scholarly journals Managing restricted patients in acute, non-secure in-patient services: clinical, ethical and resource implications of long waits for a response from the Ministry of Justice

2021 ◽  
pp. 1-6
Author(s):  
Gunjan Sharma ◽  
Penelope Brown ◽  
Ijaz Ur Rehman ◽  
Edward Chesney
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Clinical Implications ◽  
Mental Health Act ◽  
The Mean ◽  
Using Data

Aims and method In-patients subject to Section 37/41 of the Mental Health Act 1983 (MHA) require permission from the Ministry of Justice (MoJ) for leave, transfer and discharge. This study aimed to quantify the time spent waiting for the MoJ to respond to requests, using data on restricted patients recalled to a non-forensic unit over 8 years. Results Eleven admissions were identified. The mean total time waiting for response was 95 days per admission, with an estimated cost of £40 922 per admission. Clinical implications Current procedures may contribute to considerable increases in length of stay. This goes against the principles of the MHA, as non-secure services rarely provide the range of interventions which justify prolonged admission. We suggest several ways to resolve this issue, including broadening the guidance for the use of voluntary admissions and civil sections, and allowing clinicians to make decisions on leave and transfer where there is little risk.

scholarly journals Weekend new patient reviews in psychiatry: evaluation of activity over 3 months

2017 ◽  
Vol 41 (6) ◽  
pp. 337-340
Author(s):  
Michael Rutherford ◽  
Mark Potter
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Average Length ◽  
Clinical Implications ◽  
Out Of Hours ◽  
Feasible Method ◽  
Average Length Of Stay ◽  
South West ◽  
Before And After ◽  
The Mean

Aims and methodSouth West London and St George's Mental Health NHS Trust developed a system of weekend new patient reviews by higher trainees to provide senior medical input 7 days a week. To evaluate the effectiveness of these reviews, the notes for all patients admitted over 3 months were examined. The mean length of stay for patients before and after the introduction of the weekend new patient reviews were compared via unpaired t-test.ResultsA total of 88 patients were seen: 84.4% of patients were seen within 24 h of admission. Higher trainees instituted some changes in 78.9% of patients. The most frequent action was to modify medication, in 47.8%. The average length of stay after the introduction of weekend reviews was not significantly different.Clinical implicationsWeekend reviews of newly admitted patients by higher trainees is a feasible method for providing senior input to patients admitted out of hours.

The Use of Section 136 of the Mental Health Act 1983 in a Family of Rural English Police Forces

2003 ◽  
Vol 43 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Neil Greenberg ◽  
Niki Haines
Keyword(s):  
Mental Health ◽  
Mental Disorder ◽  
Police Officers ◽  
Hospital Admissions ◽  
Rural Setting ◽  
Mental Health Act ◽  
The Mean ◽  
Act Assessment ◽  
Police Forces

Section 136 of the Mental Health Act 1983 is used by police officers to detain persons who they feel might be suffering with mental disorder until a formal Mental Health Act assessment can be undertaken. Previous studies have shown that the outcomes of these assessments result in remarkably different rates of subsequent hospital admissions. Within a rural setting it has also been shown that the rate of use of Section 136 varies considerably. This study examines the use of Section 136 within a family of eight police forces that have been matched to ensure that they cover similar populations. The results show that there are considerable variations in the use of Section 136, with the Devon and Cornwall region using the section over two and a half times the mean for the group. Possible reasons for this discrepancy are discussed.

scholarly journals Adolescent units: a need for change?

2003 ◽  
Vol 27 (8) ◽  
pp. 292-294 ◽  
Author(s):  
Tim Calton ◽  
Jon Arcelus
Keyword(s):  
Mental Health ◽  
Psychiatric Diagnosis ◽  
Adjustment Disorder ◽  
General Purpose ◽  
Clinical Implications ◽  
Violent Behaviour ◽  
Mental Health Act

Aims and MethodTo describe the characteristics and diagnoses of patients admitted to a general adolescent psychiatric in-patient unit. We describe the age, gender and psychiatric diagnosis of the patient, as well as whether the patient exhibited violent behaviour in the ward, whether he/she needed to be transferred to a different service and whether he/she was admitted under a section of the Mental Health Act 1983.ResultsPatients were evenly distributed in terms of gender, with most being 14–16 years old. Diagnoses were varied with adjustment disorder predominating, but could be separated into four main groups. Levels of violence were high, being associated with detention under the Mental Health Act 1983, and often resulted in transfer to another service.Clinical ImplicationsThe needs of certain adolescents admitted to a general-purpose adolescent unit may not be best met in this environment. Current services must change to meet the needs of their patients. There may be a need for greater specialisation.

scholarly journals Workload implications of the proposed new Mental Health Act – an audit

2003 ◽  
Vol 27 (02) ◽  
pp. 54-57
Author(s):  
Sean Whyte ◽  
Clive Meux
Keyword(s):  
Mental Health ◽  
Clinical Care ◽  
White Paper ◽  
Law Reform ◽  
Clinical Implications ◽  
Health Law ◽  
Forensic Patients ◽  
Mental Health Act ◽  
The Government ◽  
Time Required

