Detaining patients in the general hospital – current practice and pitfalls

2019 ◽  
Vol 64 (3) ◽  
pp. 91-96
Author(s):  
Murray Smith ◽  
Rian O’Regan ◽  
Rainer Goldbeck
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Current Practice ◽  
Electronic System ◽  
Royal Infirmary ◽  
General Hospitals ◽  
Out Of Hours ◽  
Mental Health Act ◽  
Written Information ◽  
Psychiatric Staff

Aims Much has been written about the use of the Mental Health Act in psychiatric settings. There is, however, little written on its use to detain patients with mental disorder in general hospitals. Method and results We therefore carried out a survey of the use of the Mental Health Act in general hospital settings in Aberdeen, and also posted a questionnaire to Scottish Liaison Psychiatrists, asking about their experience of the use of the Mental Health Act in general hospitals. Over a six-month period in Aberdeen Royal Infirmary, we identified 39 detentions. Out of hours, the use of Emergency Detention Certificates was more common than use of Short Term Detention Certificates – the latter is recommended by the Mental Welfare Commission, as patients are afforded more rights. When psychiatric staff were not directly involved, procedural and administrative errors were more likely to occur. Liaison psychiatrists elsewhere in Scotland reported similar observations. Conclusion General hospital clinicians are unfamiliar with the Mental Health Act and its use. Errors in its application therefore arise, and are more common when psychiatric staff is not involved. Better education, including the provision of written information and consideration of an electronic system, may improve current practice.

scholarly journals A survey of general hospital in-patients detained under Section 5(2) of the 1983 Mental Health Act

1996 ◽  
Vol 20 (12) ◽  
pp. 733-735 ◽  
Author(s):  
Christopher Buller ◽  
David Storer ◽  
Rachel Bennett
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Conversion Rate ◽  
Psychiatric Hospitals ◽  
Patient Characteristics ◽  
Rare Occurrence ◽  
General Hospitals ◽  
Code Of Practice ◽  
Mental Health Act

Detention of general hospital in-patients under Section 5(2) is a rare occurrence. This study of the use of Section 5(2) in general hospitals uncovered a frequent neglect in following the guidelines of The Mental Health Act and The Code of Practice. Surprisingly the conversion rate of Section 5(2) to Section 2 or 3 was similar to that seen in a number of other studies conducted in the quite different setting of large psychiatric hospitals. A number of patient characteristics were identified that appeared to influence whether 5(2)s were converted to an admission Section. Each general hospital needs to develop guidelines to be followed when staff feel that a patient should be detained under Section 5(2) – an example of such a policy is included.

scholarly journals The psychiatry virtual-on-call experience: Can it improve confidence of foundation and GP trainees with out-of-hours work in psychiatry?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S28-S29
Author(s):  
Charlotte Harrison ◽  
Helen Blamey ◽  
Alistair Roddick ◽  
Kate Saunders ◽  
Tina Malhotra
Keyword(s):  
Mental Health ◽  
Interpersonal Communication ◽  
Multiple Testing ◽  
Learning Experience ◽  
Junior Doctors ◽  
Out Of Hours ◽  
Mental Health Act ◽  
Telephone Advice ◽  
Introductory Lecture ◽  
Perceived Preparedness

AimsOut-of-hours (‘on-call’) work can be perceived by junior doctors to be a daunting experience, associated with feeling unprepared and less supported. Simulated on-call programmes have been used to great effect in medicine and surgery to improve junior doctors’ skills in task prioritisation, interpersonal communication and confidence on-call. However, few psychiatry-specific programmes exist.We aimed to: i) Develop a psychiatry specific virtual-on-call programme, ii) Investigate if the virtual-on-call programme improved confidence amongst junior trainees in key areas of psychiatry practice.MethodThe Psychiatry Virtual-On-Call programme commenced in December 2020. It involves attending an introductory on-call lecture, followed later in the rotation by a 2-hour simulated on-call shift. All trainees are expected to attend during their attachment and the simulated shifts are ongoing. During the shift, trainees are ‘bleeped’ with different psychiatry specific tasks. They work through the tasks, using local intranet policies and telephone advice from the on-call psychiatry registrar. Due to COVID-19 the sessions were delivered virtually. Participants completed a questionnaire evaluating confidence in ten domains, rated on a Likert scale from 0–10. Questionnaires were completed at four time-points during the programme; pre- and post-introductory lecture and pre- and post-simulated shift. Scores were compared using Mann-Whitney U tests. Significance was defined as P < 0.05 with Bonferroni correction applied for multiple testing.ResultTwenty-nine trainees attended the introductory lecture, 25 and 21 trainees completed the pre- and post-lecture questionnaire respectively. A non-significant improvement in confidence was reported in three domains: seclusions reviews, prescribing, detention under the mental health act.At the time of writing, ten trainees had attended the on-call shift. All participants completed a pre- and post-session questionnaire. The on-call shift was a useful learning experience (median score 9), and significantly increased perceived preparedness for on-call work from 3/10 to 7/10 (p < 0.001). Confidence was significantly improved in seven domains, most markedly in seclusion reviews, prescribing and mental health act tasks.ConclusionThe psychiatry virtual-on-call programme fills a niche in the training curriculum and is perceived by trainees to be a useful learning experience. The introductory lecture improved confidence in several domains, but not as effectively as the on-call shift. The on-call shift was well received by participants and significantly improved confidence in 7/10 domains. In summary, the virtual-on-call experience improves preparedness for out-of-hours psychiatry work. Follow-up of participants at the end of their psychiatry rotation will ascertain if they felt the programme to be useful during out-of-hours work.

