Who is responsible Place of Safety Definition Definition

Who is responsible? Place of Safety?

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 hospital A care home Any 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-institutionalisation Reduced availability and utilisation of mental health care provision

Case study. PRESENTATION. WHAT WOULD YOU DO? 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 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 behaviour Acts 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 alcohol Frequent attenders Cry wolf/ heartsink etc. Use of emergency services Fear and alarm Police. . . Custody!

Managing BPD in custody Empathic Cold/hostile Consistent Inconsistent Boundaried 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.