The Mental Health Act and Emergency Medicine

Author: Phyllida Roe, Persephone Taylor, Sarah Edwards / Editor: Tim Dickinson / Reviewer: Lauren Fraser  / Codes:  / Published: 14/01/2019

Description:

Approximately 10% of all admissions to the Emergency Department (ED) are related to patients having a mental health crisis.  With the ever increasing numbers of patients requiring mental health input, it is important that we understand the law that underpins our treatment (RCEM, 2018).

These patients can be challenging to manage for many reasons. To ensure that we protect our patients and ourselves it is crucial that we have an understanding of how the Mental Health Act (MHA) works.

Overall since 2013 in England and Wales there has been an upward trend in the number of patients who are being brought into the hospital environment detailed under Section 136 of the MHA

26137 (2013/14)

23602 (2014/15)

28271 (2015/16)

It is important to remember that some patients with a history of mental health problems come to the ED for a review of their physical health needs; physical health needs always take precedence over mental health needs (NPCC, 2017).

Other patients may need to be detained under the MHA (‘Sectioned’) whilst in the ED because of the severity of their disease. It is important that we, as EM doctors, understand how we can support this process.

This module aims to take you through some of the elements of the MHA most relevant in the ED. The case studies used aim to help you develop a clearer understanding of the different Sections of the MHA and when and how they become relevant. This module focuses on the MHA in England and Wales. There are similar underlying principles in the Scottish and Northern Irish version of the MHA, but the differences are not discussed here.

This module has been designed with the RCEM curriculum in mind.

Learning Objectives:

1. An improved understanding of the MHA.
2. Understand the differences between the Sections of the MHA which are most commonly encountered in the ED.
3. Understand the recent changes to Section 136 and how this applies in the ED.
4. Understand the multidisciplinary approach needed to manage these patients.

References:

1. CQC (2014). A safer place to be Findings from our survey of health-based places of safety for people detained under section 136 of the Mental Health Act. [Accessed 24 Aug. 2018].
2. Crown (1983). Mental Health Act 1983. [Accessed 24 Aug. 2018].
3. Crown (2007). Mental Health Act 2007. [Accessed 24 Aug. 2018].
4. Crown (2015). New Mental Health Act code of practice: A revised code of practice for the Mental Health Act 1983 provides guidance for professionals. [Accessed 24 Aug. 2018].
5. Crown (2017). The Mental Health Act 1983 (Places of Safety) Regulations 2017. [Accessed 24 Aug. 2018].
6. Imm, N. (2014). Serotonin Syndrome. What is serotonin syndrome? Symptoms. [Accessed 24 Aug. 2018].
7. Knott, K. (2015). Neuroleptic Malignant Syndrome. NMS information. [Accessed 24 Aug. 2018].
8. NPCC (2018). Use of Section 136 of the Mental Health Act 1983 in 2015-2016. [Accessed 24 Aug. 2018]
9. RCEM (2018). Mental Health Tool Kit. [Accessed 24 Aug. 2018].
10. RCPsych (2017). Mental Health Act changes. [Accessed 24 Aug. 2018].

Additional resources:

RCEM – A brief guide to the Section 136

RCEM Learning – Psychiatric Emergencies for the Adult Patient

RCEM Learning Podcast October 2017 covering the MCA