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How do you restrain the patient who wants to go - what physical means do you use, and how many staff does it involve. How long will you then keep the patient "held down" and what is your end-point? Does anyone use handcuffs? Mark P > -----Original Message----- > From: McCormick Simon Dr, Consultant, A&E > [SMTP:[log in to unmask]] > Sent: 17 August 2006 12:48 > To: [log in to unmask] > Subject: Re: Psychiatric patients leaving the emergency department > > Locally we use our security to stop the clearly psychotic, or the police > if necessary. I think this is perfectly reasonable under common law as > the psychotic patient by definition has no insight to their problem and > will therefore be incompetent. Those who leave before assessment and > there are concerns about we ask the police to find and return, if > possible. Not sure what else you are supposed to have done. > > Those who are strictly neurotic but in danger of self harm are much more > difficult and a topic in themselves. I don't subscribe to the blanket > 'wanting to self harm means you are incompetent' school of thought but I > think they often have altered thought processes which do mean holding them > against their will under common law is defendable. Again, it also comes > down to a judgement call of how likely you feel they are to harm > themselves (or others). That sort of call is difficult to make as a > psychiatrist as we see in tragic cases in the media, but as a an ED > consultant we make these decisions on a fairly irregular basis. As for > your average F2 SHO, what chance have they got! > > Simon > > P.S. Interestingly, I suspect like many of you our Mental Health Crisis > team is usually very good with most of these patients and they are of > course...nurses with extended training! they do, of course, have to ask > for back up on occasion but manage mostly on their own. > _____ > > From: JULIAN HUMPHREY [mailto:[log in to unmask]] > Sent: 17 August 2006 11:19 > To: [log in to unmask] > Subject: Psychiatric patients leaving the emergency department > > > Can I give the list a new topic to consider. > > At an inquest earlier this week our emergency department was criticised by > HM Coroner for not having a policy to deal with patients deemed to be at > risk from mental health problems, who decide to leave the department. He > ordered us to formulate a policy and write to him to tell him and the > family concerned what we have done. > > The case revolved around a woman who presented to the department with > symptoms of acute psychosis, who did not express any suicidal ideation. > She was seen and assessed by an SHO and was referred immediately to the on > call psychiatric team. Before they arrived she left the department. The > police were informed and asked to bring her back. Eventually she went home > to her parents house only to disappear again and jump off a local motorway > bridge later that night. > > I have written to the MPS to clarify the legal position. > > In the meantime, do any of you have local polices to deal with this > situation? As I understand it we are unable to use section 4 or 5 under > the MHA as patients in the emergency department have not been admitted > (inpatients). The department is not a public place under section 136. So > where do we stand? Restraint under common law? > > Any thoughts or experiences welcome off list if prefered. > > > Julian Humphrey > Emergency Department > Barnsley This electronic message may contain information from Shrewsbury and Telford Hospital NHS Trust which may be privileged or confidential. The information is intended to be for the use of the individual(s) or entity named above. If you are not the intended recipient be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited. If you have received this electronic message in error, please notify us by telephone or email (to the numbers or address above) immediately.