LANARKSHIRE
PSYCHIATRIC
EMERGENCY
PLAN
Agreed document 30th September 2005
(Not yet ratified)
CONTENTS
SECTION
PAGE NUMBER
FOREWORD
3
1.
BACKGROUND
4
2.
PRINCIPLES
5
3.
SCOPE OF PSYCHIATRIC EMERGENCY PLAN
6
4.
DUTY TO INQUIRE AND WARRANTS
7
5.
PLACE OF SAFETY
10
6.
EMERGENCIES IN THE COMMUNITY
10
7.
RISK MANAGEMENT
15
8.
USE OF DETENTION (EMERGENCY AND
SHORT TERM) IN THE COMMUNITY
16
9.
TRANSPORT OF DETAINED PERSON TO
HOSPITAL
19
10.
MEDICAL TREATMENT IN EMERGENCY
21
11.
ADMISSION TO HOSPITAL
22
12.
USE OF DETENTION (EMERGENCY AND
SHORT TERM) IN THE HOSPITAL
23
APPENDIX 1 - AVAILABILITY OF APPROVED
MEDICAL PRACTITIONERS
28
APPENDIX 2 – HOW TO CONTACT AN MHO
29
APPENDIX 3 - TRANSLATION AND
COMMUNICATION PROCEDURES
32
2
FOREWORD
The implementation of the Mental Health (Care and Treatment) (Scotland) Act 2003
is a significant event for all those affected by mental health problems, whether service
users, carers or those that work in caring services. The Act both reflects and
encourages a shift in emphasis to services that are more tailored to the individual and
focused on helping people with mental problems maintain or return to their normal
levels of functioning in as many aspects of their lives as possible.
The Lanarkshire Psychiatric Emergency Plan (PEP) has been brought together
through the work of many different groups. There has been consultation about the
content and form the document should take, but also an understanding that the
procedures outlined, and therefore the document will have to adapt and change as
circumstances alter and lessons are learned as the new act is implemented in practice.
It is important to emphasise that the PEP describes procedures that will be followed in
the exceptional case rather than the rule. In most situations, people with mental health
problems or in crisis will seek help themselves and the issue of detention under the
Act will not arise. As services for those in crisis become more comprehensive and
diverse the options for offering a response other than hospital admission will improve.
For those that do require admission this document should help to ensure that a
difficult process is made as smooth as possible.
This PEP is the first time that we are aware of, that a multi-agency document
outlining the procedures to be followed in event of psychiatric emergency has been
produced in Lanarkshire. Most of the procedures reflect current practice and are
adapted to meet the requirements of the new Act, but some have been altered to
reflect consensus on good practice. It should provide a useful guide to those involved
in helping to manage what can be very difficult situations.
The PEP has been produced to try and help different agencies work together to ensure
that the principles and spirit of the Act can be maintained even in difficult
circumstances. I trust that those involved in its production will find this document
useful.
Commonly used abbreviations in document.
PEP
MHO
AMP
CPN
PAT
SAS
JLIP
GP
A&E
The Act
-
Psychiatric Emergency Plan
Mental Health Officer (Social Worker)
Approved Medical Practitioner (Psychiatrist)
Community Psychiatric Nurse
Psychiatric Assessment Team (Nursing team)
Scottish Ambulance Service
Joint Local Implementation Plan (for mental health act)
General Practitioner (family doctor)
Accident and Emergency
The Mental Health (Care and Treatment) (Scotland) Act 2003
3
1. BACKGROUND
1.1. The main provisions of the Mental Health (Care and Treatment) (Scotland)
Act 2003 commence on 5 October 2005. As part of the implementation
process in Lanarkshire a Psychiatric Emergency Plan has been agreed by the
partner agencies involved in the Joint Local Implementation Plan (JLIP).
1.2. The concept of a Psychiatric Emergency Plan (PEP) was first introduced in
the recommendations of the Bid 79 report drawn up by RARARI in 2003.
The report dealt with the management of psychiatric emergencies in remote
and rural communities and it recommended that:
1.3. “Boards should be responsible for ensuring that a Psychiatric Emergency
Plan (PEP), endorsed by all appropriate agencies and professional groups, is
in place for each locality. It should include statements on: the skills and
competencies required of staff; minimum staffing levels, and clear
arrangements on the availability of Mental Health Officers (MHOs).”
1.4. The draft Code of Practice to the mental health act, published in 2004 also
stated that
1.5. “As a means of addressing all these issues comprehensively and in a manner
which best reflects local circumstances, it would be good practice for the
relevant local agencies and service providers who might potentially be
involved in psychiatric emergencies to work together to develop and agree
on a “Psychiatric Emergency Plan” (PEP). This would allow potential local
difficulties to be addressed and contingency procedures put in place before
they arise for real. The aim of a PEP would be to agree on procedures
which would manage the transfer and detention process in a manner
which minimises distress and disturbance for the patient and to ensure
as smooth and safe a transition as possible from the site of the
emergency to the appropriate treatment setting. The professionals
involved in the drawing up of a PEP could include general practitioners,
approved medical practitioners, MHOs, other social workers, social care
workers, CPNs, ward nursing staff, independent service providers, police
officers, and ambulance personnel. It will also be important to seek input
into the preparation of a PEP from mental health service users and carers.
It would be good practice to use a PEP as a basis for joint training of all
those professionals named in the plan as having specific responsibilities in
the transfer and detention process. Similarly, it would be good practice to
ensure that the PEP is updated regularly, particularly in light of any
significant incidents or specific difficulties which may have arisen since the
PEP was last updated”.
4
2. PRINCIPLES
2.1. The implementation of the Mental Health (Care and Treatment) (Scotland)
Act 2003 is a major advance in the legislation governing care of those with
mental health problems in Scotland. The legislation is framed around a set
of principles that should be applied across all aspects of this Psychiatric
Emergency Plan. The principles are as follows:
 Non-Discrimination
People with mental disorder should, wherever possible, retain the same
rights and entitlements as those with other health needs.
 Equality
All powers under the act should be exercised without any direct or indirect
discrimination on the grounds of physical, disability age, gender, sexual
orientation, language, religion or national, ethnic or social origin.
 Respect for Diversity
Service users should receive care, treatment and support in manner that
accords respect for their individual qualities, abilities and diverse
background and properly takes into account their age, gender, sexual
orientation, ethnic group social cultural and religious background.
 Reciprocity
Where society imposes an obligation on an individual to comply with a
programme of treatment of care, it should impose a parallel obligation on
the health and social care authorities to provide safe and appropriate
services, including ongoing care following discharge from compulsion.
 Informal Care
Wherever possible, care, treatment and support should be provided to
people with mental disorder without the use of compulsory powers.
 Participation
Service users should be fully involved so far as they are able to be in all
aspects of their assessment, care, treatment and support. Their past and
present wishes should be taken into account. They should be provided
with all information and support necessary to enable them to participate
fully. Information should be provided in a way which makes it most likely
to be understood.
 Respect for Carers
Those who provide care to service users on an informal basis should
receive respect for their role and experience, receive appropriate
information and advice and have their views and needs taken into account.
 Least Restrictive Alternative
Service users should be provided with any necessary care, treatment and
support, both in the least invasive manner and the least restrictive manner
and environmentally compatible with the delivery of safe and effective
care, taking account, where appropriate, the safety of others.
5
 Benefit
Any intervention under the act should be likely to produce for the service
use a benefit that cannot reasonably be achieved other than by
intervention.
 Child Welfare
The welfare of a child with mental disorder should be paramount in any
interventions imposed on the child under the act.
2.2. The act also introduces provisions that allow people to nominate a “Named
Person” that will act in their interests and to produce an “Advanced
Statement” describing their wishes in the event that they require treatment.
More details of these provisions are available elsewhere.
3. SCOPE OF PSYCHIATRIC EMERGENCY PLAN
3.1. The Lanarkshire PEP is a guide for all who are likely to be involved in the
management of a crisis situation involving somebody who has, or is thought
to have a mental disorder that may require intervention using the Mental
Health Act.
3.2. It outlines the procedures to be followed to ensure that appropriate
assessment of any given situation can be made and then the actions that will
follow, if a decision is made that the situation requires the use of the Mental
Health Act.
3.3. These are the normal procedures to be followed in the event of situations
arising in hospital and in the community. The roles and responsibilities of
the different agencies involved in such situations are described. They do not
deal with every eventuality and there will be times when good sense dictates
that the principles of the Act will be met by following a different course of
action.
3.4. Procedures are intended to minimise distress and disturbance to those
involved in what is frequently a very difficult event in a person’s life. While
the plan concentrates on the procedures that will be followed in event of the
powers of the Mental Health Act being used, it is important to emphasise
that the principle of least restrictive alternative should be maintained. It is
also important that any diverse cultural or religious requirements are
recognised and met as fully as possible throughout.
3.5. Detailed documents describing the Procedures to be followed by AMPs and
MHOs in event of Short Term or Emergency Detention have also been
produced and should be referred to in the event of these procedures being
required.
3.6.
The production of the PEP has been guided by the Draft Code of Practice
and may be revised when the final code is produced. The code provides a
more detailed description of the various roles and responsibilities and should
be consulted where questions arise.
6
4. DUTY TO INQUIRE AND WARRANTS
4.1. Warrants under the Act can only be obtained by a Mental Health Officer, or
in the case of a patient who is already subject to powers under the Act, by an
authorised person under the Act. Details of the range of powers that may be
sought are described below:
4.2. Local Authority Duties
4.2.1. Section 33 of the Act places a duty on the local authority to make
inquiries where it appears that a person aged 16 or over in their area
has a mental disorder and:




