Section 136: Place of Safety. Hallam Street Hospital Protocol

Transcription

1 MENTAL HEALTH DIVISION Section 136: Place of Safety Hallam Street Hospital Protocol 1. Introduction 2. Purpose 3. Section 136: Place of safety 4. Exclusion Criteria 5. Reception at Place of Safety 6. Initial Assessment of Risk 7. Intoxication (Drugs or alcohol) and Violence 8. Assessment Process 9. Making Necessary Arrangements Following Assessment 10. Record Keeping 11. Returning the Person to the Community 12. Smoking in the Place of Safety 13. Appendix 1: Questions to be asked by the NIC Accepting an Individual from the Police upon Arrival of Section 136 Detainees 14. Appendix 2: Place of Safety Flowchart 15. Appendix 3: Guidance to Staff when the 136 suite is in use and Room Furniture Revised September 2016 Review September

2 1. Introduction The aim of the protocol is to ensure that a safe, competent and speedy assessment of any person removed to Place of Safety (PoS) under Section 136 is carried out by the Mental Health service. At the PoS within Hallam Street Hospital, the person will be detained in the 136 room reserved for this purpose. The management of the PoS suite will be a joint process between all professionals involved within the assessment. Any additional staffing needs will be facilitated jointly between the Duty Site Nurse (DSN) and Crisis Home Treatment Team (CHTT) Once detained under a section 136, discharge can only be undertaken following assessment by a Responsible Medical Practitioner (RMP) and Approved Mental Health Practitioner (AMHP). The police cannot de-arrest. 2. Purpose The purpose of this operational protocol is to ensure that the care of individuals placed on Section 136 and taken to Hallam Street Section 136 assessment suite are cared for in a safe and appropriate manner. The protocol also ensures that as far as possible; use of Section 136 is managed within the legal and good practice framework as identified in the Mental Health Act 1983 Code of Practice 2015.This protocol will be called the 136 Policy throughout this document. 3. Section 136: Place of Safety Section 136 is an emergency power which allows for the removal of a person who is in a place to which the public have access, to a place of safety, if the person appears to a police officer to be suffering from mental disorder and to be in immediate need of care or control, if the police officer believes it necessary in the interests of that person, or for the protection of others. The person should then receive a mental health assessment and any necessary arrangements should be made for their ongoing care. The Mental health Act Code of Practice states that the Preferred place of safety is in a psychiatric facility. The police station should be used on An exceptional basis when the persons behaviour cannot be safely managed in another environment. The maximum period a person may be detained under section 136 is 72 hours. The maximum 72-hour period begins at the time of arrival at the first PoS (including if the person needs to be transferred between places of safety). Treatment may only be given if the person consents or under common law principles. In circumstances where a person detained on a Section 136 is taken to the PoS, where an assessment is already taking place, the PoS will NOT be expected to receive the person. The 136 room PoS will not ordinarily be used for any other function. Its use is for Section 136 presentations which will take absolute priority over any other function. 2

3 4. Exclusion Criteria The Section 136 Suite should not be used for those not detained under Section136 MHA. People under the age of 18 years will not be accepted at Sandwell 136 and will be transferred to Wolverhampton 136 Suite and supported in line with Penn Protocol. Individuals in need of urgent physical healthcare as a consequence of serious illness/injury or poisoning should not be accepted under Section 136 at the health based PoS but rather transferred to a more appropriate PoS e.g. an A&E department Any Individual displaying aggressive and violent behaviour; police should discuss with 136 Nurse in Charge/DSN re individuals with a history of violent and aggressive behaviour to assess whether they can be managed safety within the suite 5. Reception at Place of Safety The Nurse in charge (NIC) on Friar is the identified professional available to receive the person subject to Section 136 and to take initial charge over arranging the assessment. In all instances of a Section 136 accessing Hallam Street Hospital, the Police will liaise directly with the Nurse in charge in the first instance. This will be done either by contacting Friar ward directly or via the main hospital switchboard. The NIC will be notified in advance by the Police that a person is being brought to the PoS. The NIC should attain details to allow cross referencing against available electronic health records systems Friar House NIC will make contact with the CHTT who in turn will liaise with the AMHP who will contact the appropriate Section 12 approved medics to arrange a team for the MHA assessment The NIC should ensure that the room is vacant, clean and only identified furniture present within the room (Appendix 3) and notify the Duty Nurse for Hallam Street Individuals detained under section 136 should access the 136 assessment room through the dedicated entrance and not through the main public reception area; this will be done to protect an individual s privacy and dignity. West Midlands Ambulance (WMA) staff will report on the physical status (confirmation that the person is well enough to be detained in the PoS) and the ambulance sheet will be given to the nurse in charge. WMA can then leave the PoS. Before the person is accepted the NIC will request the legal documentation from the Police [a supply of forms are kept within the 136 room in case of emergencies]. The NIC will speak directly with the detaining officer and seek further information as per the check list. (Appendix 1) 3

