Crises are usually situations in which there is a high level of risk to the person (or to someone else). For someone known to the services already, periods of acute distress are usually dealt with by offering increased input from the team and this may involve treatment from the CRHT for intensive home treatment or admission to an acute unit in hospital sometimes against the person’s expressed wishes.
A GP can refer to the ATS ( Assessment and Treatment team) and rate their referral as very urgent, fairly urgent or lower risk. This will result in an appointment within a few hours to a month. This can be useful for an urgent referral and a good GP can cut out a lot of stressful experiences.
Accident and Emergency (A&E) involves talking things over with someone which may help in itself. Medication may be suggested or admission to hospital. However, the wait can be several hours. The advice is often to go there, although when you are a 5ft woman alone with a 6ft son who is unwell and unwilling to go, and unwilling to stay, this is definitely not an easy option. Currently there are real efforts being made to find a different safe place for people to wait and avoid having to sit in the main department.
Ambulances can be called especially if the person is hurt (self-harm or overdose perhaps) but crews cannot make a person go with them. If there is any hint of aggression the police may also be involved.
Police can supervise someone at home if this is a suitable place or take them against their will it they are clearly very unwell, highly agitated or violent to a special ‘136 Suite’ at the hospitals (or a police station cell if this is full). This power is usually used in public places rather than people’s homes. They can be held for up to 72 hours until assessed by MH practitioners. If police come to a private house their presence alone can calm the situation, but calling them may anger the cared-for person and leave them cross with you. However, if there is a risk of harm to you or to them it is the fastest response and demonstrates that you will call for help if you feel you need to.
MH hospital acute services contact details are listed on this site however you cannot go directly and ask for a bed.
If assessed as needing admission and the nearest unit is full people will get referred to the nearest vacant bed in the Trust area or further afield. This is often very inconvenient for family who want to visit, but the person is usually brought to the closest service as soon as possible.
So when are people admitted to hospital? What is sometimes difficult for Carers to understand is that what may be a critical situation for a family may not be seen that way by the people who do the assessment. Suicidal ideas are not always enough in themselves to
ensure admission. Talking about suicide is often a sign of distress rather than a statement of intent, but is still highly stressful if they are not offered a bed and you are left at home with them and highly unsure of their safety.
The CRHT team is always part of an assessment to see if they can keep the person safely at home by offering intensive support – which still may be hard on the family.
‘At risk’ usually means that there is clear evidence from the person themselves or other people, of which you may be one, that their behaviour is likely to result in serious harm to themselves or to others in the near future.
The Mental Health Act is the only law which can take someone’s liberty away without them having committed a criminal act. It is used with great care, as misuse can lead to major repercussions for the professionals involved. It is always a last resort.
Your relative or partner may be very angry if you ‘collude’ with professionals in their forced admission to hospital in a crisis, but this may be necessary for their own wellbeing, even if they cannot recognise that fact until later on.
Being on a unit with other highly distressed people is not always restful or therapeutic, but it offers better safety and time to observe the issues in order to understand the problem better.
This Act is a piece of law that is divided into different sections. A particular section can be used in specific circumstances to admit and treat a person. This has resulted in the term ‘being sectioned.’
Those involved in the process of sectioning are two doctors, usually psychiatrists or occasionally a GP, and an Approved Mental Health Professional (AMHP) who can be from a range of professions, usually but not always a specially trained social worker.
If the person is assessed as needing to go into hospital and is prepared to be admitted voluntarily then the Mental Health Act is not used, but they can be made to stay in if they then try to leave and are still considered to be high risk.
This is a very brief summary of the powers contained in the most commonly used parts of the Mental Health Act.
|Sect.2||Period of assessment which may be followed by an offer of treatment-often used first.
Length – up to 28 days Needs 2 doctors 1 AMPH to enact
|Sect.3|| Admission for treatment (which may have a wider meaning than just medication). Can be made to accept treatment but agreement sought if possible.
Up to 6 months. May be renewed for 6 more months then yearly. 2 doctors 1 AMPH needed and then can be renewed by the Consultant Psychiatrist. Nearest Relative must be consulted. Usually follows a shorter section such as 2.
|Sect. 135/ 136||Police can remove a person to a Place of Safety (can be at a hospital or in Police custody) where they will be assessed by a suitably qualified doctor. This can be fo rup to 72 hours.|
CTO Community Treatment Orders can be used after a Sect.3 Psychiatrist in charge and an AMPH It sets conditions such as taking medication of care regularly of but allows people to live in the community. If the person does not comply they can be returned to hospital immediately. Used mainly for people who are at serious risk if they do not take their medication.
Someone who is willing to be admitted voluntarily will not be sectioned.
There are sections which can be used to prevent a person from leaving an acute unit if they are considered to still be at risk.
A person can be discharged as soon as they are considered well enough, even after a few days, regardless of the length of their section.
Being sectioned may have repercussions (job applications, visiting some countries) but it does not have any criminal implications.