The person may be or may have been subject or exposed to illtreatment; neglect; or some other deficiency in care or treatment.
or
The person’s property may be suffering or have suffered loss or
damage; or may be at risk of loss or damage
or
The person may be living alone or without care and unable to
look after themselves or their property or financial affairs.
or
Because of the mental disorder the safety of some other person
may be at risk.
4.2.2. Section 33 inquiries can be carried out by any suitable person
appointed by the local authority. Such inquiries may therefore be
carried out by a social worker or care manager or other suitable
person appointed to do so by the local authority. Section 33 inquiries
do not require to be carried out by a Mental Health Officer, although
there may be particular circumstances where the local authority
chooses this course of action for specific reasons. For example, in
circumstances where it can reasonably be anticipated that a further
application for a warrant under section 35 of the Act may be
required.
4.2.3. Section 34 gives the local authority powers to request the assistance
of a range of agencies in carrying out inquiries. These include
Health Boards; the Care Commission; the Public Guardian; the
Mental Welfare Commission; and a National Health Service Trust.
The same section places a duty on those agencies to co-operate with
such requests unless doing so would unduly prejudice the functions
of that agency.
7
4.3. Mental Health Officer Duties
4.3.1. Section 35 Warrants
Section 35 provides powers for a Mental Health Officer to apply to a
Sheriff or Justice of the Peace for warrants to support the purposes of
Section 33 inquiries, if required. These warrants can only be applied
for by a Mental Health Officer. The duration of a warrant is 8 days
beginning on the day it was granted.
There are 3 different powers that can be requested within a Section
35 warrant. These are:



To authorise entry, with the assistance of a police constable.
To authorise the detention of the person in situ for up to 3 hours
for the purposes of medical examination by a medical practitioner
named in the warrant.
To authorise a specified medical practitioner to access and
inspect medical records.
In addition to authorising the MHO and police constable, the warrant
can authorise specified persons and this may include a medical
practitioner or health staff member.
If the outcome of the assessment of the medical practitioner in
consultation with the MHO, is that the person requires immediate
admission to hospital and this cannot be achieved with the persons
consent then admission to hospital may be arranged either by a short
term or emergency detention certificate, where the grounds are met.
(See joint procedures for further guidance).
If grounds for detention in hospital are not met but it is assessed that
the person has a mental disorder and requires to be removed to a
place of safety then consideration should be given to the MHO
making an application for a Removal Order, as described below.
4.3.2. Removal Orders to a Place of Safety
Section 293 allows a Mental Health Officer to apply to a Sheriff for
a Removal Order.
A Removal Order authorises a police constable to enter premises and
it authorises the removal of a person aged 16 or above to a place of
safety for a period not exceeding 7 days.
Although the draft code of practice suggests that a Removal Order
may be appropriate in situations of high risk, account needs to be
taken of the fact that in general the ‘tests’ of proof are more stringent
and the Sheriff is generally required to give the parties mentioned in
the application the opportunity to be heard before reaching a
decision. (The Sheriff may dispense with this requirement if satisfied
that it would cause delay that would be likely to prejudice the person
who is the subject of the application.).
8
In relation to a Section 293 application, the sheriff must be satisfied
that there is mental disorder and that there is neglect or ill treatment
etc, while Section 35 simply requires the it appears the person has a
mental disorder and that they may be subject to ill treatment or
neglect etc. In addition, under Section 295 a person subject to a
Removal Order or any person claiming an interest can apply to a
Sheriff to have a Removal Order varied or recalled.
The MHO must implement the order within 72 hours of it being
granted.
Section 294 permits application for a Removal Order to be made to a
Justice of the Peace, only in circumstances where it is impracticable
to make the application to the Sheriff.
4.4. Attendance of Medical Practitioners
In general the execution of any of the above warrants should be carried out
with a medical practitioner in attendance. The grounds for such powers
require a reasonable belief that the person is mentally disordered and may be
in need of services, care and treatment or protection. Failure to have a
medical practitioner in attendance at the time of entering premises may
result in unnecessary delay and distress for the patient. It may also result in
persons being placed at risk.
4.5. Authorised Persons Duties
4.5.1. Warrant to Enter Premises for the Purposes of Taking a Patient
Section 292 permits any person authorised under the Act to apply for
a warrant to enter premises and to take a patient who is already
subject to the Act to any place or into custody. This warrant would
be appropriate for example for someone who is subject to
compulsory powers who has absconded or was refusing access
following the granting of an order or certificate. While an application
for this warrant may be made by any person authorised under the
Act, when granted, it additionally authorises any Mental Health
Officer and any police constable for the area to enter the premises
along with the original authorised person who made the application
for the warrant.
4.6. Police Constable Duties
4.6.1. Removal from a Public Place to a Place of Safety
If a police constable reasonably suspects that a person in a public
place has a mental disorder, Section 297 provides the power to
remove the person to a place of safety for up to 24 hours, if the
constable is satisfied this is necessary in the interests of the person or
for the protection of others.
9
When action is taken under Section 297 the constable must notify the
local authority; the person’s nearest relative, carer or care service and
the Mental Welfare Commission of certain matters.
These matters include:





