Mental illness assessment, management of depression and self harm; the Mental Health Act

Chapter 15 Mental illness assessment, management of depression and self harm; the Mental Health Act






Primary survey


A mental illness may cause a patient to take an overdose or injure themselves in such a way that they develop immediately life-threatening ABCD problems. These problems are covered in Chapter 14.


An immediately life-threatening psychiatric situation is where the patient wants to kill themselves, or harm others (Box 15.2), but will not comply with treatment. Management will depend on a large number of factors – not only your assessment of the problem but also the extent and availability of local services.



Enlisting the support of family and carers is often the simplest and best way to resolve such conflicts. However if this does not work you will have to call for assistance. This may be the patient’s own primary care team or the mental health team. In extreme situations where you judge that there is an immediate threat to the wellbeing of the patient, or others, you should call the police.


The Mental Health Act (MHA), in Section 63, states that the detained (or ‘sectioned’) patient’s consent is not needed for medical treatment for mental disorder (when this is under the direction of the Responsible Medical Officer). This is detailed as being:






However, the MHA does not necessarily permit the compulsory treatment of a physical disorder in a patient who is not consenting.



Secondary survey


If it is obvious that the patient is going to have to be assessed by another professional then only a brief evaluation will be required. However the following steps need to be taken to ensure the patient is suffering from a mental illness and not a physical disorder. Acute infections, intoxications, drug withdrawal syndromes, diabetes and neurological conditions are common physical conditions that may present with symptoms of mental illness/disorder. An acute confusional state may present very rapidly, especially in older patients. In the elderly this frequently can result from chest or urinary tract infections, recent life change, or progressive dementia.


Medical assessment is indicated if:












Mental health assessment


While it is difficult to completely separate the mental health assessment into ‘history’ and exam sections, it aids understanding to use the SOAPC system. Effective mental health assessment requires a very sensitive consultation style to gain the patient’s trust and showing the patient that you recognise their distress and experience. Some key principles for the mental health interview are identified in Box 15.3. Consultation skills that improve identification of emotional distress include frequent eye contact, relaxed posture, use of open questions at the beginning of the -consultation, use of minimal verbal prompts while actively listening and avoiding giving information too early in the consultation.






Jun 14, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Mental illness assessment, management of depression and self harm; the Mental Health Act

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