4 The NIC will ensure the individual detained under Section 136 is informed of their rights both verbally and in writing under Section 132 of the Mental Health Act 1983 on arrival to the 136 suite. This should be recorded on the monitoring form and in the clinical notes. Account should be taken of language, learning disability or cultural difficulties. Access to legal advice should be facilitated whenever it is required. The police officers have the power to search a person they detain under section 136, as they would in the case of a person arrested for an offence. The Police should instigate a full search of the 136 detainee in the presence of the Nurse in Charge. NB. A person detained under Section 136 is known as a detainee by the police; the person is a member of the public and not a patient until assessed by Mental Health Professionals and agreement of the need for mental health care and treatment. 6. Initial Assessment of Risk The police will complete the Mental Health Act Monitoring Form and a copy given to the Nurse in Charge. The police and NIC will undertake a joint Risk Assessment to determine if the police are required to remain. Ref: the 136 Policy. It is advisable that the Police remain for the initial hour so that a clear picture of any risks can be established, the police will be advised this will be reviewed each hour/as necessary. The actual time the police remain in attendance will be agreed by the conveying officers and the DSN/ Nurse in Charge. The police will remain with the person until the completion of a risk assessment between police and nursing staff, the police must remain at the PoS for as long as the patients health or safety, or the protection of others makes their presence necessary. The police will also remain where there is a likelihood of a breach of the peace. The receiving teams initial assessment of risk (jointly where possible), will normally commence within one hour of the persons arrival in the 136 assessment suite. It is accepted that each case should be judged on its merit and some flexibility must be allowed. This may require consultation between the Duty Inspector, Nurse in Charge and Duty Psychiatric Doctor to negotiate the length of time the Police will remain. The above will be based on presenting risks and concerns posed to the safety and wellbeing of the individual and others. Where there are problems the Service /On-call Manager should be notified immediately, this notification should also happen if the PoS is occupied and another person is brought to the unit. The Nurse in Charge will ensure adequate staffing for the 136 suite, on occasions this will be required at short notice. The process will need good communication across the teams, careful consideration of the most appropriate staff to support the suite and accepted as a joint responsibility under the leadership of the Nurse in Charge/ Duty Nurse. The staffing needs will be based upon risks and safety of the person detained under Section 136, care staff and others who are involved. 4

5 Once the decision is made for the police to leave the Nurse in Charge/ Duty Nurse will monitor and manage the staffing requirement of the 136 detainee as follows: A minimum of 1 staff should be present at all times and have access to SAS alarm Friar ward and CHTT should be contacted in the first instance (CHTT are available 24 hours a day 7 days per week ) Staff from Abbey and Charlemont can be considered if the above services are unable to support. Bank staff will be booked under the budget code of the service that is unable to provide the cover. In line with the least restrictive principal; an initial assessment of the person detained can be undertaken by the section 12 approved doctor prior to the arrival of the AMHP. However, if the person requires a MHA assessment arrangements will be made for a MHA assessing team of 2 x RMP and an AMHP to be available. On completion of the MHA assessment the person detained under Section 136 will be either discharged home with or without mental health support or recommended for admission to hospital. If recommended for admission, the CHTT in conjunction with the DSN will source a bed. Until the bed has been identified the individual will continue to be detained under a Section 136 MHA. 7. Intoxication (Drugs or alcohol) and Violence Being under the influence of drugs, alcohol, being unruly or abusive is not an automatic basis for exclusion from the PoS at Hallam Street Hospital: It may be indicative of other underlying problems; Can require clinical /nursing oversight during sobering up ; May require clinical /nursing oversight or pharmacological intervention; It may require active police support to prevent escape or disturbance and to protect NHS staff and / or property. It may not be possible to complete the assessment immediately if the person is not in a fit state to be interviewed. Reasons for the delay in conducting the assessment should be documented and the assessment should then be done at the earliest suitable opportunity. Discussions need to be held between the police and PoS staff. It may be agreed that a police officer remains in the assessment area until the assessment has been completed. In certain circumstances there is a power to transfer people from one PoS to another, which may be considered (CoP ) 8. Assessment Process The same care should be taken in examining and interviewing people in places of safety as in any other psychiatric assessment. No assumptions should be made about a 136 detainee simply because the police have been involved, nor should they 5