the person’s name and address
date and time of removal to the place of safety
circumstances giving rise to the removal
the address of the place of safety
when the place of safety is a police station why this was the case.
4.7. Making a Referral
It is important that when someone has reason to believe that a person
appears to have a mental disorder and may be in circumstances that require
further inquiry under Section 33, that a referral of those concerns should be
made to the local social work office during normal hours or to the out of
hours service. See contact details in appendix.
5. PLACE OF SAFETY
5.1. When removing a patient under a Section 292, 293 and 294 the place of
safety under the Act means:



a hospital ( both acute and psychiatric)
premises which are used for the purpose of providing a care home
service
Other suitable place (other than a police station), the occupier of which is
willing temporarily to receive mentally disordered person.
5.2. In Lanarkshire the appropriate Place of Safety will be determined by the
individual circumstances of the case. Where the person involved is known
to services and possible need for admission has been recorded as part of
relapse management section of care plan, then the appropriate Psychiatric
Unit should be regarded as the Place of Safety. In most other cases the Place
of Safety will be the local Accident and Emergency Department or Out of
Hours Treatment Centre. A decision on appropriate place of safety should
be taken after discussion with the Psychiatric Assessment Team. If the
situation is one of such urgency that there is no time to discuss this with the
Assessment Team then the Accident and Emergency Department is
appropriate.
5.3. At the present time it is not anticipated that care homes or other suitable
places will be used as a formal place of safety as defined under the Act in
Lanarkshire.
10
6. EMERGENCIES IN COMMUNITY
6.1. There are a number of ways in which a person who may require emergency
intervention from mental health services will come to the attention of
services.





In most cases the person themselves (or a relative/carer/neighbour) will
contact Primary Care Services. In working hours this will be their own
local GP practice and out of hours, this will be through NHS24 and the
Primary Care out of hours team.
The person (or a relative / carer/ neighbour on the person’s behalf) may
come to the attention of services in the community including social
work, care providers, housing or other support services.
The person may present to Accident and Emergency directly.
The person (or a relative/carer/neighbour) may call an Ambulance
directly
The person may be involved in a situation that requires the Police who
may identify a potential mental health problem.
6.2. Where a psychiatric emergency is suspected in the community it is essential
that all the available information be used to make a risk assessment of the
situation in advance. If there is thought to be a risk of violence, the police
should be contacted and asked to attend in a discreet manner. If the situation
appears to be very urgent from the information available, it may be advisable
to arrange an ambulance and nurse escort in advance of assessment.
6.3. Role of Ambulance Service if first to identify potential psychiatric
emergency
6.3.1. The public, police, NHS 24, GP or any carers can access the
ambulance service in an emergency. How the SAS respond to such
requests will depend upon the information available. Response
category will be categorised depending upon that information.
Calls originating from general public are triaged via Priority Based
Dispatch Protocols. Calls originating from medical practitioners and
Nursing staff including PAT will be classed as emergency if
requested. In such cases the ambulance will go directly to the
patient’s locus. If SAS called by NHS 24, SAS will attend, assess the
patient, treat as necessary and if safe will take to hospital.
6.3.2. Role of ambulance staff in emergency:





Attend and assess
In hours - contact GP for advice
Out of hours – contact PAT directly for advice
Treat as required
Transport to hospital
11
6.4. Role of police if first called to emergency situation
The police can be involved in crisis situations usually initiated by a 999 call
from members of the public, carers and health workers requesting assistance.
Upon receiving such a request the police response is as follows:






Attend incident
Support partner agencies
Contact PAT for advice
Provide control and restraint if appropriate
Assist with transport and escort if required. This may mean that the
police will transport the individual to the A&E dept or an agreed
hospital in accordance with relapse management plan if it is felt that
this is the safest option
Remove to police custody if this is thought to be most appropriate
response.
In attending an incident the role of the police is to:


Provide proportional response
In partnership with other agencies assess seriousness of situation
Take the lead role where there is increased risk of harm to self or
others, or there is a hostage situation - actual or potential. In that
particular case they will provide a negotiator and the situation will be
handled by the Public Order Team.
6.4.1. Role of the police in civil detentions
There may be occasions when staff will be unable to manage safely a
situation within community premises or person’s home. If there is a
clear threat to any person’s personal safety, the assistance of the police
should be requested. Where possible the need for police assistance
should be carefully considered before proceeding and suitable
arrangements agreed with the police prior to commencing the
assessment. However, it may not always be practical for staff directly
involved in the assessment to anticipate that police assistance may be
required, and the decision to involve the police may be taken by any
member of the team involved in the detention at any stage.
In the case of the police being called to assist in a detention:


Once the police arrive at the scene they will discuss situation
with staff involved and if necessary will take charge and make
decisions about restraint and removal of the person to a place of
safety. Frequently, the presence of the Police will be sufficient to
ensure that the situation is brought under control without the
Police having any direct involvement.
It is not part of the role of police to restrain persons in order for
them to have medication administered
12
6.4.2. In a situation where an individual is at home and access gained,
police attendance will only be necessary if situation is one of
potential risk and other partner agencies attending request assistance.
6.4.3. In a situation where access has been denied, entry to premises can
only be obtained through the obtaining of a warrant or removal order,
by a Sheriff or Justice of the Peace, granted in terms of Sections 292
and 293 of the Act outlined in Section 4. The MHO will liaise with
the police in advance of making the application as per joint
procedures regarding warrants and duty to inquire. Once they have
obtained the relevant warrant, the MHO will liaise with the police in
attendance and will report on the known circumstances of the patient
at that time. The medical practitioner will advise on any known
medical aspects.
6.4.4. In siege circumstances, trained Public Order Officers who have
specialist equipment and training will attend and take the lead role.
Depending on the circumstances the police will then convey the
patient to a place of safety or hand over to the Medical Practitioner.
6.4.5. In situations where an incident occurs in a public place and a police
officer reasonably suspects that a person has a mental disorder; is in
immediate need of care; and considers that it is in the interests of that
person or for the protection of the public, the officer under Section
297 of the Act may remove that person to a place of safety. In such a
situation the police officer will contact the PAT in the first instance
for information and advice. PAT will obtain any information about
person available to them and advise on appropriate place of safety. If
no information is available PAT will ask the officer to bring the
person to Accident and Emergency for assessment. If the patient is
brought to Place of Safety under Section 297 for assessment a
medical practitioner must see them. The police must inform the local
authority and nearest relative that they have taken this action as soon
as reasonably practicable.
6.5. The Psychiatric Assessment Team (PAT) will develop and maintain close
links with Police services, particularly those stations where there are custody
suites. Custody officers can contact PAT by telephone when they have
concerns about mental health of somebody they have detained. PAT team
will be able to advise of care plan if one exists or provide advice on how to
manage the situation, including bringing the person to hospital for
assessment.
6.5.1. The PAT will assess as priority persons brought to A&E by the
police. The police will remain with the person in the A&E
department until completion of the assessment.
a)
If assessed as having mental disorder and requiring admission,
police presence no longer required.
13
b)
c)
d)
e)
If assessed as having mental health problems a suitable
assessment of need must be undertaken. Decisions should be
made about any required emergency service in collaboration
with other health, social work and housing services. Particular
consideration must be given to whether the person is a
vulnerable adult and should be dealt with in accordance with
joint procedures for vulnerable adults and/or whether there are
any child welfare or protection matters that require action. If
needs do not require urgent action referral to routine services
should be made as soon as possible.
If no diagnosis of mental disorder and crime has taken place,
the person will be discharged from A&E into police custody
with the option of follow up and further assessment by the
Forensic CPN/Court Liaison Service. The PAT nurse will
ensure that information is relayed to that service in time for the
next day’s court appearance. If assessment the next day
suggests detention under Mental Health Act is required then the
duty AMP and MHO should be contacted and will assess at the
court.
If no diagnosis of mental disorder, no crime committed and
assessed as having no community care or other significant
needs the person will be discharged from A&E. If necessary
the police can assist in the person’s removal from the
department.
If person is intoxicated with alcohol or drugs it is likely to be
difficult to make a reasonable assessment of their mental
health. The value of such assessment will vary according to the
degree of intoxication. If intoxication is to such a degree that a
proper assessment is not possible then an appointment for an
assessment the next day should be offered – either at hospital
by PAT if likely to be released or by court liaison as in (c) if
charged.
6.5.2. In certain circumstances the police may be involved in the
transportation of patients to hospital:



