Fascinating stuff Tom, your observations highlight several complex issues. Perhaps it should be made clear that a Section136 does NOT authorise psychiatric admission - a S136 is simply a device within the mental health act to mandate assessment by a psychiatrist in a place of safety (places of safety can include a police station, A&E department, or psychiatric reception suite where such services exist). Once S136 assessment is complete further sections under the MHA would need to be invoked if the patient still refuses admission (either Section4, S2, or S3) - as you know these sections require an Approved Social Worker and Section12 approved doctor, as a minimum, before the patient can be forced into hospital. These procedures, while potentially frustrating, provide essential checks and balances when it comes to safe-guarding a patient rights, for example, a decision might be taken to wrestle some poor sod to the ground in order to inject them against their wishes (a thoroughly unpleasant task) - several bodged restraints have resulted in death. http://www.guardian.co.uk/society/2007/feb/16/youthjustice.law Clearly your psychiatric patient needed admission but many other patients also need admitting - perhaps it's akin to taking a patient with severe LVF, say, directly to the medical ward and asking for a bed ? The patient with LVF may well need a bed but only after angioplasty because they are suffering pulmonary oedema after a silent MI. The disturbed psychiatric patient described in your anecdote may well have had a forensic history, for example, and may have benefited from admission to secure psychiatric setting (PICU) rather than the ? acute ward he was taken to.