6 be presumed to be in any less need of support and assistance during the assessment. The Duty Psychiatric Doctor should follow the usual assessment procedure when seeing a patient on admission, including appropriate physical examination. An individual waiting in the PoS should receive a competent assessment of their physical presentation using the 136 PoS Physical Health Standard Operating Procedure. In the event of acute deterioration of a physical disorder such as infection, suspected drug overdose, traumatic injuries etc. the 136 detainee should be transferred to the Emergency Department. It is reasonable to expect that a section 12 approved doctor and an AMHP can currently attend a Place of Safety to commence a face-to-face assessment within 3 hours of being requested to do so, with the aim to reach a standard of 2 hours in the future. The availability of the AMHP will need to be considered particularly out of hours that may have an impact on timing. Where any prolonged delay in achieving a joint assessment is identified, that would cause undue stress to the individual, the duty psychiatric doctor should commence the assessment. Doctors examining the patients should be approved under section 12 of the Mental Health Act. Only under exceptional circumstances will the assessment be undertaken by a doctor, not approved under the Act, Where this has been the case, the doctor concerned should record the reason for that. In all cases once the duty psychiatrists have completed their assessment they will discuss the case with the Responsible Consultant (RC)/ on call Consultant (who must be approved under Section 12) Where the duty psychiatrist, having examined the person and after discussion with the RC/ on call Consultant, concludes that the person is not mentally disordered and requires no other treatment or care then they cannot be detained and the Section 136 must be discharged, as there is no reasonable legal ground for the holding power to continue. In this situation there is no requirement for the person to be seen by an AMHP. The authority to detain a person under section 135(1) or 136 ends as soon as the assessment has been completed and suitable arrangements have been made. This may include detention under part 2 of the Act, informal admission, an offer of community treatment or other arrangements necessary for a safe discharge including necessary social arrangements. If a doctor assesses the person and concludes that the person is not suffering from a mental disorder then the person must be discharged, even if not seen by an AMHP. CoP Where the conclusion is that the person has a mental disorder but compulsory admission is not thought to be necessary and the person is consenting to appropriate after care the person should still be seen by an AMHP. The doctor and AMHP should jointly ensure that follow up is arranged, whether informal admission or referral to community service or social care. 6

7 The outcome should be discussed and agreed with the senior doctor before the Section 136 can be discharged. Under the Mental Health Act 1983, there is no upper or lower age limit within the Act; therefore there is no basis to refuse a person at a place of safety. 9. Making Necessary Arrangements Following Assessment One of five outcomes follows the joint assessment: The patient is discharged c/o GP The patient is discharged with a referral to primary/secondary mental health services Admission to Crisis Home Treatment Team Admission to hospital as an informal patient Admission to hospital under Section 2 or 3 of the MHA Once the assessment is completed and the further detention of the patient is deemed unnecessary, and there is no informal admission, the AMHP and the Consultant should agree a satisfactory return to the community. The PoS staff will inform the Police of this decision. Following the assessment, if the person requires further assessment or treatment, but refuses informal admission, an assessment for Section 2 or 3 of the MHA 1983 should be carried out. The assessing doctor should complete a medical recommendation and ideally the GP should complete the second medical recommendation. If the GP is not able to attend, a second medical recommendation should be sought from another (Section 12) approved doctor under the Mental Health Act The AMHP should complete the application. The necessary arrangements should then be made for the individuals admission to a Psychiatric hospital under either Section 2 or Section 3 of the MHA If the persons GP is not available and it would cause undue delay to get another doctor who is approved under Section 12 of the Act, to conduct an assessment, then admission could be consider under section 4 of the Mental Health Act. This should be consider only under exceptional circumstances where additional delay would be detrimental to the individual Section 5(2) or Section 5(4) cannot be utilised to facilitate an admission or extend the holding powers of the Section 136 Timescales are a target and it is accepted that each case should be judged on its merit and some flexibility must be allowed. If the provisional assessment suggests that detention under the Mental Health Act is likely to be necessary then a full assessment for admission can be carried out at this stage. Where the person is known to be on CTO (Community Treatment Order) and compulsory admission is indicated, the recall power should be used. An application for detention cannot be made in respect of a person who is known to be on CTO. 10. Record Keeping The person will not be formally admitted, but Monitoring Form will be completed by the Police and copied to the NIC. 7

8 The NIC will be responsible for ensuring that the Mental Health Act Officer is notified the next working day and that all relevant documentation is sent to the office within 1 working day. The NIC will also record disputes and outcomes and submit this information to the Service Manager who will instigate a further review at the Local Multi-Agency Group Meeting. 11. Returning the Person to the Community There is a joint responsibility on all agencies to ensure that any person not requiring admission, following assessment, is given assistance in returning to the Community The police service will bear responsibility for the repatriation or the costs of repatriation for all those individuals with whom they have remained involved during the assessment process (including those wholly assessed in the ED); AND those who are not deemed by the assessing RMPs as mentally disordered within the meaning of the MHA; The NHS will bear responsibility for the repatriation or the costs of repatriation for all those persons who are deemed by the assessing RMPs to be mentally disordered within the meaning of the MHA but with whom the police have not remained. Paragraph 13.4 of PoS Policy. 12. Smoking in the Place of Safety The Trust operates a Smoke-Free Policy. A small courtyard is attached to the 136 suite where detained individuals may be permitted to smoke. 8