If the situation becomes unsafe and there is risk of harm to the
patient or others
If a crime has been committed
If there is high level of aggression – verbal or physical – and
the situation cannot be contained
In such situations this would be considered as the safest and quickest
way to get the patient to hospital for further assessment and treatment.
14
6.6. Co-ordination between agencies in advance of assessment
In most cases situations will be resolved through intervention of medical
practitioner, PAT team and MHO as outlined in sections 8 – 10 of PEP. On
rare occasions where a multi-agency response is thought to be required in
advance of the assessment, a lead person will be identified to co-ordinate
that response.
In situations where there is known or suspected violence or in a hostage
situation the police will take the lead role and will involve the medical
practitioner and MHO only when safe to do so. In most other cases the PAT
will take lead role in co-ordinating Medical practitioner, MHO, ambulance
and police response, ensuring principle of least restrictive option is
maintained. If the Ambulance Service is called to a situation first, they will
take lead role in requesting the presence of other agencies if required.
6.7. Information sharing in emergency situation
In an emergency or potential emergency situation it is important that a
balance is struck between the management of risk and the duty of
confidentiality about individuals personal information. Information should
be shared on a need to know basis – the information provided should be
basic, but sufficient to describe any problems and identify risk.
Information shared should be sufficient to assist agencies to make a decision
in an emergency situation and also ensure the safety of the responding
services’ personnel.
Examples:
Primary Carer and/or Named Person
Any identified risk factors
Recent contact with services
Likely indicators of relapse and advice on de-escalation.
Hepatitis B/C status if known
Systems to improve electronic sharing of information between NHS sites
and between agencies are being developed. The use of Care Plan summaries
detailing agencies involved in care, named person, relapse management
plan, presence of advance statement and any other needs will assist this
process. These summaries will be held by service users and by all agencies
involved and consent should be sought that these can be shared with other
agencies at times of emergency.
7. RISK MANAGEMENT
7.1. The detention of persons in any setting can have a large element of the
unknown. It is important to attempt to access records or gain as much
background information as possible to assess risk. Areas of potential risk of
the person to themselves or others can be influenced by a number of factors
and all transfers should have any potential risk identified.
15
7.2. The following points should always be considered in identifying potential
risk, but this list is not exclusive:








Do the person and/or his/her family have a history of violence?
Does the person have a history of dangerous impulsive acts?
Does the person have a history of carrying weapons?
Does the person appear to be under the influence of drink or drugs?
Is the person expressing intent to harm you or others?
Are there signs of anger or frustration?
Is the person displaying sexually inappropriate behaviour?
Are there other environmental risk factors such as aggressive pets?
Good practice dictates that, in all cases, staff should refer to their own
agency's policies and guidelines on, e.g. lone workers and personal safety
and should have completed appropriate training. The following are
examples that should be considered if the interview is being conducted in a
community-based establishment:







Conduct the interview in an area that is easily accessible to other staff
in the event of an emergency;
Try to use an interview room that has been fitted with an alarm system
and use it to notify other staff should a threatening situation arise;
Remove obvious hazards from the area being used to conduct the
interview;
Balance issues of privacy with environmental, safety and observational
considerations;
Always communicate an intention to detain a person to other staff
within the establishment;
Consider having another member of staff present during the interview;
and
The movement of the detained person around the interview room
should be unrestricted as far as is reasonably practicable, bearing in
mind the potential risk the person may pose to him or herself or others.
If the interview is being conducted in a private dwelling setting:



Respect disagreements with the person over detention decisions and
allow for non-confrontational explanations;
Staff should carry a mobile phone in the community; and
Staff should ensure that they have received the appropriate
management of aggression training.
It is incumbent upon all statutory services to act in the best interests of
persons to deliver high quality care and to treat persons with respect
and dignity at all times. All procedures should be directed towards the
best overall interests of the person, being based on the principle of
minimum necessary force or action to achieve a desired outcome, and
to be carried out in a safe, professional and competent manner. The
underlying principles of the Act relating to the care of the person
should be observed at all times. A pragmatic approach should also be
taken to ensure the smooth running of any function discharged under
the Act with good communication being fundamental.
16
8. USE OF DETENTION (EMERGENCY AND SHORT TERM) IN THE
COMMUNITY
8.1. This section summarises actions to be taken in event that detention in
community is considered the likely outcome of assessment. More detail is
contained in the Joint Lanarkshire “Procedures for Emergency Detention”
and “Procedures for Short Term Detention” and also in the Code of Practice.
8.2. Assessment and decision to use emergency or short term detention.
8.2.1. Where a potential concern has been identified in the community the
first point of contact will normally be the persons Primary Care
practice. In working hours a GP should make arrangements to assess
the person, visiting if the person cannot or will not attend the
practice. If it is clear from the nature of the information given to GP
that there is a likelihood of assessment for detention they should
contact the duty MHO immediately, in advance of visit. A joint visit
may be made if appropriate or MHO may decide to await GP’s
assessment before agreeing to visit.
8.2.2. If a situation arises out-of hours then contact will be through NHS 24
to the Lanarkshire Out-Of Hours service. The Psychiatric
Assessment Team attached to the service should be involved in
discussion of the situation at an early stage. If detention appears to be
a possibility the duty MHO must be consulted. A joint visit
involving doctor, PAT nurse and MHO may be agreed in these
circumstances.
8.2.3. If a situation in community involves somebody well known to
psychiatric services within normal working hours, then contact may
be made directly with local mental health team who will advise
appropriately. In some cases a decision may be made to request an
assessment by AMP directly, particularly if duty AMP or another
available AMP already knows person. Again, early contact with the
duty MHO is essential.
8.3. A short-term detention certificate is the preferred “gateway order” because,
as compared with an emergency detention certificate, it can only be granted
by a specialist in psychiatry; the consent of an MHO is mandatory; and it
confers on the patient and the patient’s named person a more extensive set of
rights, including the right to make an application to the Tribunal to revoke
the certificate.
17
8.3.1. During working hours (Monday to Friday 9am till 5pm) each locality
will have a duty Approved Medical Practitioner who will be
available to provide advice and where circumstances allow will make
arrangements to examine the person after a GP assessment. (See
Appendix 1 for details). The duty AMP will not have other fixed
commitments and will be able to prioritise requests for assessment in
the community. On most occasions the arrangements will be made to
assess immediately after the GP together with MHO who may
already be present. If AMP is dealing with other priority cases they
will agree an appropriate time for assessment after discussion with
the GP and MHO but will assess during that working day.
8.4. Use of short term detention in the community
The criteria for granting a short term detention certificate are described in
Section 44 of the Act.
The AMP must consider it likely that the following criteria are met:





