Mental Health Act 2007 Transport Guide

Introduction: Why MHA Transport Is Different

The Mental Health Act 1983 (substantially amended in 2007) provides the legal framework for the compulsory detention and treatment of people with severe mental disorders in England and Wales. For NHS commissioners and transport providers, understanding which powers apply — and what they require — is not just a legal compliance issue. It directly shapes how a transport booking is assessed, staffed and delivered.

Transporting a detained patient is qualitatively different from non-emergency patient transport (NEPTS). The patient may be acutely unwell, physically and verbally challenging, and their legal status determines what actions the crew can lawfully take during the journey. A crew that does not understand the distinction between an informal patient (who has capacity and consents) and a detained patient (whose movement is authorised by law) may inadvertently breach patient rights or expose the commissioner to liability.

This guide covers the five most common transport scenarios under the MHA 2007: S135 warrant execution, S136 Place of Safety conveyance, S2 (assessment) transfers, S3 (treatment) transfers, and transport of informal (voluntary) mental health patients.

Section 135 — Warrant to Enter and Remove

Section 135 authorises a magistrate's court to issue a warrant allowing an Approved Mental Health Professional (AMHP) and a police officer to enter premises and remove a person believed to have a mental disorder to a Place of Safety. There are two sub-types:

• S135(1):Person believed to have a mental disorder, living alone or unable to care for themselves. Initial entry to assess. Used to convey to a Place of Safety for assessment. Maximum detention: 24 hours (extendable to 36 hours by a doctor).
• S135(2):Used to retake a patient who is already subject to a section (e.g. S2 or S3) and has gone AWOL. The warrant allows entry to premises to retake and convey back to hospital.

Transport requirements: An AMHP and police officer must accompany the patient (or at minimum be present at the premises). Specialist transport is commissioned to provide the vehicle and clinical crew for conveyance from the premises to the Place of Safety or receiving hospital. The transport crew does not execute the warrant — police retain legal authority on the premises.

Clinical considerations: Patients being removed under S135 are often in a highly distressed state. De-escalation skills are critical. PMVA training and experience in managing acute mental health crisis are essential for the transport crew.

Section 136 — Removal from a Public Place

Section 136 gives police officers (and, since 2017, certain other authorised persons) the power to remove a person from a public place to a Place of Safety when they appear to be suffering from a mental disorder and to be in immediate need of care or control. S136 is the most commonly used MHA power in specialist transport.

• Duration: 24 hours from arrival at the Place of Safety, extendable to a maximum of 36 hours by a doctor (not an AMHP).
• Place of Safety: Under the Policing and Crime Act 2017, police custody can only be used as a Place of Safety in exceptional circumstances for adults, and is prohibited entirely for under-18s. Health-based S136 suites are the preferred destination.

Transport requirements: The transport crew must be able to:

• Assess and manage clinical risk during conveyance
• Apply de-escalation techniques
• Use physical intervention (restraint) only as a last resort, in line with BILD RRN standards
• Complete a clinical observation record during transport
• Handover formally to the Place of Safety clinical team
• Complete MHA documentation at handover

Key provider requirement: All crew deployed on S136 transport should hold BILD ACT RRN PMVA accreditation and Safeguarding Level 3 minimum (Level 4 recommended for providers working regularly with detained patients).

Section 2 — Admission for Assessment

Section 2 authorises compulsory admission to hospital for assessment (or assessment followed by treatment) for up to 28 days. An application is made by the nearest relative or an AMHP, supported by two registered medical recommendations.

Transport to hospital: The applicant (typically the AMHP) is responsible for ensuring transport to hospital is arranged. The patient is a detained person from the time the S2 application is made — even before arrival at hospital. A patient who refuses to travel is legally subject to the detention — they can be conveyed to hospital without their consent (but physical restraint should be a last resort, and documented).

Clinical level required: S2 transport should be staffed by crews trained in mental health and familiar with MHA documentation. The transport crew should receive a written clinical handover from the AMHP or responsible doctor before departure, including relevant risk information.