9 Appendix 1 Questions to be asked by the Nurse Accepting an Individual from the Police upon Arrival of Section 136 Patients 1. Name, date of birth and address? 2. What are the circumstances that have warranted a detention under a 136? 3. Is the person under the influence of alcohol or drugs which may compromise their initial assessment? If so they may require attendance at A&E. 4. With regard to their physical condition: Has the person self-harmed? Under the influence of illicit drugs / alcohol? Have they taken an overdose? Has the officer asked the patient these questions? 5. Has the person been violent to police/family/property/other? Is there a history of violence or aggression? PNC checks to be completed. Is the person carrying any sharp objects/weapons? A search by the Police in presence of the nurse will be required to ensure everyone s safety. the 6. Does the person have any underlying physical health conditions that are not stable and may be compromised if treatment not given i.e. Diabetes, epilepsy and asthma. 7. Have they been searched? 8. Were they carrying a weapon? 9. Please record Officer s details relaying information? 10. Please record summary of advice given to the police and document any concerns you may have on the monitoring form and hospital assessment form. 11. Please record examples of Good Practice and ensure feedback is recorded under comments on the monitoring form. 12. Inform Police of outcome. 9

10 Appendix 2 Place of safety Flowchart Call directly to NIC on Friar or via Penn Reception from Police re PoS availability NIC to attain name and D.O.B, cross reference against electronic records Accept to Hallam POS YES Ensure appropriate PoS is determined NO NIC to inform CHTT who will arrange assessment with Medics Weekdays 9-5 CRHT staff grade or Hallam Site Doctor (if Section 12 approved) or Locality Consultant based on detainees address. out of hours 2 nd on call or On call Consultant and AMHP from CHTT of acceptance into Hallam PoS Ensure patient is given rights and restrictions in accordance with the MHA Alternate PoS to be utilised, Police station or A&E Inform Duty nurse for site. to promote awareness and any additional arrangements that may need to be made. Ensure room is not in use and tidy Ensure dedicated entrance is utilised. NIC to ensure safe acceptance into suite Police to complete Mental Health Act monitoring form Complete risk assessment with police / NIC / Medic to determine patient safety and continued Police presence Determine staff presence within suite this should be Friar / CHTT however also a joint responsibility of all involved Refer any disputes with Police to Service / On Call Manager Joint assessment to be facilitated with Medic, AMHP (CHTT) Where they would be considerable delay in facilitating a joint assessment the Medic can commence their assessment Where the Medic, having examined the person concludes that the person is not mentally disordered and requires no other treatment or care; Section 136 must be discharged and the person no longer detained. There is no requirement for the person to be seen by an AMHP. 10

11 The outcome should be discussed and agreed with the Senior doctor before the Section 136 can be discharged. Where the conclusion is that the person has a mental disorder but compulsory admission is not thought to be necessary and the person is consenting to appropriate after care the person should be seen by an AMHP. The doctor and AMHP should jointly ensure that follow up is arranged. Following the assessment, if the person requires further assessment or treatment, but refuses informal admission, an assessment for Section 2 or 3 of the MHA 1983 should be carried out. There is a joint responsibility on all agencies to ensure that any person not requiring admission, following assessment, is given assistance in returning to the Community Section 5(2) or Section 5(4) cannot be utilised to facilitate an admission or extend the holding powers of the Section 136 Section 4 should only be considered under exceptional circumstances where a significant delay in completing the assessment would prove detrimental to the individual Bed management responsibilities will fall in line with Trust policy Inform Police of outcome of the assessment utilising identified Log number (This should be identified at the top of the Mental Health Act monitoring form) If at any point significant concerns are raised re physical health, the Ambulance service should be called to re-direct the detainee to the Emergency Department at New Cross If at any stage the detainee becomes aggressive and concerns raised in regards to the safety and well-being of all, once the police have left, the police must be recalled using number. 11

12 Appendix 3 Guidance to Staff when the 136 Suite is in use and Room Furniture At the place of safety within Hallam Street Hospital, the person will be detained in the room reserved for this purpose The 136 place of safety, upon notification of the need for its use will take absolute priority over any other function. It is imperative that the rooms use starts of and is left in a clean and uncluttered state No additional furniture should be placed within the room Room furniture includes the following only: 2 x large sofa 1 x small table 1 x secured TV fixed on the wall. There are toilet facilities attached to the 136 room. There is also a kitchen attached which is kept locked at all times. 12