The patient has a mental disorder
The patient’s ability to make decisions about medical treatment is
significantly impaired as a result of mental disorder.
It is necessary to detain the patient in a hospital to determine what
medical treatment should be given or to give the patient treatment.
There would be significant risk to the health, safety or welfare of the
patient or safety of any other person, if the patient were not detained
Granting a short term detention certificate is necessary
The onus is on the AMP to demonstrate that they consider it likely that the
above criteria are met.
The AMP must consult with and obtain the consent of the MHO before a
short term certificate can be granted.
The AMP must be satisfied that there is no conflict of interest in relation to
the medical examination of the person.
8.4.1. An AMP cannot issue a short term detention certificate without the
consent of an MHO. Where it is impractical to arrange a joint
interview it should be borne in mind that consent and subsequent
detention may occur within three days of the initial examination by
AMP.
8.4.2. Procedures to be followed in event of refusal of consent by MHO are
detailed in the Procedures for Short Term Detention.
8.5. Use of Emergency detention in the community
The criteria for granting an emergency detention certificate are described in
Section 36 of the Act.
18
The criteria are that it is likely that:


The patient has a mental disorder
The patient’s decision-making ability with regard to medical treatment
is significantly impaired, as a result of the mental disorder.
and the medical practitioner is satisfied that,



It is necessary as a matter of urgency to determine what medical
treatment should be provided
There would be significant risk to the persons health, safety, or
welfare, or safety of others
Short term detention would involve undesirable delay.

The doctor must consult a MHO, unless it is impracticable to do so,
and must receive the consent of the MHO.

There must be no conflict of interest in relation to the medical
examination.
8.5.1. If the medical examination suggests the criteria of presence of mental
disorder, significantly impaired judgement by reason of mental
disorder, urgency and significant risk are met they should still seek to
use a Short Term Detention unless this would involve undesirable
delay, and there is urgent clinical necessity.
8.5.2. If this is deemed to be an undesirable delay due to clinical urgency
then the GP should consult with the duty MHO about whether the
issuing of an Emergency Detention Certificate may be appropriate,
using form DET1. Such a consultation will involve the MHO
interviewing the person and cannot be a telephone consultation
unless the MHO has had very recent contact with the person
involved. If the MHO agrees appropriate, they will provide consent.
If not, the MHO will provide a written statement detailing the safe
and viable alternative arrangements that are being put in place and
why these are preferable to detention.
8.5.3. If urgency is so great that there is insufficient time to arrange a
consultation with a MHO then the GP can issue emergency detention
without consent, but must provide a report to relevant Hospital
Managers about why no consent has been obtained. Hospital
Managers will pass this report to the Mental Welfare Commission, to
the relevant Local Authority, to the patients nearest relative and to
the Named Person, where known.
8.5.4. Out of hours, the GP must discuss with the duty MHO and arrange a
consultation if at all possible. If this is not possible then 8.5.3
applies.
19
8.5.5. It is also advised that the GP or nurse from the Psychiatric
Assessment Team if involved in the assessment should contact the
duty consultant for advice, if detention is being considered. If the
situation is one of such urgency that this is not possible, then contact
should be made after the situation has been resolved. Duty consultant
will offer advice and if situation is one where Short Term Detention
would be more appropriate, will make arrangements to attend.
8.5.6. If contacted by telephone, the consultant may provide advice but
ultimate responsibility for decision to issue Emergency Detention
Certificate lies with the attending doctor in consultation with the
MHO. If the consultant decides to attend to assess the situation
personally and the team agrees it is clinically safe to await their
arrival, the consultant will assume responsibility for decision on
arrival at scene.
8.5.7. Medical Practitioners are strongly advised to use the form provided
(DET1) when using Emergency Detention. A written statement
containing all the statutory information would be theoretically valid
but may be open to challenge in court. The certificate must be issued
on same day as examination, or within four hours if examination
after 2000 hours on that day. The certificate must be presented to
Hospital Managers before detention becomes valid.
9. TRANSPORT OF DETAINED PERSON TO HOSPITAL
9.1. In event of emergency or short-term detention the responsibility for making
arrangements for transfer to hospital lies with the medical practitioner who
has issued the certificate. The receiving service will assume responsibility
for making arrangements once informed of the detention by the GP or AMP,
but responsibility for the care of the detained person remains with the
medical practitioner until the person is admitted to hospital.
9.2. GP or AMP should inform the duty doctor at the appropriate receiving
hospital, giving patient details, confirmation of detention, and their own
contact phone number as well as requesting an escort and transportation for
the detained person. Duty doctor will ascertain whether there are any
particular requirements or risks that will affect the arrangements for
transport.
9.3. The duty doctor in turn should contact the nurse in charge of the unit passing
on the contact phone details and any other information about the situation
that is available. The charge nurse will organise escort and transportation
and then contact the GP or AMP to confirm arrangements and timescales.
20
9.4. Responsibility for the care of the patient remains with the GP or AMP until
the person is admitted to hospital. In practice in the community this will
mean until the escort and transport arrive. In general they will remain at the
scene until the escort and transport have arrived and the detained person has
safely left the scene. GP or AMP may only normally leave the scene if they
are satisfied that situation is safe and there are appropriate others prepared to
take responsibility until the escorts arrive. Appropriate others would include
assessment team staff or community mental health staff and would not
normally include relatives or carers.
9.5. In the event of a medical practitioner being called to another emergency,
they will need to make a judgement about the relative clinical risk in the two
situations. If another situation requires their immediate attendance they will
try to ensure that any risks in the Psychiatric emergency situation are being
managed effectively and will return as soon as possible unless the person has
been transported to hospital. The responsibility for care in these situations
remains with the medical practitioner but it is accepted that the duty to care
for others may require a judgement to be made about priority.
9.6.
Transportation will normally be provided by the Ambulance Service in
these circumstances. Arrangements should be made for escorts to go
directly to the scene using a taxi and the Ambulance Service is asked to
prioritise collection of detained person and escorts from the scene. In such
circumstances the Ambulance Service will treat transport of escorted patient
to hospital as an emergency.
9.7. There may be circumstances – particularly in some situations where there is
less urgency – where the use of a taxi or other transport would be safe,
would hasten process and be less distressing for the person involved. The
responsibility for deciding whether a proposed arrangement is acceptable
lies with the medical practitioner that has issued the certificate, but the
decision to use an alternative transport can only be taken if all those
involved (Doctor, nurse escort, relatives etc) agree. Under no circumstances
will a detained person be transported to hospital by car unless somebody
other than the driver is able to sit with them and is confident that they will be
able to ensure the detained persons safety.
9.8. If there are no beds at the appropriate hospital the Bed Management Policy
will be followed. Site page-holder will take responsibility for finding a
suitable bed elsewhere. If a bed is available at an alternative site within
Lanarkshire the page-holder should then pass responsibility to the admitting
hospital to make arrangements for the escorts to attend from that hospital
and the transport to take person directly to the place the bed is available.
21
9.9. If no bed is available within Lanarkshire and detention is an emergency
completed by a GP, the site page-holder will make arrangements for the
detained person to be escorted to their local hospital for examination by duty
psychiatrist. If appropriate, the page-holder will then identify a bed as per
Lanarkshire Psychiatric Bed Management Policy. The duty doctor or in
most cases duty consultant may then need to negotiate admission with
alternative site. Generally the hospital to which the person would normally
have been admitted should then take responsibility for the escort and
transport to the boarding hospital.
10. MEDICAL TREATMENT IN EMERGENCY
10.1. There will be very few situations where the use of emergency sedation is
appropriate or justified in the community during a crisis situation. If risk is
deemed high and urgent action is required then the Police should be called to
assist in rapid transport to Place of Safety.
10.2. The Act does not have any provisions that allow emergency medical
treatment in the community. Section 243 allows for administration of
medication without consent once a person has been detained in hospital.
Section 243 of the Act allows the administration of medical treatment,
without consent to