Psychiatric Units in District General Hospitals and Traditional Mental Hospitals: Some Recent Evidence

1982 ◽  
Vol 140 (2) ◽  
pp. 160-165 ◽  
Author(s):  
S. Mahadevan ◽  
D. P. Forster
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Mental Hospital ◽  
Routine Data ◽  
District General Hospital ◽  
Organizational Structures ◽  
General Hospitals ◽  
Psychiatric Units ◽  
Patient Service ◽  
The Way

SummaryUsing routine data from the Mental Health Enquiry, the work of two district general hospital (DGH) units and a mental hospital was examined. There was a marked difference in the way the two DGH units operated and between the way the mental hospital worked as support hospital or as independent complete in-patient service. The operational policy practised by psychiatrists is more important than the structure of the system. It is important to establish sensitive policies for a wide variety of organizational structures.

Comparison of accredited person and medical officer discharge decisions under the Mental Health Act of NSW: A cohort study of deliberate self-poisoning patients

2021 ◽  
pp. 000486742110096
Author(s):  
Katie McGill ◽  
Matthew J Spittal ◽  
Jennifer Bryant ◽  
Terry J Lewin ◽  
Ian M Whyte ◽  
...  
Keyword(s):  
Mental Health ◽  
Propensity Score ◽  
General Hospital ◽  
Psychiatric Hospital ◽  
Propensity Score Analysis ◽  
Medical Officer ◽  
Patient Characteristics ◽  
Risk Difference ◽  
Discharge Destination ◽  
Mental Health Act

Background: The Accredited Persons Programme was introduced in 2003. The relevant Mental Health Acts (NSW) authorised reviews by appropriately credentialed non-medical health professionals as part of the process of detaining and treating a person without consent: an authority previously held by medical officers. Evaluations of the Programme are needed. Objective: To compare discharge decisions for hospital-treated deliberate self-poisoning patients made by an Accredited Person and Medical Officers. Methods: For a 10-year cohort (2003–2012) of index hospital-treated deliberate self-poisoning admissions at the Calvary Mater Newcastle, we compared Accredited Person and Medical Officer discharge decisions from the general hospital. We specifically examined discharges to the psychiatric hospital under a Mental Health Act certificate (used as an index of the Accredited Person’s use of the authority under the Accredited Persons Programme) compared to any other discharge destination. Unadjusted and adjusted logistic regression models and a propensity score analysis were used to explore the relationship between clinician type and discharge destination. Results: There were 2237 index assessments (Accredited Person = 884; Medical Officer = 1443). One-quarter (27%) were referred for assessment under the Act at the psychiatric hospital, with the Accredited Person significantly more likely (32%) to require this compared to the Medical Officers (24%); Risk Difference: 8.3% (4.5 to 12.1). However, after adjusting for patient characteristics; Risk Difference: −3.0% (−5.9 to −0.1) and for propensity score, Risk Difference: −3.3% (−6.7 to 0.1), the Accredited Person and Medical Officer likelihood of discharging for an assessment under the Act was similar. Conclusions: The Accredited Person assessed more clinically complex patients than the Medical Officers. After adjusting for clinical complexity and propensity score, the likelihood of referral for involuntary psychiatric hospital care was similar for Accredited Person and Medical Officers. Our evaluation of the Accredited Person programme in the general hospital was favourable, and wider implementation and evaluation is warranted.

Knowledge about the Scottish Mental Health Act in a General Hospital Setting

2008 ◽  
Vol 53 (2) ◽  
pp. 15-17 ◽  
Author(s):  
BJ Baig ◽  
J Walker ◽  
ES Crowe ◽  
SM MacHale ◽  
H Aditya ◽  
...  
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Hospital Setting ◽  
Mental Health Act

scholarly journals A qualitative study to investigate Swiss hospital personnel’s perceived importance of and experiences with patient’s mental–somatic multimorbidities

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicola Julia Aebi ◽  
Seraina Caviezel ◽  
Rainer Schaefert ◽  
Gunther Meinlschmidt ◽  
Matthias Schwenkglenks ◽  
...  
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Health Professionals ◽  
Interprofessional Collaboration ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Negative Stereotypes ◽  
General Hospitals ◽  
Perceived Importance ◽  
Hospital Patients