Section 3 — Admission for Treatment

Section 3 authorises compulsory admission to hospital for treatment. Unlike S2, it has no fixed time limit but must be renewed every 6 months. Transport scenarios include:

• •
  Initial admission under S3: Transport from the assessment location to the receiving hospital. Similar requirements to S2 transport.
• •
  Inter-hospital S3 transfer: Transfer between hospitals — for example, step-up to PICU, or transfer to a specialist service. The responsible clinician at the sending hospital must authorise the transfer. A S3 patient retains their detained status during inter-hospital transfer.
• •
  Leave of absence (S17) return: If a patient on S3 fails to return from authorised leave, the Responsible Clinician can recall them. Specialist transport may be commissioned to return the patient from community to hospital.
• •
  AWOL retrieval: A patient absent without leave under S3 can be retaken by authorised persons (including transport staff acting under the direction of an AMHP or police) and returned to hospital.

Informal (Voluntary) Mental Health Patients

An informal patient is someone admitted to a mental health unit voluntarily — they have not been detained under the MHA and retain the right to refuse treatment and, in principle, to leave. In transport terms, informal patients present a different legal and clinical picture:

• They cannot be physically restrained if they wish to leave the vehicle (except in very limited circumstances where DoLS or MCA applies)
• They must consent to transport — if they withdraw consent during the journey, the crew faces a clinically and legally complex situation
• Any use of force against an informal patient who retains capacity is potentially unlawful
• If an informal patient's capacity deteriorates during transport and they pose an immediate risk to themselves or others, the crew should contact the clinical team immediately and consider whether the MCA 2005 best interests provisions apply

Practical implication for commissioners:Do not assume that “mental health transport” automatically means the patient is detained. Always confirm the legal status of the patient at the point of booking, and ensure the transport provider has the clinical training to recognise and respond appropriately to the differences.

The Mental Capacity Act 2005 — How It Interacts

The Mental Capacity Act 2005 (MCA) runs alongside the MHA and is crucial in transport contexts. For informal patients who may lack capacity:

• A best interests decision can authorise transport even without the patient's explicit consent, provided the patient lacks capacity and the transport is in their best interests
• The Deprivation of Liberty Safeguards (DoLS) — or its replacement, the Liberty Protection Safeguards (LPS) when enacted — may be required if the transport constitutes a deprivation of liberty
• Transport staff are not authorised to make DoLS authorisations — these must be arranged by the responsible authority before transport
• If a patient has a valid Lasting Power of Attorney (LPA) for health and welfare, the attorney's decisions must be respected (within their scope)

Transport crews working in mental health settings should have a working understanding of MCA capacity assessment principles and the concept of best interests — not as legal experts, but sufficiently to recognise when a patient may lack capacity and to escalate appropriately.

CAMHS and Under-18 Specific Provisions

Transport of children and young people under the MHA has specific additional requirements:

• S136 — children: Police custody is prohibited as a Place of Safety for under-18s under the Policing and Crime Act 2017. Health-based Places of Safety are mandatory.
• Age-appropriate environments: Section 131A of the MHA requires that under-18s admitted to hospital under the Act must be accommodated in an environment appropriate to their age and needs. This affects transport: the vehicle and crew should be appropriate for a young person.
• Additional safeguarding: All crew working with under-18s must hold Enhanced DBS on both barred lists and Safeguarding Level 4. A parent or responsible adult should be offered the opportunity to accompany the young person wherever clinically appropriate.
• CAMHS-trained crew: Providers should be able to demonstrate crew-specific training in working with children and young people in mental health crisis — this goes beyond standard safeguarding training.

Commissioner Requirements — Evidence Checklist

When commissioning MHA transport, commissioners should require evidence of the following from every provider:

• Written MHA transport policy, reviewed annually, covering all relevant sections (S135, S136, S2, S3, informal, CAMHS)
• Staff training matrix demonstrating MHA awareness training for all clinical crew
• PMVA/restraint training record with expiry dates for every crew member
• Safeguarding training levels (Level 4 for staff regularly working with detained or high-risk patients)
• Enhanced DBS records for all clinical staff
• Documentation templates for each transport type (clinical observation record, MHA handover form, incident report)
• Serious incident process for any use of force or restraint during MHA transport
• Named clinical lead with responsibility for MHA transport governance
• CQC registration (ambulance service regulated activity) — verifiable at cqc.org.uk
• Quarterly commissioner reporting including any MHA-specific incidents, response times and patient feedback