Save the patients life
Prevent serious deterioration in the patients condition
Alleviate serious suffering on the part of the patient
Prevent the patient behaving violently and / or being a danger to
themselves or others.
Following this treatment the administering doctor has a responsibility to
inform the Mental Welfare Commission of their action within 7 days.
10.3. Where the GP or AMP in consultation with nurse escort on arrival assess
that there is a high level of risk of harm to patient or others through
disturbed or violent behaviour and there is no alternative, a decision may be
taken to administer emergency medication. Such an action will be taken as a
common law decision and is not covered by the mental health act but it
would be good practice to ensure that the criteria described in section 243
have been met.
10.4. Where the need to administer urgent medical treatment does arise a decision
to provide urgent treatment will be based on professional judgement.
However, it is important to recognise that the assessment of the likelihood of
‘serious deterioration’ and ‘serious suffering’ is a subjective process. A
person who is experiencing symptoms and behaviours as a result of mental
disorder can be difficult to manage and may become oppositional or verbally
aggressive or abusive. It would be expected that such behaviour would not,
in itself, be seen as criteria for the giving of urgent medical treatment.
22
10.5. The decision to administer urgent medical treatment should therefore be
informed by the presence of the criteria listed at Section 243 of the Act
rather than as a means of managing a “difficult” person. The use of sedative
medication will be restricted to exceptional circumstances and will not be
used as a way of subduing a person who is difficult to manage or is
demanding of staff time and attention.
10.6. If sedation is required a short-acting benzodiazepine will be the drug of
choice. The attending medical practitioner is responsible for prescription
and administration of emergency medication. If medication is administered
under common law there is no requirement to provide a report to the Mental
Welfare Commission.
11. ADMISSION TO HOSPITAL
11.1. The GP or AMP must ensure the emergency or short term certificate is given
to the Hospital Managers before the patient is admitted, as the patient’s
detention in hospital is only authorised when the certificate is given to the
Hospital Managers.
11.2. For these purposes the Nurse in charge of the admitting ward will be deemed
to be acting on behalf of Hospital Managers and is authorised to receive the
certificates.
11.3. Nurses providing escort may convey the certificate to hospital on behalf of
the GP or AMP.
11.4. If the patient is brought to hospital by other means (e.g. Police) it remains
the responsibility of GP or AMP to ensure certificate arrives before
admission takes place and this will normally mean the GP or AMP
delivering the certificate themselves. In such circumstances it would be good
practice for the GP or AMP to attend the ward anyway to ensure effective
handover of relevant clinical information.
11.5. A patient’s initial experience of hospital and detention can be influenced
considerably by the procedures involved with the admission
11.5.1.
Patient’s should be treated with sensitivity and respect and afforded
the greatest degree of privacy achievable.
11.5.2.
Wherever possible, a member of ward staff should be available to
offer support and explain all relevant procedures to the patient.
11.5.3.
It is good practice for the patient to be allocated a named nurse
who is available to them at the time of the admission.
11.5.4.
It is also good practice to provide the patient with an information
pack. This is in addition to the Hospital Managers’ statutory duties
under Section 260.
23
11.6. MHO actions following the Admission of a Patient. Where the MHO has
given consent to a detention certificate, along with others, they will wish to
take steps to ensure the following:
11.6.1.
The patient is aware of their rights and status
11.6.2.
The patient has access to information on representation including
advocacy and where necessary is provided with assistance to
contact these services.
11.6.3.
The patient has access to interpretation and translation services or
services that address other communication needs, as required.
11.6.4.
The patient and any carers or dependants have the contact details of
a MHO
11.6.5.
Ward staff and the patient’s AMP have contact details for a MHO
and any known details of a Named Person or Advance Statement.
11.6.6.
The patient’s AMP and Hospital Managers are notified if the
patient has a Financial or Welfare Attorney or Guardian and their
contact details.
11.6.7.
The needs of any carers or relevant family members are addressed
at this time and suitable arrangements for on-going support and
follow up are put in place. In particular, the MHO will wish to
ensure that any carer is informed of their right to have their needs
assessed and arrangements are made to undertake this where
requested.
11.6.8.
The needs of any children or need for child care support must be
addressed and referral made to appropriate children’s services as
required.
11.6.9.
The MHO must consider whether any remaining adults (within the
household or otherwise dependant) have become vulnerable as a
result of the patient’s admission to hospital, and must take
appropriate action in accordance with the Vulnerable Adults
Procedure.
11.6.10. The MHO must be satisfied that the responsibilities of the local
authority under the National Assistance Act 1948 are met in respect
of any need to take steps to protect the patient’s property or arrange
for the alternative care of pets.
11.7. Further details on procedures to be followed after admission are contained in
the appropriate detailed procedure documents.
24
12. USE OF DETENTION (EMERGENCY AND SHORT TERM) IN THE
HOSPITAL
12.1. This section of the PEP gives an outline of procedures to be followed when a
person is deemed to meet criteria for detention but is already in hospital. It
covers procedures in Psychiatric wards but can also be applied in Accident
and Emergency departments and other wards of the hospital.
12.2. In a hospital situation the Short Term Detention Certificate remains the
gateway order of choice for the reasons previously stated.
12.3. Any registered medical practitioner can issue an Emergency detention
certificate provided the criteria outlined in section 36 (see para 8.5) are met.
It is advised that they contact the duty Psychiatric team for advice before
doing so. In situations of clinical urgency, a medical practitioner working at
grade of SHO or more senior in Accident and Emergency or any other
hospital department can issue a certificate without referral to the duty
psychiatrist. They must still make every effort to consult an MHO prior to
detention. If this is not possible they must provide a report detailing why to
Hospital Managers who will pass this to Mental Welfare Commission and
relevant Local Authority.
12.4. In most cases where detention is being considered in hospital it will be
possible to seek advice of the duty psychiatrist or the Psychiatric Assessment
Team. They will attend and make assessment where possible or offer advice
on appropriate action if not able to attend immediately.
12.5. During working hours (mon-fri 9am –5pm) each locality will have a duty
Approved Medical Practitioner who will attend in event of a potential
detention. If duty AMP engaged in an assessment in the community and no
other AMP immediately available then the hospital duty psychiatrist, usually
and SHO or staff grade will attend and advise.
12.6. Out-of-hours, the initial referral will be to the on-call duty psychiatrist for
the hospital, who may be resident or non-resident.
12.6.1.
If the duty psychiatrist is resident they will be expected to attend a
situation where potential detention is required immediately.
12.6.2.
If the patient is in A & E or a non-psychiatric hospital ward and the
duty psychiatrist is non-resident or occupied with another situation,
where detention a possibility, telephone advice will be given and
the Psychiatric Assessment Team will assist.
12.6.3.
If the patient is in a psychiatric ward and duty psychiatrist is nonresident or occupied with another situation where detention a
possibility, consideration should be given to using Section 299 of
the Act – Nurses Holding Powers.
25
12.7. Nurses Holding Powers
12.7.1.
Section 299 allows a nurse of prescribed class RMN & RNLD to
detain a patient pending medical examination to determine whether
an Emergency Detention Certificate or Short Term Detention
Certificate should be granted. Form NUR1 should be completed in
these circumstances.
12.7.2.
The class of nurse prescribed is a nurse registered in Sub-Part of
the Nurses' Part of the register established and maintained in
accordance with article 5 of the Nursing & Midwifery Order 2001;
entry includes an entry to indicate that:
a) the nurse has a recordable qualification in mental health
nursing or learning disabilities nursing;
b) the nurse's field of practice is mental health nursing or learning
disabilities nursing
12.7.3.
They can only hold a patient who is currently in a Psychiatric ward,
not A&E or any other ward of the hospital.
12.7.4.
A patient may only be detained by a nurse if he/she believes it to be
likely:



