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The purpose of this paper is to review policy or guidance on the implementation of Section 5(4) written by NHS mental health trusts in England and health boards in Wales.

A Freedom of Information request was submitted to all trusts in England (n=57) and health boards in Wales (n=7) asking them to provide a copy of any policy or guidance on the implementation of Section 5(4). Documents were analysed using content analysis. Specific attention was given to any deviations from the national Mental Health Act Codes of Practice.

In total, 41 (67.2 per cent) organisations had a policy on the implementation of Section 5(4). There was a high level of consistency between local guidance and the Mental Health Act Codes of Practice. There were however; different interpretations of the guidance and errors that could lead to misuse of the section. Some policies contained useful guidance that could be adopted by future versions of the national Codes of Practice.

The research has demonstrated the value of examining the relationship between national and local guidance. Further research should be undertaken on the frequency and reasons for any reuse of the section.

Greater attention should be given to considering the necessity of local policy, given the existence of national Codes of Practice.

This is the only research examining the policy framework for the implementation of Section 5(4).

The draft Mental Health Bill 2004 proposes transfer of the main monitoring functions of the Mental Health Act Commission (MHAC) to the Healthcare Commission (or in practice whatever body succeeds the Healthcare Commission) with the abolition of the MHAC on implementation of the Bill when enacted. This paper describes the present role and remit of the Mental Health Act Commission, outlines the government's strategy on inspection and regulation and identifies the importance of protecting the rights of vulnerable adults and children with mental disorders. The reasons for retaining independent scrutiny and inspection of mental health services are explored and structures and mechanisms that might assist in achieving an effective regulatory environment are proposed.

This paper aims to conceptualise the residential and psychiatric hospital as a space where criminality and social harms can emerge. Because of recent media scandals over the past 10 years concerning privately-owned hospitals, this study examines the lived experiences of service users/survivors, family members and practitioners to examine historic and contemporary encounters of distress and violence in hospital settings.

The study consists of 16 biographical accounts exploring issues of dehumanising and harmful practices, such as practices of restraint and rituals of coercive violence. A biographical methodology has been used to analyse the life stories of service users/survivors (n = 9), family members (n = 3) and professional health-care employees (n = 4). Service users/survivors in this study have experienced over 40 years of short-term and long-term periods of hospitalisation.

The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. Practitioners recalled comprehensive experiences of violence within historic mental hospitals, although violence that may be considered criminal appeared to disappear from hospitals after the Mental Health Act (1983). These reports of criminal violence and coercive abuse appeared to be replaced with dehumanising and harmful procedures, such as practices of restraint.

The data findings offer a unique interpretation, both historical and contemporary, of dehumanising psychiatric rituals experienced by service users/survivors, which are relevant to criminology and MAD studies. The study concludes by challenging oppressive psychiatric “harms” to promote social justice for service users/survivors currently being “treated” within the contemporary psychiatric system. The study intends to conceptualise residential and psychiatric hospitals as a space where criminality and social harms can emerge. The three aims of the study examined risk factors concerning criminality and social harms, oppressive and harmful practices within hospitals and evidence that violence occurs within these institutionalised settings. The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. These reports of violence include dehumanising attitudes, practices of restraint and coercive abuse.

We describe how Supervised Discharge (Section 25) of the Mental Health Act 1983 was used to promote mental health care in the community for a man with mild learning disabilities and paranoid schizophrenia who has had repeated relapses and hospital admissions. The new compulsory Community Treatment Order in England and Wales introduced by the Mental Health Act 2007 is explored in comparison with Section 25 Supervised Discharge, which it has now replaced, and compared with similar legislation already introduced in Scotland. The practice implications of the new supervised community treatment orders are discussed.

The current role of the approved social worker (ASW) will be changed to that of the approved mental health practitioner, who may be a nurse or other mental health professional, if proposed legislation comes into force in England and Wales. This has implications for service users, carers and the mental health workforce. This article draws on literature and a conference discussing this change attended by practitioners and policy‐makers. It considers the complexity of the ASW role and the implications for the AMHP, and sets the related issues in the context of integrated working.

There are a great many people with mental health problems receiving treatments that are aimed primarily at managing aggressive or challenging behaviours by means of sedation, seclusion or restraint. The management of these behaviours is frequently justified under Part IV of the Mental Health Act 1983, which permits treatments ‐ without consent if necessary ‐ for a person's mental disorder. Alternatively, the behaviours have been managed at common law on the basis that the patient is incapable of giving a legally effective consent to behaviour management and the interventions are considered to be in the person's best interests. This article considers the management of difficult behaviours in adults with mental health problems. This issue is particularly timely as there have been a considerable number of legal challenges in this area in recent years. This article reviews the practical contexts in which behaviour management, which here covers sedation, seclusion and restraint, is used with adults with mental health problems and explores the legal justifications for these interventions. Although the justification for the management of challenging behaviours is frequently asserted (or, more likely, presumed) to be therapeutic, a review of the research literature and recent case law casts doubt on the credibility of this therapeutic justification.

One of the main features of the reform of the Mental Health Act 2007 was the introduction of community treatment orders (CTOs). CTOs represent a fundamental shift in the rights of people with severe mental health problems, who have been detained in hospital under section 3 of the Mental Health Act and subsequently discharged. The call for the introduction of CTOs or similar legislation has been a feature of mental health policy over the past 20 years. Despite the detailed discussion of the relationship between ethnicity and psychiatry, there has been very little attention paid to the way that race was a factor in the community care scandals of the 1990s. This article, through the consideration of two very high profile cases ‐ Christopher Clunis and Ben Silcock, explores the media's influence on the construction of the debate in this area. In particular, it explores the way that the media reporting of the two cases had a role in not only perpetuating racial stereotyping, but also the stigmatising of those experiencing acute mental health problems. In addition, with the use of government papers obtained under the Freedom of Information Act, it considers the response to and the attempts to influence the media debate at that time.