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.