that the patient has a mental disorder;
that it is necessary for the protection of the health, safety or
welfare of the patient or for the protection of the safety of any
other person for the patient to be immediately restrained from
leaving the hospital;
that it is necessary to carry out a medical examination of the
patient to determine whether an emergency or short-term
detention certificate should be granted;
and


that the patient is not already detained
that it is not practicable to have the patient examined
immediately by a medical practitioner.
12.7.5.
The “holding period” lasts for up to 2 hours to allow a medical
practitioner to attend.
12.7.6.
If the Medical Practitioner arrives during the second hour of the
holding period, a further 1-hour holding period from the time of the
medical practitioner arriving comes into force to allow time for
examination.
12.7.7.
A written record must be made in nursing notes stating why the
patient was detained, the time the holding period began and the
reasons for detention
26
12.8.
12.7.8.
Notification of must be made to the on call Mental Health Officer
and the Hospital Manager as soon as practicable after the holding
power begins by the nurse applying the holding period.
12.7.9.
The Hospital Managers must make notification to the Mental
Welfare Commission within 14 days.
Involvement of MHO in hospital detentions
12.8.1. On receipt of referral from A&E, another hospital ward or from
nursing staff on psychiatric ward identifying possible requirement
for detention the duty AMP or psychiatrist should contact the duty
MHO and advise them of details.
12.8.2. In situation of acute risk, where for example patient is being
restrained, the duty psychiatrist may decide to apply emergency
detention certificate without consultation and provide report to
Hospital Managers.
12.8.3. In all cases in working hours, the duty MHO will attend and assess
with AMP whether a short term detention certificate should be
issued. Out of hours the duty MHO must be consulted, unless it is
not practicable to do so and arrangements made to assess the
patient.
12.9.
Decision to grant an emergency detention out-of-hours
12.9.1. If the duty psychiatrist decides to grant an emergency detention
certificate in any part of the hospital, with or without consultation
with MHO they must inform the duty consultant and discuss next
steps.
12.9.2. Duty consultant should check that arrangements are in place so that
an AMP will review detention as soon as practical. In most cases
that will be the next day (including weekends). This may involve
telephone “hand-over” to duty consultant at 9am the following day
or to local duty AMP if next day is a working day.
12.10. Duties of AMP as soon as practical following emergency detention
12.10.1. Duty AMP (one for all Lanarkshire at weekends, one for each
locality during working week) should contact duty MHO to
discuss arrangements for review of any patients detained.
12.10.2. Duty AMP must ensure that any patients detained in nonpsychiatric wards are also reviewed. These patients cannot be
discharged by non AMP medical/surgical consultants until their
detention has been reviewed by an AMP.
27
12.10.3. Where Short Term Detention is thought necessary and MHO
gives consent, AMP should complete form DET2 and pass to
Hospital Managers.
12.10.4. Where emergency detention is revoked, the duty AMP should
complete form REV1 and pass this to the Hospital Managers.
Patient may remain in hospital as an informal patient or be
discharged at this point.
28
APPENDIX 1 – AMP AVAILABILITY
Approved Medical Practitioners are those approved under section 22 of Mental Health
(Care and Treatment) (Scotland) Act. Consultant Psychiatrists and most staff grade
psychiatrists meet criteria and will be approved once they have completed a
designated training course.
Short Term Detention is the preferred gateway order and requires an AMP. AMPs
must also review any Emergency Detention “as soon as practicable” and a person
detained as an emergency on a medical or surgical admission ward cannot be
discharged until an AMP has revoked detention.
Each of the three localities in Lanarkshire will therefore designate a duty AMP that
will remain available to perform these duties for those aged 16-65. For advice for
under 16’s contact should be with local Child and Family Clinic and for those aged
over 65 with appropriate Old Age Psychiatry Team.
The duty AMP will normally cover a working week from 9am till 5pm Monday to
Friday. Outwith these hours the duty consultant will also be duty AMP. Rotas will be
maintained by or on behalf of lead clinician on each site.
On Saturdays, Sundays and on public holidays duty consultant will normally attend to
review any patients admitted on emergency detention the previous night
Role of duty AMP.



