Sign in to follow this  
Followers 0
smithy

section in casualty

31 posts in this topic

Can you apply a 5(4) in casualty? I was under the impression one was meant to use common law.

Share this post


Link to post
Share on other sites
Can you apply a 5(4) in casualty?  I was under the impression one was meant to use common law.

In England and Wales, until the new law comes into force this is the rule:

1. If a patient has to be detained under MHA in an emergency situation, [highlight]Section 4[/highlight] has to be used.

2. However, If the decision is already made for the patient to be admitted, (he/she is now technically inpatient but needs to be transferred to the Psychiatry ward) and the patient is technically in the same premises as the Psychiatry ward, (meaning same trust and same building!), then 5(2) or 5(4) could be applied.

8-)

Share this post


Link to post
Share on other sites
Can you apply a 5(4) in casualty?  .

no u can't

Share this post


Link to post
Share on other sites

no....

casualty is not a ward...

Share this post


Link to post
Share on other sites

You can if the patient has been admitted i.e. not just clerked!

Some admitted patients stay in casualty awaiting transfer to another ward.

If not admitted - best practice law (what used to be called common law).

F_S

Share this post


Link to post
Share on other sites
You can if the patient has been admitted i.e. not just clerked!

Some admitted patients stay in casualty awaiting transfer to another ward.

If not admitted - best practice law (what used to be called common law).

F_S

Thanks, Freudian, you are right, as always.

I shall correct my earlier statement. It is not enough that the decision has been made. The patient must be registered into the ward's books as admitted. If the patient is assessed while awaiting transfer to the admitted ward, 5(4) or 5(2) can be applied.

Share this post


Link to post
Share on other sites

This brings an interesting few points....

No you cant apply 5(2) or 5 (4) (RMHN only) if theyre in A+E as it is deemed a public place.

However, you can apply a S4, 2 or 3.

If they are too aggressive/violent -> police and assessment by the EDT and MHA at the police cells. Another option is a S136 -> place of safety for 72hrs.

The admission process is debatable and remains slightly undefined: to facilitate a section 5 of the MHA.

Theoretically, we can use the mental capacity act to move individuals if they lack capacity and it (moving them) is in their 'best interests' as long as the court of protection is involved (as there are stipulations for deprivation on section 5 of the MCA).

In practice, if there is mental disorder: Section 4/2 is preferable.

Share this post


Link to post
Share on other sites

To smithy:

I presume you are a doctor.

Why would you want to use 5(4)?

Share this post


Link to post
Share on other sites
You can if the patient has been admitted i.e. not just clerked!

Some admitted patients stay in casualty awaiting transfer to another ward.

If not admitted - best practice law (what used to be called common law).

F_S

Where is this referred to? We always had interesting discussions about when a patient is admitted. When he/she walks in, or when they are seen by the admitting doctor, or when entered in to the ward books ( what happens at night? are the books still open? No administrative staff)? Would be interesting to know especially as many people don't have their paperwork done upto many minutes or hours after arrving on psychiatry wards.

Share this post


Link to post
Share on other sites

...Coming back to my earlier comment about the admission process not being set or clearly defined....

..I dont think the MCA 2005 would neccessarily allow this patient to be moved as they are likely to be mentally disordered however, and go against human rights act i.e. deprivation of liberty... But it is an interesting theroretical route....

Share this post


Link to post
Share on other sites

Cheers guys

I'll provide the senario which triggered this question.

On call, nurse at a&e has a patient who has taken significant overdose. Patient not medically fit. Has consumed alcohol (unknown quantity).

Nurse wants you to go down and do something to ensure the patient cannot leave.

You can't get there in time.

Whats the advise.

I figured if could not be pursueded to stay...

1) [least aggressive] let them leave and call police

2) Call security, hold under common law.

What else can be done?

Share this post


Link to post
Share on other sites

I would advise :

- persuade patient to stay voluntarily for assessment & treatment

- if suspicion of mental illness, instigate MHA assessment for S2 or S4

- in the circumstances mentioned, an assessment of capacity could be carried out by senior A&E doctor. If felt incompetent to decide regarding treatment, a decision could be made in their best interest, which could also include detaining them in A&E under the MCA2005.

Obviously the MHA trumps the MCA, so the MCA should only be used if no suspicion of acute mental illness.

Share this post


Link to post
Share on other sites

I always get so confused on this issue.

