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Complex Situations (SLO7)
A 60 year old man, with a known history of schizophrenia, has been brought into ED by his family as they are concerned that he has stopped taking his medications, and stopped leaving the house or seeing people. The patient claims that the government are spying on him and controlling his thoughts, that the radio is talking directly to him and that he sometimes hears a voice talking about him in his head. He wants to go home as he believes the staff in the ED are also working against him. The psychiatric team are present in the department and will perform a mental health assessment. He is in the ED observation ward which is considered an inpatient bed. Which section would likely be used for the patient in this situation?
Answer:
Section 2 allows compulsory admission for up to 28 days for assessment. Sections 2 requires an application from an approved mental health professional (AMHP), or the person's nearest relative, and written recommendations from two doctors; one of whom is section 12 approved (usually a psychiatrist) and one who has previous acquaintance with the individual (usually the person's GP if at all practicable). Where there is no obvious person to provide the second medical recommendation (for example because the person is not registered with a GP or is not known to local mental health services), another section 12-approved doctor is usually asked to assess the individual. However, in cases where this is not practicable, any registered medical practitioner may provide the second recommendation as long as there are no potential conflicts of interest (for example, they work in the same hospital as the doctor providing the first recommendation).Mental Health Act
Complex Situations (SLO7) / Mental Health
Last Updated: 6th September 2022
If the person needs to be admitted to hospital, every attempt should be made to persuade them to go voluntarily. If admission is necessary but the person declines, compulsory admission may be arranged under sections 2, 3, or 4 of the Mental Health Act.
The Mental Health Act (2007) allows compulsory admission of people who:
- Have a mental disorder of a nature and degree that warrants assessment or treatment in hospital, and
- Need to be admitted in the interests of their own health or safety, or for the protection of other people.
Compulsory admission is arranged using the appropriate section of the Mental Health Act:
- Section 2 allows compulsory admission for up to 28 days for assessment.
- Section 3 allows compulsory admission for up to 6 months for treatment.
- Sections 2 and 3 require an application from an approved mental health professional (AMHP), or the person's nearest relative, and written recommendations from two doctors; one of whom is section 12 approved (usually a psychiatrist) and one who has previous acquaintance with the individual (usually the person's GP if at all practicable).
- For admission under section 2, where there is no obvious person to provide the second medical recommendation (for example because the person is not registered with a GP or is not known to local mental health services), another section 12-approved doctor is usually asked to assess the individual. However, in cases where this is not practicable, any registered medical practitioner may provide the second recommendation as long as there are no potential conflicts of interest (for example, they work in the same hospital as the doctor providing the first recommendation).
- Section 4 is used in exceptional cases to permit compulsory admission for up to 72 hours if there is urgent necessity, and where undesirable delay would occur while trying to arrange admission under section 2.
- It requires an application from an AMHP (or the person's nearest relative) and just one medical recommendation, preferably from a doctor with previous acquaintance (usually the GP).
- Where the person has been compulsorily admitted under an emergency section 4, this section is usually converted to a section 2 (usually requiring further involvement of the GP).
- Section 5 is used to permit emergency holding powers for admitted patients to provide temporary restraint whilst awaiting assessment by a psychiatrist. A patient in an Emergency Department is not an inpatient, so cannot be detained under this Section. Restraint permitted by The Mental Capacity Act or Common Law is all that is available to provide temporary restraint for individuals who are a manifest danger either to themselves or to others while awaiting assessment by a psychiatrist.
- Section 5 (2) doctor holding power, duration 72 hours
- Section 5 (4) registered mental health nurse holding power, duration 6 hours
- Section 136 may be used by police to take people from a public place to a place of safety and enable examination by a registered medical practitioner and interview by an AMHP. The person's GP, where known, may be informed.
N.B. Young people aged 16 or 17 years who have capacity to consent, but refuse to do so, cannot be admitted or kept in hospital for treatment for a mental disorder on the basis of their parents' consent — they will need to be formally detained under the Mental Health Act.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