To assess those detained as an emergency “as soon as practicable”, whichever
hospital ward they are in.
To be available to discuss referrals from General Practitioners where
immediate detention may be considered. If appropriate to then visit within an
agreed timescale – same working day is minimum standard – to assess in
consultation with MHO whether short term detention appropriate.
To be available to discuss cases assessed by PAT team or court liaison team
where detention may be required. If necessary to visit and assess these patients
along with duty MHO.
.
Duty AMP can be contacted using the following numbers:
Monklands / Cumbernauld area
Motherwell / Clydesdale
Hamilton / East Kilbride
01236 748748
01698 245000
01355 585000
during working hours and on 01698 24500 out-of-hours
29
APPENDIX 2 – MHO AVAILABILITY
Local authorities have a duty under Section 32 Mental Health (Care & Treatment)
(Scotland) Act (2003) to ensure that Mental Health Officers (MHO) are available to
discharge their duties and responsibilities in respect of the Mental Health Act (2003),
Adults With Incapacity (Scotland) Act (2000) and the Criminal Procedures (Scotland)
Act 1995.Mental Health Officers will play a significant role in many parts of the new
Act, similar to the role they played under the 1984 Act but greatly extended.
Short Term Detention is the preferred gateway order and AMP’s must consult and
gain the consent of a MHO. Emergency Detention Order is an option available to
medical practitioners where it is necessary as a matter of urgency to detain the person
for assessment. It is no longer appropriate to seek consent from a relative and the
services of a MHO should be accessed where practicable.
1
North Lanarkshire Arrangements
North Lanarkshire Council has 33 MHO’s dispersed across various care setting within
the council. A duty rota is in operation and each area has a worker available for
interventions under the Act.
From 8-45am to 4-45pm Monday to Thursday and 8-45am to 4-15pm on Friday
the Duty Mental Health Officer can be accessed by contacting:
Social Work Headquarters at 52-60 Merry Street, Motherwell, ML1 1JE
Telephone number 01698 332662 or 01698 332299.
Libby McGhie or David McLean will take all relevant details and contact the
duty MHO for your area. The MHO will then contact the Medical Practitioner to
discuss the referral.
30
2
South Lanarkshire Arrangements
Mental Health Officer Rotas in South Lanarkshire are being circulated to all
likely to require them. The co-ordinators for the rotas are the Senior Social
workers in the Community Mental Health Teams details below.
Anne Marie Mitchell
CMHT
Hamilton/Blantyre
David McCorrison
Clydesdale Resource
Network
Rosaline McGarry
CMHT East
Kilbride/Strathaven
Gwen Scott
CMHT
Rutherglen/Cambuslang
3
9 High Patrick
Street,
Hamilton, ML3
7ES
Lanark Health
Centre,
Woodstock
Medical Campus,
Woodstock Road
Lanark, ML11 7DH
4th Floor, Atholl
House,
Churchhill Avenue,
East Kilbride, G74
1LU
Eastvale Resource
Centre,
130A Stonelaw
Road,
Rutherglen, G73
2PQ
Tel : 01698
455459
Mobile: 07795
090372
Tel : 01555
667159/667160
Mobile: 07795
090367
Fax : 01698
454870
Tel : 01355
233354
Mobile: 07795
090366
Fax : 01355
576524
Tel : 0141 531
4117
Mobile 07795
454719
Fax : 0141
531 4107
Fax : 01555
667180
Out of Hours services – both council areas
West of Scotland Social Work Standby Service offers an emergency Social Work
Service including Mental Health Officer Services. The Priority contact telephone
number for Lanarkshire Health staff to access a MHO is 0141 305 6900
To access the West of Scotland Social Work Standby Service for other services please
contact 0141 305 6920.
.
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DRAFT 200905
APPENDIX 3
LANARKSHIRE PSYCHIATRIC EMERGENCEY PLAN:
INTERPRETATION & SUPPORTED COMMUNICATION SERVICES
SUMMARY PROCEDURES
1 Introduction
1.1 The following guidelines are developed as a quick reference for staff, they do not
replace any existing interpreting policy or procedures. Staff should make themselves
aware of existing interpreting policies and procedures, appropriate to their respective
organisations, via their line manager.
1.2 Staff should provide interpreting services appropriate to the needs of individual
clients. These needs may be best met by:
 A signer or lip reader
 An interpreter
1.3 A professional/independent interpreter should be used to provide interpreting services in
relation to assessment and decision about care and treatment, see section 2 to 5 below.
The following information should be recorded in the person’s notes:


Who provided interpretation, including interpreter’s I.D code?
What method was used i.e. face to face or via a telephone interpreting service such as
Language Line?
1.4 If a non-independent interpreter was used i.e. member of staff or family member, the
record should note:





What efforts were made to access an independent interpreter?
The reason for proceeding with the assessment or interview rather than waiting for an
independent interpreter?
Who provided interpreting and their relationship to the person?
Any conflicts of interest?
Any difficulties accessing interpreting services should be brought to the attention of
the appropriate head of service for the respective organisation.
1.5 To support consistency, every effort should be made to use the same interpreter
throughout the duration of the persons care and treatment, if the client wishes.
1.6 Dungavel Detention Centre use Global Interpreting Services to provide interpreting for
the people detained there. When a detainee requires services out-with the centre Global
Interpreting Service continue to provide the interpreting.
2 Procedure
2.1 Staff may become aware of the requirements for interpretation or supported
communications services:
 At the time of referral
 At the time of appointment
 At the point of admission or emergency assessment
 At the point of attendance at Hospital or Clinic
2.2 It is important that arrangements for interpretation services be put in place at as early a
stage as possible.
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3 Non-Emergency/ Non-Urgent Circumstances
3.1 In non-emergency/ non-urgent circumstances the following numbers should be contacted
to arrange professional interpretation or supported communication services:
ORGANISATION
SERVICE
NHS Lanarkshire
Linkline
Monday – Friday
9am – 5pm – who
will secure the
services of an
interpreter.
Where possible staff should
arrange through Line
manager.
CONTACT
01698 855588
Out of hours answer machine available
outside business hours for non-urgent
requests
North Lanarkshire
Council
South Lanarkshire
Council
Strathclyde Police
Scottish Ambulance
Service
3.2 In the event of the client’s attendance being cancelled or changed, staff must notify the
appropriate organisation on the number above, immediately to enable alternative
arrangements to be made.
4 Emergency/ Urgent Circumstances
4.1 In the event of an emergency or when no advance notice is given, staff should
contact the following numbers to arrange interpretation or supported
communication services:
ORGANISATION
SERVICE
CONTACT
NHS Lanarkshire
Linkline
Monday – Friday
9am – 5pm
01698 855588
Out of hours answer machine
available outside business hours
for non-urgent requests.
Strathclyde Hospital
Switchboard (Out of
hours emergencies)
01698 245000
North Lanarkshire
Council
South Lanarkshire
Council
Strathclyde Police
Scottish Ambulance
Service
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5 Using Interpretation Service
5.1 The interpretation services are designed to be straightforward and easy to use however the
following guidelines are provided by Language Line to facilitate the interpretation
process. Interpretation can be provided both face to face and via telephone interpreting. It
is likely that telephone interpretation will be used in most emergency circumstances.
Here are the step-by-step guides for using both:
5.2 Telephone interpreting - a simple 4 step process:




Step 1: Identify the language required (a language card may help)
Step 2: Call the appropriate number for the service
Step 3: Brief the interpreter
Step 4: Speak directly to your client
5.3 Face to Face interpreting - a simple 6 step process:







Step 1. Identify the language required
Step 2. Call the appropriate number to book the interpreter
Step 3. Brief the interpreter before they attend the interview
Step 3. Arrange the meeting room for maximum clarity and comfort
Step 4. Introduce the interpreter and set the scene
Step 5. Speak directly to your client
Step 6. Debrief the interpreter once the conversation is finished
34