Analysis
Should more people who need psychiatric help be brought to emergency departments? CHANGES TO the Mental Health Act (MHA) 1983 could lead to more patients in England and Wales being brought inappropriately to emergency departments (EDs), nurses claim. The government is reviewing sections 135 and 136 of the legislation, which concern the powers of police to remove people who need immediate psychiatric support to ‘places of safety’. As part of the review, the Department of Health and Home Office are asking if such places should include police cells and EDs. Ideally, designated safe places should be specialist mental health assessment suites located in psychiatric or acute hospitals, but police stations can be used in exceptional circumstances. RCN Emergency Care Association chair Janet Youd warns that, if the government accedes to mental health campaigners’ demands for police stations to be declassified as places of safety, extra patients will arrive at EDs and ‘undoubtedly cause extra pressure’ on services. ‘Police cells are not the places to be, but neither are EDs, where most staff are not mental‑health trained,’ she says. Police often take patients who need psychiatric help to EDs, even though they lack staff who have been trained to care for people with mental health problems. According to the Health and Social Care Information Centre, the number of people detained under sections 135 and 136 in UK hospitals rose from 8,759 in 2008/09 to 14,296 in 2012/13, an increase of 63%. During 2012/13, an estimated 7,761 additional orders were made in which the places of safety involved police custody, accounting for around 36% of orders. Ms Youd says that the provision of ‘environmentally appropriate mental health assessment units’ with appropriately trained staff would reduce the burden on hospitals and the police. EMERGENCY NURSE
Alamy
The government is consulting on whether police stations can continue to be regarded as places of safety for mental health patients, as Stephanie Jones-Berry reports
‘For somebody who is mentally unwell, a busy ED, where people are in pain and distress, is not the place to be.’ Ms Youd says that aggressive or violent psychiatric patients pose a risk to staff and other patients, as well as to themselves. She explains that ED nurses have too little access to important mental health history notes and may be unaware of more dangerous patients’ potential for violence. Emergency facilities for patients with mental health problems are too varied, she says, adding that there should be a review of emergency mental health care that goes beyond the issue of police powers. ‘Some EDs employ specialist mental health nurses, while others have senior nurses who lead on mental health, but there is no national standard on dealing with [mental health] patients,’ says Ms Youd. ‘We need a national review into acute emergency mental health facilities because there is massive national shortage of mental health beds.’
Faculty of Emergency Nursing board member Phil Downing agrees that specialist mental health assessment suites, training and resources will be needed if more mental health patients are directed to EDs as a result of the MHA review. ‘If the ED becomes the default place of safety for these patients, we need to ensure there are enough staff with the skills and abilities to care for them, and that the environment meets their specialist needs.’ Registered professionals A report by the Independent Commission on Mental Health and Policing published last year states that EDs must provide patients with access to registered mental health professionals for emergency assessments. Such access varies, however. Humber NHS Foundation Trust, for example, offers the services of a mental health liaison team to EDs at the Hull Royal Infirmary and Castle Hill Hospital, both part of Hull and East Yorkshire Hospitals NHS Trust. The team is available between 8am and 10pm each day. According to the latest figures, about 120,000 patients are seen at the infirmary’s ED each year and almost 4,500 of these are referred to the liaison team. The bulk of these referrals, says liaison team lead nurse Kerrie Harrison, involve children and adults who have self-harmed or attempted suicide. The government’s consultation on sections 135 and 136 of the MHA closes on June 3. Recommendations from the review will be made in the autumn. Stephanie Jones-Berry is a freelance journalist
Find out more Further details on the consultation are available at tinyurl.com/keq4u2s May 2014 | Volume 22 | Number 2
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 27, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
9
Should more people who need psychiatric help be brought to emergency departments? CHANGES TO the Mental Health Act (MHA) 1983 could lead to more patients in England and Wales being brought inappropriately to emergency departments (EDs), nurses claim. The government is reviewing sections 135 and 136 of the legislation, which concern the powers of police to remove people who need immediate psychiatric support to ‘places of safety’. As part of the review, the Department of Health and Home Office are asking if such places should include police cells and EDs. Ideally, designated safe places should be specialist mental health assessment suites located in psychiatric or acute hospitals, but police stations can be used in exceptional circumstances. RCN Emergency Care Association chair Janet Youd warns that, if the government accedes to mental health campaigners’ demands for police stations to be declassified as places of safety, extra patients will arrive at EDs and ‘undoubtedly cause extra pressure’ on services. ‘Police cells are not the places to be, but neither are EDs, where most staff are not mental‑health trained,’ she says. Police often take patients who need psychiatric help to EDs, even though they lack staff who have been trained to care for people with mental health problems. According to the Health and Social Care Information Centre, the number of people detained under sections 135 and 136 in UK hospitals rose from 8,759 in 2008/09 to 14,296 in 2012/13, an increase of 63%. During 2012/13, an estimated 7,761 additional orders were made in which the places of safety involved police custody, accounting for around 36% of orders. Ms Youd says that the provision of ‘environmentally appropriate mental health assessment units’ with appropriately trained staff would reduce the burden on hospitals and the police. EMERGENCY NURSE
Alamy
The government is consulting on whether police stations can continue to be regarded as places of safety for mental health patients, as Stephanie Jones-Berry reports
‘For somebody who is mentally unwell, a busy ED, where people are in pain and distress, is not the place to be.’ Ms Youd says that aggressive or violent psychiatric patients pose a risk to staff and other patients, as well as to themselves. She explains that ED nurses have too little access to important mental health history notes and may be unaware of more dangerous patients’ potential for violence. Emergency facilities for patients with mental health problems are too varied, she says, adding that there should be a review of emergency mental health care that goes beyond the issue of police powers. ‘Some EDs employ specialist mental health nurses, while others have senior nurses who lead on mental health, but there is no national standard on dealing with [mental health] patients,’ says Ms Youd. ‘We need a national review into acute emergency mental health facilities because there is massive national shortage of mental health beds.’
Faculty of Emergency Nursing board member Phil Downing agrees that specialist mental health assessment suites, training and resources will be needed if more mental health patients are directed to EDs as a result of the MHA review. ‘If the ED becomes the default place of safety for these patients, we need to ensure there are enough staff with the skills and abilities to care for them, and that the environment meets their specialist needs.’ Registered professionals A report by the Independent Commission on Mental Health and Policing published last year states that EDs must provide patients with access to registered mental health professionals for emergency assessments. Such access varies, however. Humber NHS Foundation Trust, for example, offers the services of a mental health liaison team to EDs at the Hull Royal Infirmary and Castle Hill Hospital, both part of Hull and East Yorkshire Hospitals NHS Trust. The team is available between 8am and 10pm each day. According to the latest figures, about 120,000 patients are seen at the infirmary’s ED each year and almost 4,500 of these are referred to the liaison team. The bulk of these referrals, says liaison team lead nurse Kerrie Harrison, involve children and adults who have self-harmed or attempted suicide. The government’s consultation on sections 135 and 136 of the MHA closes on June 3. Recommendations from the review will be made in the autumn. Stephanie Jones-Berry is a freelance journalist
Find out more Further details on the consultation are available at tinyurl.com/keq4u2s May 2014 | Volume 22 | Number 2
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 27, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
9