Abstract Background Mental–somatic multimorbidity in general hospital settings is associated with long hospital stays, frequent rehospitalization, and a deterioration of disease course, thus, highlighting the need for treating hospital patients more holistically. However, there are several challenges to overcome to address mental health conditions in these settings. This study investigated hospital personnel’s perceived importance of and experiences with mental–somatic multimorbidities of patients in hospital settings in Basel, Switzerland, with special consideration of the differences between physicians and nurses. Methods Eighteen semi-structured interviews were conducted with nurses (n = 10) and physicians (n = 8) in different hospitals located in Basel, Switzerland. An inductive approach of the framework analysis was used to develop the themes. Results Four themes emerged from the data analysis: 1) the relevance of mental–somatic multimorbidity within general hospitals, 2) health professionals managing their emotions towards mental health, 3) knowledge and competencies in treating patients with mental–somatic multimorbidity, and 4) interprofessional collaboration for handling mental–somatic multimorbidity in hospital settings.The mental–somatic multimorbidities in general hospital patients was found to be relevant among all hospital professionals, although the priority of mental health was higher for nurses than for physicians. This might have resulted from different working environments or in efficient interprofessional collaboration in general hospitals. Physicians and nurses both highlighted the difficulties of dealing with stigma, a lack of knowledge of mental disorders, the emphasis place on treating somatic disorders, and competing priorities and work availability, which all hindered the adequate handling of mental–somatic multimorbidity in general hospitals. Conclusion To support health professionals to integrate mental health into their work, proper environments within general hospitals are needed, such as private rooms in which to communicate with patients. In addition, changes in curriculums and continuing training are needed to improve the understanding of mental–somatic multimorbidities and reduce negative stereotypes. Similarly, interprofessional collaboration between health professionals needs to be strengthened to adequately identify and treat mentally multimorbid patients. A stronger focus should be placed on physicians to improve their competencies in considering patient mental health in their daily somatic treatment care.

scholarly journals Has the COVID-19 pandemic affected out-of-hours presentations in CAMHS?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S321-S321
Author(s):  
Sacha Evans
Keyword(s):  
Mental Health ◽  
Emergency Departments ◽  
Child And Adolescent ◽  
North Central ◽  
Out Of Hours ◽  
Mental Health Act ◽  
The North ◽  
Training Scheme ◽  
Phone Calls ◽  
Mental Health Difficulties

AimsThe aim of this project was to look at whether the COVID-19 pandemic, specifically lockdown, has impacted out-of-hours presentations to Child and Adolescent Mental Health Services (CAMHS) in North Central and East London.MethodSpecialist Registrars (SpRs) on the Royal London/Great Ormond Street CAMHS Higher Training Scheme are contacted for advice regarding all CAMHS presentations in the North Central and East London area. Responsibilities includes provision of advice to 6 hospitals (including 4 emergency departments) and 4 child and adolescent inpatient units. A record of all phone calls and call-outs, including Mental Health Act and Section 136 (S136) assessments are maintained and this study compares pre- and post-COVID-19 data to see if there are any differences in number of presentations, on-site assessments (including Mental Health Act and S136 assessments over 2019 and 2020.ResultNumbers of CAMHS presentations were lower in 2020 (mean 74 patients per month) compared with 2019 (60 patients per month). This was consistent across all months except October and December. The largest difference was seen in March: 109 patients presented in March 2019, compared with 55 in March 2020. This is also reflected in the number of assessments conducted on site. However, there do not appear to be differences in the numbers of Mental Health Act or S136 assessments undertaken over 2020, compared with 2019.ConclusionCAMHS out-of-hours presentations dropped off significantly at the start of the COVID-19 pandemic in the UK, and in particular, with the first lockdown (March to July 2020). Specialist Registrars provided advice via telephone less frequently in 2020 compared with 2019, and were required to do fewer on-site assessments of children and young people presenting with mental health difficulties.There were no significant differences in Mental Health Act or S136 assessments between the two years, however, these numbers are too small to make any meaningful conclusions.It is likely that children and adolescents were less likely to present to emergency departments for assessment of their mental health difficulties during the COVID-19 pandemic, rather than this reflecting a true reduction in mental health difficulties.Recommendations:It is helpful to continue to monitor CAMHS out-of-hour presentations.Trusts may want to consider alternative settings for providing emergency CAMHS assessments, for example, mental health hubs.Limitations:This provision of data is subject to recall bias.

scholarly journals The use of the Mental Health Act in learning disabilities

1996 ◽  
Vol 20 (10) ◽  
pp. 596-598 ◽  
Author(s):  
Yan Kon ◽  
Nick Bouras
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Learning Disabilities ◽  
Current Practice ◽  
The South ◽  
Violent Behaviour ◽  
Mental Impairment ◽  
Young Males ◽  
Mental Health Act

Psychiatrists in learning disabilities in the South-East Thames Region were asked to fill in questionnaires on the last five patients they had sectioned in an attempt to describe current practice in their usage of the Mental Health Act (1983). Clients tended to be sectioned under the category of mental impairment and were mainly young males with violent behaviour. Treatment of mental illness was less of a problem.

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