When assessments under the Act may be needed
GPs are frequently approached in the first instance by a relative or other carer of a patient, worried about the mental health of a patient. Following his/her own assessment it is normal practice for the GP to request a domiciliary visit by a consultant psychiatrist where this is warranted.
If following an examination by the consultant psychiatrist a patient needs admission to hospital and it appears that informal admission is not appropriate an Approved Social Worker (ASW) should be contacted to make arrangements for the patient to be formally assessed for admission to hospital under the Act.
The Act allows the compulsory admission of a patient who is very distressed or ill (for example, actively psychotic or manic) solely in order to improve their health, even if they are not thought to be at immediate risk of harming themselves or others.
There will be situations where an emergency admission is required and it may not be possible or practicable for a consultant psychiatrist to examine a patient before a request for a compulsory admission to hospital is made. In these situations the GP should approach the ASW directly.
Where the patient is thought to need hospital admission but is unwilling to be admitted to hospital as an informal patient the ASW will make the arrangements for the patient to be formally assessed for admission under the Act. The ASW will usually ask the GP to carry out a medical examination and, if appropriate, provide a written medical recommendation for detention of the patient under the Act.
A patient may also in some circumstances be detained by the police under section 136 of the Act to enable him to be examined by a registered medical practitioner and interviewed by an ASW. Where this occurs the patient's GP, where known, will usually be contacted.
The Act cannot be used for the compulsory treatment of addictions unless the criteria for detention under the Act are also met.
The Medical Recommendations
The recommendations required for the purposes of an application for admission to hospital under the Act have to be provided by two doctors ("registered medical practitioners") who have personally examined the patient either jointly or separately. In the case of an application for an "emergency admission" under section 4 however only one medical recommendation is required. This recommendation may also be provided by a GP.
GPs may apply to become "section 12 approved". The local Strategic Health Authority should be able to provide further information.
First medical recommendation: Every application must be supported by a recommendation from a practitioner approved under section 12(2) of the Act "as having special experience in the diagnosis or treatment of mental disorder". Health Service Guidelines HSG (96)3, available from the Department of Health sets out criteria for approval under section 12(2) of the Act. In the wake of devolution of powers to Strategic Health Authorities with effect from 1 April 2002, revised guidance was issued (December 2002) to recognise the new structure and impact. The revised guidance indicated that the regional and approval arrangements that existed prior to 1 April 2002 would effectively continue to operate as before. (Both publications are available on the Department of Health website at http://www.doh.gov.uk.)
Second medical recommendation: In accordance with section 12(2) of the Act the second recommendation shall, if practicable, be provided by a doctor with "previous acquaintance" with the patient unless the doctor making the first medical recommendation has previous acquaintance with the patient. GPs are often best placed to undertake this role, and do not need to be specially approved under the Act to do so. Where there is no obvious person to provide the second medical recommendation, for example, because the patient is not registered with a GP or is not known to local mental health services, another section 12 approved doctor is usually asked to assess the patient. In cases where this is not practicable any registered medical practitioner may provide the second recommendation as long as they do not work in the same hospital as the doctor providing the first recommendation.
Last edited: 2/2/2004
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