My understanding of the legal side of things is that the guidance to the Mental Health Act says that if you are using anything other than a Section 2 or 3 this is in a genuine emergency rather than for administrative convenience. I attended a meeting a few years back when this was discussed. The legal bods felt that on the whole you could hold the patient under common law until the psychiatrist got there to apply a S2 or 3; but that this should not take an unreasonably long time i.e. the psychiatrist should be in their car on the way to you.
The 2004 BAEM/ RCPsych document "Psychiatric services to accident and emergency departments" which is what you should probably base policies (although I've got to say it's got a lot of gaps in it where you'd hope it would give at least a flow chart guideline) says that with non consenting patients requiring treatment of a physical disorder, A and E staff have a duty to detain an if necessary restrain the patient in order to allow a psychiatric assessment for capacity. In extreme emergency where time does not allow waiting for a psychiatrist, the A and E doctor's own assessment of capacity should be used. However where the issue is assessment or treatment of a mental disorder, the Act should be followed. Note that the phrase used is "in extreme emergency". It is also clear in law that a person with mental illness including one who attempts suicide can have capacity.
The BAEM/ RCPsych document does have a nice flow chart for sedating the disturbed patient.
I think that what the coroner might be looking for is at least in part the service level agreement for provision of psychiatric services (if there is no inpatient team in your own trust); or if some staff perform some psychiatric role what their training is and how does their work get reviewed.
I have to admit that our own guidelines aren't great. Drawing up a service level agreement saying that an appropriate psychiatrist will attend within 40 minutes of being called seems reasonable on paper but is difficult in practice.
Matt Dunn
Warwick
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