Assessing an acutely disturbed person in the community

• Published in: BMJ (Online) 2019-03, Vol.364, p.l578-l578
• Main Authors: O'Brien, Aileen, Kaar, Stephen, Ibison, Judith, Chalmers, Julie
• Format: Article
• Language: English
• Subjects: Alcohol; Checklist; Commitment of Mentally Ill; Communication; Crisis intervention; Empathy; Forensic science; Health risk assessment; Humans; Medical History Taking; Mental disorders; Mental health; Mental health care; Patient assessment; Patient Safety; Patients; Physician-Patient Relations; Practice Guidelines as Topic; Primary Health Care; Psychiatry; Psychosis; Psychotic Disorders - diagnosis; Psychotic Disorders - psychology; Referral and Consultation; Risk Assessment - methods; Risk factors; Schizophrenia; Suicide; Suicides & suicide attempts
• ISSN: 0959-8138; 1756-1833
• DOI: 10.1136/bmj.l578

What you need to know Attempt to de-escalate the situation: listen, acknowledge the person’s feelings, reassure them that you wish to help, offer a quiet space to talk, a drink, and time to speak and be listened to In rare circumstances, where there is an imminent physical risk to the person or others, use internal alarms to alert the rest of the practice, contact police, and consider evacuating the area Check for the presence of physical and mental health comorbidities, the role of recreational drugs or alcohol, and acute life stressors (relationships, housing, finances, access to services) Establish any risk factors, such as a history of aggression, self harm, or suicide attempts, recent psychiatric admission, or a forensic history If the situation cannot be safely de-escalated then Section 136 (S136) of the Mental Health Act is a police power in the United Kingdom to remove someone to a place of safety for assessment and it can now be used in any part of a general practice or community clinic You are urgently called to reception where a 25 year old man is shouting about the building having been taken over by demons. Immediate actions Use non-aggressive verbal and non-verbal communication, while monitoring the situation for potential risks to the person and to staff and other patients in the waiting area.1 Communication Focus on the person, listen to what they are saying Ask their name Present a calm demeanour Consider the potential physical risk to staff and patients and take action if the risk is high, by using silent internal alarms to attract help; considering evacuation of patients or staff at risk; having other staff call the police (ideally out of earshot of the distressed person); Alert clinical staff that a rapid assessment of the person may be needed. Figures from NHS digital 2015-16 show a rise of 18% from the previous year, to 22 965.4 During this period, 17.8% of people detained on S136 subsequently went on to be detained under Section 2 or Section 3.4 (box 3).Box 3 Different types of Mental Health Act sections The person is suffering from a mental disorder of a nature (chronicity, prognosis, previous response to treatment) and/or degree (current manifestation of the illness, eg, severity of current symptoms, impact on functioning etc.) that warrants Section 2 Detention in hospital for assessment for up to 28 days. Mental health services available could be the local community mental health team/home treatment team/liaison psychiatry/street t