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
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.
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 YOUR mental health KNOWLEDGE WITH OUR QUICK QUIZZES
All mapped to the ACCS & Emergency Medicine HST curriculum!
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