WHO Guide to Mental and Neurological Health in Primary Care
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Homepage :: Legal issues :: Use of the Mental Health (Scotland) Act 1984 :: During the assessment

During the assessment

The patient is interviewed as comfortably as possible with the following questions in mind:

  • Is there any possible evidence of mental disorder?
  • Is there a risk to the health or safety of the patient or a danger to others?

If the answer to both of these questions is yes:

  • Will the patient consent to informal admission? And if so, is that realistic based on past experience or aspects of the current interview?
  • Are there any community alternatives to admission, eg giving medication at home, community mental health nurse visits, crisis services, day hospitals?

For Section 24:

  • Seek the consent of the MHO or a near relative. A list of who is considered a ‘relative’ under the Act can be found on form A. Being involved in the compulsory admission of a relative to hospital can sometimes damage family relationships; therefore, if practicable, advise the relative that there is an alternative ( ie an MHO can perform the consent role). If it is not practicable to seek consent from either an MHO or a near relative, a single doctor's recommendation is sufficient, but the reason for failure to seek consent must be explained on the recommendation form. If the relative and MHO refuse consent, compulsory admission cannot go ahead.
  • Complete the recommendation on form A (or on practice-headed notepaper). Include the following: full  details of your qualifications; a declaration that you have examined the patient at the time of the application; that the patient is subject to a mental disorder; that treatment is necessary in the interests of the health or safety of the patient or the protection of others; state the reasons why detention is urgently necessary and use of section 18 is precluded; whose consent has been obtained or reasons why it has not been possible to obtain the consent of an MHO or a near relative. The documentation must be completed on the same day as the patient examination.

For Section 18:

The MHO will normally take responsibility for co-ordinating the assessment, bringing relevant papers and ensuring the process complies with the law.

The team needed for a Section 18 (six months for treatment) is:

  • A Section -20-approved doctor. Where the patient is known to the service, this doctor should be the patient's own consultant psychiatrist.
  • The nearest relative or a MHO (the MHO makes a more comprehensive assessment of the social aspects of the case and advises on the legal issues that may arise during the process).
  • A doctor with prior knowledge of the patient (ideally the GP).

All professionals strive to reach a consensus and if the two doctors agree to make the medical recommendations for compulsory admission, the MHO makes the application to the Sheriff within seven days. The MHO must make the application even if the two doctors disagree with the medical recommendations. The Sheriff may call a hearing, which may involve the attendance of the GP to court.

Last edited: 4/12/2003

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