A Comedy of Errors?

Imagine a patient taken to A&E by ambulance after taking an overdose who is then admitted to the poison’s unit of the acute, general hospital. A mental health assessment is requested as routine, because of the overdose, but is scheduled to take place tomorrow once the patient is anticipated to be medically well enough to undergo that assessment.  Later on the day of admission, he becomes distressed on the ward and attempts to leave but the junior doctor on-call places him under a s5(2) Mental Health Act order.  Still distressed, he patient lashes out at staff and verbally threatens them, so they desist in attempts to prevent them from leaving and call security to stop him getting out of the hospital. For whatever reason, security cannot locate the patient and he is presumed to have absconded.

The crux of this little anecdote is to get at the legal powers that are now in play. The ambulance service were requested to attend the patient’s home address and return him to hospital – an interesting decision, given that he had lashed out at hospital staff and threatened them.  What powers would a paramedic or technician have in this situation?! – the answer will be revealed towards the end!

Enquiring with the ward staff about the missing man, they are told by nursing staff that the Mental Capacity Act allows them to bring the person back – someone who has taken an overdose must be suicidal and that means they lack capacity, right?! – the answer is towards the end but the paramedics are unconvinced and given a stand-off, because the patient would not return, the ambulance service seeks the support of the police.  A section 5(2) MHA patient is refusing to return, can the officers help them out?! – answer towards the end, but the police claim to lack powers in this situation, can therefore add nothing to it and decline to attend.

ABSENT WITHOUT LEAVE

We’re still not getting very far, are we?! – an overdose patient, not yet medically fit and potentially suicidal according to ward staff and we can’t work out whether they can be returned and / or whether anyone has a legal power to do this. So far, we have various ward staff – including those who instigated the power! – two paramedics who could be elsewhere answering 999 calls and the police who have probably interrupted perfectly good coffee and doughnuts(!) to turn down the chance to help; and despite their collective training, we’re still unsure about this.

Welcome to the health and criminal justice systems of the fifth largest economy in the world! – inspiring, isn’t it?!

So far, the only people who are right in summing up the predicament they are in, are the ambulance service: they have no powers of their own to rectify this situation and yet they are the people stood near the patient’s house with the responsibility for them.  The advice they’ve had from the ward is wrong; the support they’ve not been given by the police is wrong and there is a clear and easy answer to this situation! … that does not rest with the paramedics only.

This patient is absent without leave, missing from section 5(2) MHA – he may be retaken by a constable, an AMHP or anyone else authorised by the managers of the hospital, in the 72hrs after the section was implemented.  As all of this happened in the first day of absence, there was well over two days in which to get it sorted.  As with all other powers for AWOL patients, there is no power of entry in order to return the patient, so a warrant under s135(2) MHA would be required. Of course, what I don’t know, is how the communication occured between the various parties. Did the ambulance control room tell the police it was a section 5 patient? – we know that some problems of this kind is actually just about communication.

BECOMING JADED

If this post sounds slightly cynical or jaded(!), I fully accept the rebuke! – I’ve noticed myself recently becoming quite impatient with these sorts of things. I unintentionally woke up the dog shouting at the tellybox this week when I saw #999whatsyouremergency on Channel 4 and I suspect it’s because there is a human limit to the amount of times a person can keep saying the same things, over and Over and OVER, again and Again and AGAIN … and that I’m towards that limit after another two years of working on nothing but this stuff, bringing me to a total a five full years over the last twelve and ongoing attention in between those jobs. I may need to go and be a policeman again!?

All that said, I did then immediately had a sharp word with myself: this AWOL situation is one of almost forty different scenarios where people who are not where they are meant to be under the MHA, need to be considered for return.  The law allows for people to become AWOL under the following twenty sections of the MHA –

  • 2
  • 3
  • 4
  • 5(2)
  • 5(4)
  • 7
  • 17A
  • 35
  • 36
  • 37
  • 38
  • 37/41
  • 42
  • 45A
  • 47
  • 47/49
  • 48
  • 48/49
  • 135(1)
  • 135(2)
  • 136(1)

And in addition to the above sections allowing for some people to be ‘absent’, some of them also allow for people to have absconded. These AWOL situations have various timescales that apply to the period within which people can be re-detained and returned, ranging from a few hours to indefinitely; and they don’t allow that same group of professionals from the above scenario to act. Some of these things are police-only powers.  In the police-only powers – 35(10), 36(8) and 38(7) – the person should not be returned to the hospital from which they’re missing, but to a courtroom. One of these things requires a warrant from the Ministry of Justice before the legal power can be invoked.

All clear for you?! … no wonder people less involved in this are confused! I asked a question on Twitter as part of writing this blog, seeking to understand what people thought the answers were and there are other professionals, including mental health professionals, getting this wrong. Why wouldn’t they?! – we don’t actually provide legal education of any reasonable standard for our professionals – I make an exception for the Approved Mental Health Professionals who are trained and examined on this stuff; but certainly MH nurses get next to nothing.

So for what it’s worth, here are some links to other posts I have done with reference materials and other ideas to use smartphones to access material quickly.  We can all imagine what would be said if this patient had come to harm whilst everyone was busy not knowing what they were doing, yet we didn’t really give any of these people the chance to get it right by training them properly —

Finally, if you want this stuff easily accessible, do what I’ve done and create a reference section of BLOGs on your phone’s homescreen.  Instant access to this stuff which I know various police and paramedics have resolved situations for them in seconds – at least in terms of knowing what they have to do!

I can explain most of this stuff, but I can’t understand it for you or look it up for you when you need it most! … but good luck with it.


IMG_0053IMG_0052Winner of the President’sMedal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award


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5 thoughts on “A Comedy of Errors?

  1. Scary that the correct answer seemed so difficult to get to. Staff who are likely to be involved should surely have a simple cheat sheet
    ……

  2. Hi Michael, Noticed in this blog that you state a AMHP, Police Officer or anyone authorised by the hospital manager can return someone using S18 MHA. I believe in this and another blog you did not mention any member of hospital staff can also use this power. Can I just clarify if this omission was intentional or not so I can ensure I haven’t missed anything.
    One of the things I have been working on with my local trust is encouraging hospital staff to use this power themselves when it is appropriate to do so in the absence of RAVE (Without the E obviously) Risks. This would be at a known home address or known location.

  3. Wow. You clearly know your stuff. I have BPD. As a result, I have used up some of the emergency services. You are right. No one knows what they are doing. I remember being s136’ed and the police not

  4. Very informative. I have BPD and as a result, i have come into contact with the emergency services many times – especially the police. One time, I was section 136’ed and the police didn’t know what hospital to take me to. They took me to one hospital and they were told by the staff there that I needed to be taken to my local hospital. I wasn’t in my local area when I was sectioned. These two hospitals were about 11 miles apart. The police were basically running around looking for the right hospital to take me to. That is just one example. I was thinking ‘what a waste of time for them.’

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