Place of Safety?Who is responsible?
Definition
Definition
Section 297. Removal from a public place. A person who is in need of immediate care
and treatment and it is considered that it is in the best interests or necessary for the protection of that person, a constable can remove that person to a place of safety.
This enables arrangements for a medical practitioner to carry out examination, make the necessary arrangements considered necessary for that person.
A person can be detained for not more than 24 hours.
Place of safety
A place of safety means:-A hospitalA care homeAny other suitable place (other than
a police station) the occupier of which is willing temporarily to receive mentally disordered persons.
If no place of safety is immediately available, a person can be removed to a police station.
Contact between the police and people with complex mental health care needs is rising...
Reasons given for this include:
Changing trends in alcohol and drug use
De-institutionalisationReduced availability and utilisation
of mental health care provision
Case study.
PRESENTATION.
A 53 year old man is brought to custody under Section 297 of Mental Health Care and Treatment Act Scotland 2003.
No place of safety available
He has been drinking alcohol.
You are called to assess him for ‘fitness’
WHAT WOULD YOU DO?
What are you being asked to do?
What do you understand by the terminology?
What would you do first?
Mr Armitage
Fitness to be detained
Fitness for interview
Fitness for release Fitness for
interview Fitness for court
Breath alcohol Background story What information
do you need? Where do you get
the information? Would you assess
if drunk?
Mr Armitage
He has been in contact with emergency psychiatry earlier this evening.
He was deemed to be unassessable.
His BRAC equal to 5-6 units.
Last drink: 4 hours ago.
Name/age/occupation
Overdose? Vital signs Presenting
condition What has
happened tonight? Patient Electronic records
(consent?)
Mr Hugh Armitage
Found in body of water
At night Handcuffed to a
suitcase He says he is fine
and would like to go home.
Local government worker
Lives alone Never married Bereaved of his
mother Can give consent Records show he is
on SSRI for the 4 months since bereavement.
Hugh
Vital signs Low BM Temp ok. Does not appear
intoxicated. He wants to
continue. Food and tea!
Anti Ligature Suit Observation cell First time in custody No next of kin Retiring in 3 weeks Social network- non
intimate No significant other Mum was devout Hugh- not so much No money worries
Hugh
Has had sexual fantasies about men for many years.
Has acted out only a handful of times.
Feels deeply ashamed
Libido very much active in his imagination.
Just wants to go home.
Denies any suicidality
Now sober What do you think? Risk? Onward referral? Gut
feeling/intuition Capacity- plenty! Plausible
Mr Hugh Armitage
Left custody , no crime had been committed, the detention was lifted, he was fit for release. Follow up had been arranged with his GP. Sadly, he completed his suicide the same day. What could have been done differently?
More common presentations.
Upset about real or perceived abandonment
Relationships are intense- love or hate- little middle ground
Unaware of own ethics, values or own feelings.
Low self esteem Impulsive- difficult to control
behaviourActs without thinking
Index of suspicion...
Self harming behaviour with little suicidal intent
A longing to feel something that is unattainable
Anger outbursts against those caring for them
Occasional symptoms bordering on psychotic at times of distress.
Chronic sense of emptiness
Borderline Personality Disorder
Don’t respond well to admission to hospital.
Use of drugs and alcoholFrequent attendersCry wolf/ heartsink etc.Use of emergency servicesFear and alarmPolice...Custody!
Managing BPD in custody Empathic
Consistent
Boundaried
Cold/hostile
Inconsistent
Unboundaried
Keep yourself safe.
Keep yourself safe
Splitting teams
Be aware
Support each other
Clinical Supervision
In conclusion
Place of safety issues are a national problem
Intoxicated people who are suicidal will come into police custody after being refused place of safety.
Whilst this problem is being addressed:
Be person centred Provide mental health assessment
and onward support and provision where necessary.