Sunday, 6 June 2010

This Much I Know Part 1: (Not Necessarily Reliable) Advice from an Old AMHP to a New AMHP

I have now corrected the section on transporting to hospital so that it now actually makes sense.
It is not always necessary to arrange two doctors before attending a MHA assessment.
• I know that quite a lot of AMHP’s will automatically arrange for two doctors to attend when receiving any request for an assessment under the MHA. While this can sometimes save time, it can also cause delays – I know that I’ve often spent an hour or two trying to locate a Sec.12 doctor, and sometimes have not managed it at all.
• There are often occasions when an initial assessment by the AMHP can obviate the need for doctors to attend – remember, you are an AMHP, therefore you are the one making a final decision. If you make the initial assessment and conclude that the patient is not detainable, or there is a clear alternative, or the patient is willing to have an informal admission, then those two medical recommendations would be irrelevant.
• It’s obviously more difficult if you have a long way to go, but if the patient is just round the corner, perhaps in the local police station, then you are in an ideal position to make a rapid decision as to whether or not it is appropriate to use the MHA.
• (And yes, I know that a doctor and an AMHP have to assess a patient detained under Sec.136 – but if the Forensic Medical Examiner has seen the patient you don’t necessarily need a second doctor in order to make your own assessment. There’s been many a time when someone detained under Sec.136 in a police station overnight has no detectable mental disorder when assessed in the morning, by which time they’ve sobered up and have nothing more serious than a bad headache.)

The top of a wheelie bin can provide a good surface for completing the section forms.

Know when to make a strategic retreat.
• Someone I was assessing under the Mental Health Act in their home at one point said to the psychiatrist and me:
“I will count to 10. If you are still in my house by then, I will kill you.”
We left.

Be creative when arranging for transport to hospital.
• While it is usually best for a patient to be transported in an ambulance, especially if they have been formally detained, there are many factors to consider. At least in the area I work, it can sometimes take 2 hours or more for an ambulance to actually turn up. This delay may not necessarily be in the best interests of either the patient or their relatives. There are many occasions when I have had to work very hard to keep the patient or their relatives calm while waiting for transport.
• Consequently, taking into account Para 11.2 of the MHA Code of Practice (“Patients should always be conveyed in the manner which is most likely to preserve their dignity and privacy consistent with managing any risk to their health and safety or to other people") as well as Para 11.21 (“AMHPs should not normally agree to a patient being conveyed by car unless satisfied that it would not put the patient or other people at risk of harm and that it is the most appropriate way of transporting the patient.“), at times I have taken the professional decision to transport the patient by car (but always with at least one escort, and preferably two).
• If you do decide that it is appropriate to transport the patient by car, I would recommend that the patient sits in the back seat behind the front passenger seat, with the escort beside them.

When interviewing a patient, make sure you are sitting between the patient and the door
• In case you need to make a quick exit.

Section 4 does have its place
• I’ve given a number of examples of my use of Section 4 in the blog. In every case it has been out of dire necessity rather than choice.
• A Section 4 can save time, but only if you have identified that it is a genuine emergency and obtaining a second doctor would involve undesirable delay.
• It should never be seen as expedient or a “quick fix”.

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