isn't the record. In the notes, write the time you were called and the time you saw the patient, your examination and risk assessment, and who you discussed it with. Add your decision, the time the form was furnished, and who you told: the nurse in charge, the Mental Health Act office if it's staffed, and the team.

What the Mental Health Act 2025 changes, and when

The Mental Health Act 2025 received Royal Assent on 18 December 2025. It amends the 1983 Act rather than replacing it, and most of it isn't in force yet. As of 23 October 2026, the commenced parts don't touch the holding powers.

What it will mean for this topic:

• Section 5(2) itself is unchanged. Same 72 hours, same nominated deputy rule.

• The nurse's test in section 5(4) will be reworded. It will ask whether serious harm may be caused to the health or safety of the patient or someone else, unless they're immediately stopped from leaving. That change isn't in force.

• What you're bridging to will change. The section 2 and 3 criteria get a serious harm test, and autism or a learning disability alone will no longer ground a section 3. Neither is in force.

• Form H1 hasn't changed. The current form is still the 2008 one, as amended in 2020.

In the CASC, examiners want the law in force today. Describe section 5(2) as it stands, and mention the reforms as reforms.

What I'd do before your next on-call

• Find out if you're the nominated deputy, and for which wards.

• Know where the Form H1 copies are kept and how your hospital accepts them: internal mail, electronic or by hand.

• When the call comes, go and see the patient. Listen, try to keep them informally, ring your senior, then decide.

• Write reasons that the person reading them at nine the next morning could act on.

If you remember one thing, make it this: section 5(2) buys time for an assessment. Use it for that, start the assessment at once, and end it the moment it's no longer needed.

Raj

References

1. UK Parliament. Mental Health Act 1983, section 5: application in respect of patient already in hospital (c. 20). 1983, revised to October 2026. https://www.legislation.gov.uk/ukpga/1983/20/section/5

2. Department of Health. Mental Health Act 1983: Code of Practice, chapter 18, Holding powers. 2015. https://www.gov.uk/government/publications/code-of-practice-mental-health-act-1983

3. Secretary of State for Health. The Mental Health (Hospital, Guardianship and Treatment) (England) Regulations 2008 (SI 2008/1184), including Form H1. 2008, amended 2020. https://www.legislation.gov.uk/uksi/2008/1184/contents