Aims and Method To estimate specific time and resource implications for professionals, if proposed changes to the Mental Health Act 1983 (England & Wales) in the Government's white paper were to be implemented unchanged. An audit of time spent on current procedures was extrapolated. Results The amount of time required to comply with the Act will rise substantially (by 27% overall). Social workers and independent doctors will spend 30% and 207% more time respectively, complying with the Act, but psychiatrists providing clinical care to forensic patients should be largely unaffected. Clinical Implications If the Government presses ahead with its plans for mental health law reform as currently proposed, extra resources will be required to provide additional social work and independent medical time – or other services for patients will suffer.

scholarly journals ‘Role Over’ or Roll Over? Dirty Work, Shift and Mental Health Act Assessments

2019 ◽  
Vol 49 (8) ◽  
pp. 2187-2206 ◽  
Author(s):  
Sarah Vicary ◽  
Alys Young ◽  
Stephen Hicks
Keyword(s):  
Mental Health ◽  
Sociological Theory ◽  
Doctor Who ◽  
Dirty Work ◽  
Medical Assessment ◽  
Mental Health Act ◽  
The Social ◽  
Independent Review ◽  
Using Data ◽  
Verbatim Quote

Abstract The rise in numbers of applications for people being formally detained in hospital is one of the reasons given for the independent review of the Mental Health Act in England and Wales. These figures have led to concerns that the legislation might be flawed, including in relation to the process of Mental Health Act Assessments. Discussed in this article are two of the roles involved: the doctor who is responsible for conducting a medical assessment and the Approved Mental Health Professional (AMHP) who is responsible for assessing the social circumstances and in addition making the application. Using data from a study into AMHPs and the lens of the sociological theory ‘dirty work’, we discuss shift, an aspect of dirty work not yet applied in this context. We focus on AMHPs’ perceptions of the behaviour of doctors as encapsulated in the verbatim phrase ‘role over’. We argue that AMHPs, including social workers, justify or, to play on the words of the verbatim quote, roll over. This finding adds to the understanding of behaviour as it is understood within psychiatric occupations, including social work, during Mental Health Act Assessments.

scholarly journals When all else fails

1999 ◽  
Vol 23 (11) ◽  
pp. 654-656 ◽  
Author(s):  
Stephen Pereira ◽  
Dominic Beer ◽  
Carol Paton
Keyword(s):  
Mental Health ◽  
Treatment Option ◽  
Oral Treatment ◽  
Clinical Implications ◽  
Small Minority ◽  
Clozapine Treatment ◽  
Blood Tests ◽  
Mental Health Act ◽  
Valuable Treatment ◽  
Treatment Refractory

Aims and methodA small minority of treatment-refractory patients who could benefit from treatment with clozapine, refuse to comply with blood tests or oral treatment. Treatment with clozapine can be enforced under the Mental Health Act.ResultsAn aide memoire was developed locally to guide clinicians through the process of enforcing clozapine treatment.Clinical implicationsIt is possible to enforce treatment with clozapine under the Mental Health Act and so offer a valuable treatment option.

scholarly journals The impact of COVID-19 on an inpatient mother and baby unit: a service evaluation

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S316-S316
Author(s):  
Joanna Cranshaw ◽  
Gertrude Seneviratne ◽  
Ranga Rao ◽  
Julia Ogunmuyiwa ◽  
Rebecca McMillin ◽  
...  
Keyword(s):  
Mental Health ◽  
Length Of Stay ◽  
Social Services ◽  
Unit Length ◽  
Perinatal Period ◽  
Service Evaluation ◽  
Psychotic Illness ◽  
Mental Health Act ◽  
Mother And Baby Unit ◽  
The Impact

AimsUnique challenges have been faced by women in the perinatal period during the COVID-19 pandemic and the impact of this is compounded for women suffering from mental illness. This service evaluation looked at different aspects of the treatment pathway on a specialist inpatient psychiatric Mother and Baby Unit during the pandemic to identify what changes occurred.MethodData were collected for all admissions to the unit between January 2019 and October 2020, with the beginning of the pandemic being defined as on or after 1st March 2020. Information was collected retrospectively from electronic clinical notes on ethnicity, length of stay, diagnosis, mental health act use and restrictive practice, medication, psychology, occupational therapy and social services involvement.ResultThere were 114 admissions to the MBU during the study period. 4 were parenting assessments rather than acute psychiatric admissions and were excluded from the analysis, giving a sample of 110 women. 58% (62/110) were classed as “pre-pandemic” and 43.6% (48/110) were “during pandemic”. 95.45% (105/110) of women were postpartum 4.55% (5/110) were pregnant. Mean length of stay was shorter during the pandemic at 44 days, compared to 61 pre-pandemic. There was greater use of the mental health act during the pandemic: only 43.75% of patients were informal throughout admission, compared to 70.97% pre-pandemic. Mean duration of detention was shorter at 25 days (32 pre-pandemic). Psychotic illness made up a greater proportion of diagnoses during the pandemic: 56% (27/48) compared to 44% (27/62) pre-pandemic. The next most common diagnostic group was mood and anxiety disorders, which made up 29% (14/48) of diagnoses during the pandemic, but 43% (27/62) pre-pandemic. Outcomes as measured using the Health of the Nation Outcome Scale showed a mean improvement between admission and discharge of 6.65, compared to 5.15 pre-pandemic. HONOS scores were higher on admission during the pandemic (12.83, vs 10.88), suggesting a higher level of acuity.ConclusionDuring the COVID-19 pandemic on this Mother and Baby Unit, length of stay was shorter, a greater proportion of patients were detained under the mental health act (although length of detention was shorter) and psychotic illness was more prevalent. This study demonstrates that there were differences in this perinatal inpatient population during the pandemic and this may be a reflection on the wider impact of COVID-19 on perinatal mental health.