If the patient has taken a lethal overdose that requires treatment and have capacity to make a decision on this, if they refuse the treatment , does this equate to suicidal ideation? if so how is this managed. If there is no evidence of a depressive or any other mental illness, would you treat under common law and then admit on a S2 for assessment?

Share this post


Link to post
Share on other sites

Yes MCA 2005 is theoretical but wont apply in this situation as its mental health act territory.

No such thing as common law (well there is) its now called best interests.

MCA applies to pretty much everything (but has its exclusions -> marriage, parenting etc.) thats not mental health related. However, to detain someone goes against ECHR and therefore needs a 'higher' source (ie. court of protection) than merely 'best interests...'

In all likelihood, if someone has taken lots of paracetamol to end their life - they need to be detained formally (depending on the risk assessment / MSE etc.) i.e. mental health act vs. MCA. The powers to detain within the MCA are limited. If detention is considered, a MHA assessment should take place / discussion with the appropriate team.

Share this post


Link to post
Share on other sites

Thanks for the clarification, Smithy.

If the patient is unable to give consent because of alcoholic intoxication or paracetamol induced delirium, the A&E clinician can detain the patient under best practice/common law.

In case the patient is capable of giving consent, but wants to leave, still he/she has to be assessed to rule in/rule out the presence of mental illness. In such a case they have to be detained under Sec(4) pending ASW assessment.

But if what you need is current holding power until the patient can be assessed, common law still can be used.

Correct me, kindly, if I'm wrong.

Share this post


Link to post
Share on other sites

sounds reasonable... nocturnal.

I would not rule out getting the medical cons/ deputy doing a section 5(2) if there was enough in the way of mental health concerns/risk. Ideally, if there are no clear mental health issues -> best interests / MCA.

Security, historically are very reluctant to hold ppl. who are not detained under the mental health act but should be advised to if they are incapicitous and lack capacity and do not have any significant mental disorder under 'best interests' - specifically thinking about deliriums etc.

Share this post


Link to post
Share on other sites

Has anyone been in a situation where they have had to let someone go following a serious overdose and no possible way to keep them in the dept/have treatment?

Share this post


Link to post
Share on other sites
Has anyone been in a situation where they have had to let someone go following a serious overdose and no possible way to keep them in the dept/have treatment?

Of course, yes.

During those times, I've gone home with a laden heart and have slept fitfully.

Nowadays I take a more philosophical view of say, seeing someone driving recklessly and hoping everyone gets home safely!

Share this post


Link to post
Share on other sites

Nurse wants you to go down and do something to ensure the patient cannot leave.

The nurse needs to be told that we are not the police or in the habit of detaining the inebriated.

The MHA is clearly inappropriate here. The doctors looking after the patient can detain him/her under Best Practice law. If this hapens regularly then get your consultant to email her A&E counterparts.

Noct - practically speaking, a Sec 4 is rarely done.

Share this post


Link to post
Share on other sites

I know, but I'm fortunate to have had the said rare experience of having initiated a sec(4). In that situation, we were holding the patient under common law until the ASW came to assess the patient.

Share this post


Link to post
Share on other sites

yes, agreed intoxication will nullify the mental health act process.. can hold them under best interests and then assess them when they are sober..

If the act (ie. OD) was serious enough and they were requesting to leave (and are sober, say) then it is tricky... obviously if there is ongoing intent and they are unwilling to stay... then a mental disorder seems likely... (i know im assuming a lot)

If theres no evidence of MI / MD (illness / disorder) - and they had capacity..youd have to let them go...

in this situation methionine vs parvolex is a good idea as TTO's and a robust plan re : followup re: LFTs etc made with GP..

Capactiy should be viewed as a graded process... ie. more stringent actions depending on the outcome.

Share this post


Link to post
Share on other sites

I would just add MHA only applies to treatment of the mental disorder though !

Share this post


Link to post
Share on other sites
yes, agreed intoxication will nullify the mental health act process

Share this post


Link to post
Share on other sites

Good practice (and an ideal situation) would be to hold them (under best interests, if sufficient concerns) until an assessment can be done.

When someone is intoxicated it can often lead to inaccuracies in their assessment.

Admittedly, if the picture is clear cut - and mental disorder is clearly there - a MHA assessment and detention under the MHA can be done.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
Sign in to follow this  
Followers 0