1. Who is responsible?

3.  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.

4.  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.

6.  Changing trends in alcohol and drug use  De-institutionalisation  Reduced availability and utilisation of mental health care provision

7. 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?

8.  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?

9.  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?)

10.  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.

11.  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

12.  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

13. 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?

14.  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

15.  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

16.  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!

17.  Empathic  Consistent  Boundaried  Cold/hostile  Inconsistent  Unboundaried

18.  Keep yourself safe  Splitting teams  Be aware  Support each other  Clinical Supervision

19.  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.