scholarly journals Place of safety orders in England: changes in use and outcome, 1984/5 to 2010/11

2013 ◽  
Vol 37 (3) ◽  
pp. 89-93 ◽  
Author(s):  
Patrick Keown
Keyword(s):  
Mental Health ◽  
Annual Rate ◽  
Clinical Implications ◽  
Absolute Rate ◽  
Annual Change ◽  
Mental Health Act ◽  
Real Increase ◽  
The Absolute

Aims and methodTo detail changes in the use of place of safety orders in England, including the outcome of these detentions, using publicly available data.ResultsThere was a sixfold increase in the rate of the Mental Health Act Section 136 detentions to places of safety in hospitals between 1984 and 2011. The use of Section 135 and the rate of subsequent detention under Section 2 or 3 also increased, but the proportion of people detained fell as the absolute rate of detention increased. There was a wide variation between regions in the use of hospitals or police stations as places of safety. The change in the annual rate of detention under Section 136 was associated with the annual change in the population of England.Clinical implicationsThe increase in detentions to places of safety in hospitals may in part reflect their move from police cells. It may also reflect a real increase in overall rate of detention and possibly a change in the threshold for the use of Section 136 detentions.

scholarly journals Impact of crisis resolution and home treatment services on user experience and admission to psychiatric hospital

2011 ◽  
Vol 35 (3) ◽  
pp. 106-110 ◽  
Author(s):  
Victoria Barker ◽  
Mark Taylor ◽  
Ihsan Kader ◽  
Kathleen Stewart ◽  
Pete Le Fevre
Keyword(s):  
Mental Health ◽  
Home Treatment ◽  
Service Users ◽  
Crisis Resolution ◽  
Mental Health Act ◽  
Psychiatric Admissions ◽  
Patient Care Service ◽  
Patient Stay ◽  
The Mean ◽  
The Impact

Aims and methodCrisis resolution and home treatment (CRHT) teams began operating in Edinburgh in late 2008. We ascertained service users' and carers' experiences of CRHT using a standardised questionnaire. We also assessed the impact of CRHT on psychiatric admissions and readmissions by analysing routinely collected data from November 2003 to November 2009.ResultsThere was a 24% decrease in acute psychiatric admissions in the year after CRHT began operating, whereas the previous 5 years saw an 8% reduction in the admission rate. The mean duration of in-patient stay fell by 6.5 days (22% decrease) in the 12 months following CRHT introduction, alongside a 4% decrease in readmissions and a 17% reduction in Mental Health Act 1983 admissions. Although the mean response rate was low (29%), 93% of patients reported clinical improvement during CRHT care, 27% of patients felt totally recovered at discharge from CRHT, 90% of patients felt safe during CRHT treatment, and 94% of carers said their friend or relative got better with CRHT input.Clinical implicationsCrisis resolution and home treatment service in Edinburgh had a positive impact during the first 12 months in terms of reduced admissions, reduced duration of in-patient stay and reduced use of the Mental Health Act. The service can catalyse a more efficient use of in-patient care. Service users and carers report high rates of improvement and satisfaction with CRHT.

scholarly journals Characteristics and outcomes of patients admitted to a psychiatric intensive care unit in a medium secure unit

2001 ◽  
Vol 25 (8) ◽  
pp. 296-299 ◽  
Author(s):  
Mairead Dolan ◽  
Alan Lawson
Keyword(s):  
Mental Health ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Implications ◽  
Maximum Security ◽  
Case Files ◽  
The Mean ◽  
Secure Unit ◽  
Challenging Behaviours ◽  
Discharge Criteria

Aims and MethodThere have been no reports on psychiatric intensive care units (PICUs) in medium secure psychiatric facilities. Using case files, we retrospectively examined the characteristics and outcomes of 73 patients who were admitted to a PICU in a medium secure unit between 1 July 1994 and 30 April 1998.ResultsThe PICU population was predominantly male, suffering from illness and detained under Part III of the Mental Health Act, 1983. Although the mean length of stay was 75 days, the majority were ultimately transferred to less intensive nursing environments and only nine required transfer to maximum security. In 10% of cases PICU admission was owing to lack of appropriate facilities elsewhere.Clinical ImplicationsAlthough the PICU was intended as a crisis facility for the management of challenging behaviours, its function was affected by the lack of clear admission and discharge criteria and appropriate facilities for patients with diverse mental, physical and security needs.

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