Mental Health

Aims For The Week

  • List the staff safety requirements for the assessment of mental health patients

  • Implement the suicidal risk assessment with the ED mental health assessment proforma

  • List factors that increase the risk of suicide completion

  • Perform a mental state examination

  • Correctly utilise the Mental Health Act and discuss its legal limitations

  • Describe the circumstances in which a psychiatric referral should be made

  • Correctly utilise the Emergency Detention procedure

  • List the differential diagnoses for acute behavioural disturbance

  • Develop an appropriate management strategy for acute behavioural disturbance and psychosis

  • Correctly utilise the Adults with Incapacity Act and discuss its legal limitations


The Basics

A quick note on the general approach to patients with mental health problems.

And how to perform a Mental State Examination


Mental Health ACT

It is really important that everyone understands the Mental Health Act, which is explained well by this document. Make sure that you read about the Emergency Detention Certificate & we also have some useful information which can be given to patients to explain what is happening to them.




You should be familiar with the Emergency Detention Procedure.


Another important legislation to be aware of is the Adults with Incapacity Act.


Assessing Capacity to refuse

How do you treat someone who has taken an overdose (eg paracetamol) and is refusing treatment?

  • St Emlyn’s post: Ay, There’s The Rub – The Mental Capacity Act in the ED (note slight differences because it refers to the English law, but the principles are the same).

  • Mental Welfare Commission for Scotland advice


The Violent Patient

Another great post from Life In the Fast Lane about managing the violent & aggressive patient. Note this is written in Australia, therefore some aspects do not apply, such as the use of mechanical restraints & using a personal duress alarm. Our most common management would be with benzodiazepines or haloperidol.



Further Reading

A good place to start that provides an overview of the issues:

  • St Emlyn’s blog : Are we doing all we can for mental health?


A great run down on mental health diagnoses & investigations by LITFL.



These short modules from RCEM are very useful:

  • Disturbed or psychiatric patients in ED

  • Acute behavioural disturbance


Test Yourself


All mapped to the ACCS & Emergency Medicine HST curriculum!


More Weekly Themes



Hannah Bell