To see any of the other Paramedic Series blogs, refer to the index:
There are three kinds of ‘assessments’ that are referred to when people get into the parlance about mental health and it is important that police officers and paramedics understand the three and how they connect:
- Mental health assessment – this is an informal assessment of mental health by a clinician. Could be a force medical examiner in police custody; it could by Community Psychiatric Nurse (CPN) from a Community Mental Health Team (CMHT) visiting a person in their home; it could by members of the MH CrisisTeam in response to an out-of-hours call. It could also be something that police officers think paramedics can do! The purpose behind a generic assessment of someone’s mental health will vary from case to case: it could be a part of routine care planning; it could be a necessary precurser to formal assessment under one of the two mechanisms below.
- Section 135/6 assessment – This is a statutory process of assessment undertaken jointly by an Approved Mental Health Professional and a Registered Medical Practioner (RMP) whilst someone is in a place of safety having been detained by the police. This process is intended to identify whether someone may be suffering from a mental disorder, whether there are any unmet mental health or social care needs arising from it and / or whether or not someone may need to be fully assessed for admission under the Mental Health Act. It is good practice, but not a strict requirement, that the RMP in the assessment is “section 12 approved” – this means “having special experience in the diagnosis or treatment of mental disorder”.
- Mental Health Act assessment – this is the formal process of considering whether or not a person may need to be admitted to hospital under the Mental Health Act. The process will usually involved an AMHP, and two RMPs one of whom MUST be “section 12 approved”. Following assessment, they have the option of admitting the patient to hospital under the MHA, under section 2 or section 3 of the Act, or on a voluntary basis; OR they may refer the ongoing care of the person to a community-based mental health team or to their GP. In urgent circumstances the AMHP and one “section 12” RMP can apply for admission to hospital under section 4 of the Act but only where waiting for the second RMP would present ongoing risk because of the inaction.
WHAT DOES THIS MEAN?
In various situations where paramedics and / or police officers encounter situations where they are wondering if someone needs a “mental health assessment”, it is important to be clear about what we mean. Imagine the emergency services in someone’s private premises, worried about someone who has self-harmed or is threatening to do so.
This does not automatically mean that someone needs to be formally assessed for admission under the Mental Health Act, but they may need a mental health assessment of some description. This is one of those situations where police officers may call you for advice / support, or if you are concerned about keeping someone immediately safe, you may call them.
Difficulties in this situation may present themselves in one of several ways:
- If it is thought that a safe, secure assessment under s135/6 is needed, neither the police service nor the ambulance service can guarantee this – you will need to engage the duty AMHP and this may have to occur via the crisisteam, depending on your local arrangements. Remember: the police have no legal authority in someone’s private dwelling unless there is a criminal offence or a breach of the peace.
- If it is thought that a full Mental Health Act assessment is required, you will still need to engage the duty AMHP, possibly via the CrisisTeam.
- It is only when the assessment is a generic evaluation of someone’s mental health or mental capacity is it going to be the case that you consider either contacting the person’s out-of-hours GP of the CMHT / CrisisTeam.
- This is why the ambulance service ends up taking people to A&E – with a voluntary, consenting patient who potentially has unmet mental health needs, A&E is the only available option unless the situation can lead to them being detained by the police, for example because of an offence or because of them having been encountered in a public place.
SOMEBODY NEEDS TO DO SOMETHING
There is a phrase once used to do describe the function of policing “Something’s happening that ought not to be be happening about which somebody ought to do something NOW!” It will often by applicable to paramedics as well and in mental health situations it may be better faced together: some people react well to the police – whether through fear or favour – others react far less well, but paramedics can be seen as more appropriate or approachable. They key is to mutual support, but an understanding of the above types of mental health assessment can only make influencing people, whether the are patients, AMHPs or CrisisTeams, more manageable and predicated on knowledge.
Don’t forget three methods of using this blog to find out more:
- There is a full index of over 500 posts on all manner of topics.
- There is a series of “Quick Guides” originally intended for police officers, but some will be of interest to paramedics.
- There is a “search” facility in the top right hand corner: by entering any keywords on policing / mental health will bring up the relevant posts, including entering sections of the MHA like “s136″.
To see any of the other paramedic blogs, refer to the index:
Update on 01st April 2015 – since writing this article, a new Code of Practice has come into effect in England. It doesn’t substantially alter the post but certain reference numbers have changed. My summary post about the new Code of Practice (2015) is here, the new Reference Guide is here and the full document is here. The Code of Practice (Wales) remains unchanged.
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