Mariam Alexander’s article (What’s it really like to section a patient? I wish I didn’t know, 12 November) brought back memories of numerous mental health assessments during my career as an approved mental health professional (AMHP), with my original core training in social work. Dr Alexander correctly states that a MHA involves three professionals: two doctors and an AMHP. She and the second doctor have the right to complete a recommendation for a patient to be detained under the Mental Health Act (MHA), but do not have the power to admit the patient to hospital until the AMHP is satisfied that the grounds for admission have been met. He or she will then complete a separate application for detention.
Similar articles in the past relating to admissions to psychiatric hospitals have often overlooked the role of the AMHP, who has overall responsibility under the MHA to stage-manage the assessment from beginning to end, which also involves identifying and communicating with the patient’s nearest relative. AMHPs are also obliged under the MHA to ensure that all alternatives to detention have been explored prior to completing an application. Dr Alexander is right that psychiatrists cannot predict the future, but it was always my experience that potential risk management was a shared process, and if suicide occurred as the result of a least restrictive alternative to detention, a debriefing support consultation involving all the professionals would follow.
Finally, I sincerely share Dr Alexander’s deep anxieties relating to mental health assessments, particularly where one has no other alternative to detaining a highly disturbed patient on a hospital ward, where they feel more isolated.
Robert Wightmore
Tiverton, Devon
• It is sad that Mariam Alexander’s article has no mention of the role of the GP in managing psychiatric emergencies. A doctor known to the patient and his family immediately reduces the tension, as well as providing historical background for the psychiatrist and psychiatric social worker. In 38 years as a GP, including eight as a clinical assistant in psychiatry, police support was never requested nor physical restraint needed. Patients, no matter how disturbed, accept an injection from their own doctor. For most, sectioning was a once-only occasion. I had three patients with two episodes and one with three. Distressing at the time it may be, but no sectioned patient ever left my list later. It is tragic that the medical practitioner who had most to offer, and was the instigator of the procedure, is no longer involved.
Dr Wally Johns
Bath
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