GP/Medical Practitioner considers need for medical recommendation

The GP/medical practitioner must interview the person as soon as possible and consider whether or not a medical recommendation should be made on the grounds that the person appears to meet the criteria for admission for assessment as set out in Article 4 of the Order. LINK TO ROLE OF GP/ MEDICAL PRACTITIONER

Who should carry out this assessment and if necessary make the medical recommendation that the person be admitted to hospital for assessment?

The Order (Article 6) states that the medical recommendation for admission for assessment should be given, if practicable, by the patient's own GP. If this is not possible, a medical practitioner who has previous acquaintance with the person can make the recommendation. However a doctor on the staff of the admitting psychiatric or learning disability hospital should only do so in cases of urgent necessity. Any doctor, who is not the person's GP and who is examining the person with a view to making a medical recommendation should make all efforts to consult with the GP or access the person's relevant medical records.

What if the person is not registered with a G.P.?

In this circumstance the assistance of a medical practitioner should be sought through local emergency primary care arrangements.

What are the criteria for admission for assessment?

The grounds or criteria for admission to hospital for assessment are that the person is:

  • Suffering from "mental disorder of a nature or degree which warrants detention in hospital" for assessment ( or for assessment followed by medical treatment) and
  • Failure to so detain the person would create a substantial likelihood of serious physical harm to the person or to other persons.

The GP/medical practitioner should consider the evidence that can be used in determining that there is a substantial likelihood of serious physical harm to the person or others as set out in Article 2 (4) and paragraphs 23 and 24 of the Guide.

The GP/medical practitioner should consider alternatives to admission including assistance from the mental health home treatment team or other community health and social care services as he will be required to state in the Medical Recommendation Form 3 that "reasonable provision for his/her safety is not available in the community". LINK TO FORM 3

If the nearest relative has declined to make the application or it has not been possible to contact or identify the nearest relative, the ASW should be asked to undertake an assessment in relation to an application for detention for assessment.

The GP/medical practitioner and ASW should consider whether a separate or joint interview with the person should be conducted. This should take account of the patient's wishes and any other concerns in the assessment situation.

The Code, 2.5 states that "it is good practice for the professionals involved in the application for admission to be present at the same time (although it may be advantageous for each to interview the patient separately".

What other factors need to be considered when interviewing the patient?

In addition to ensuring that the interview takes account of the Principles contained in the Code of Practice 1.8, the following good practice guidelines should be considered.

  • If the person who is being assessed does not speak English as a first or competently as a second language, the professionals must seek assistance from an interpreter through arrangements set out by the Regional Interpreting Service. All health and social care professionals/ staff have a legal duty to provide an interpreter in these circumstances under the Northern Ireland Act 1998, Race Relations (Northern Ireland) Order 1997 and Human Rights Act 1998. This duty will also apply in relation to the communication needs of the nearest relative.
  • A professional interpreter can be accessed 24 hours a day, 7 days of the week through the Northern Ireland Health and Social Services Regional Interpreting Service, Telephone 028 9056 3794. Their Code of Practice contains additional guidance including how to contact an interpreter in an emergency situation. LINK TO Code of Practice and Guidelines on Booking Interpreters for HSC Staff and Practitioners.

What if the person has other communication difficulties?

If the patient has difficulty either in hearing or speaking, the assistance of interpreters or staff with specialist skills should be sought. Friends, relatives or other persons should not be used as interpreters unless in for very routine administration tasks such as setting up an appointment.

What additional factors need to be considered?

Where the person is still unable or unwilling to communicate adequately (despite assistance from interpreters) the decision to proceed will have to be based on whatever information can be obtained from other sources. The person should not be interviewed through a closed door or window except where this is necessary to avoid serious risk to other people. Where there is no immediate risk of physical danger to the person or to others, consideration should be given to seeking a warrant under Article 129 (1) of the Order. LINK TO WARRANTS APPENDIX

The person should not be interviewed when under the effects of sedative medication, short-term effects of drugs or alcohol unless it is not possible to delay because of the person's disturbed behaviour and the urgency of his needs. If these particular concerns exist the interview should be postponed.

The person should be interviewed in private except if there is a risk of physical violence. In this event the GP/medical practitioner and ASW or Nearest Relative can insist on another person being present.

If the person would like another person e.g. a friend, family member or advocate present during the interview and any subsequent action, the professionals involved should assist in securing the person's attendance unless the urgency of the case or some other proper reason makes it inappropriate to do so. Code 2.6

What if there is a risk of serious physical harm in the assessment situation?

In situations where initial information gathered indicates that there may be a risk of violence in the assessment situation against the professionals involved in the assessment process or other persons, the Code advises that those involved "should consider calling for police assistance and should know how to use that assistance to minimise the risk of violence".
Code 2.5

This risk may not be immediately apparent and the need for such assistance should be continually assessed by the professional involved.

Similarly, if it becomes apparent that the assistance of police is not necessary the police should also be advised as soon as possible.

Any request for assistance should follow an assessment by the applicant (ASW or nearest relative) and the GP/medical practitioner of the risks that do or potentially could exist and should be both proportionate and necessary.

However the PSNI should not be routinely asked to attend situations where a person is being assessed for possible admission for assessment in hospital.

The PSNI will not attend in cases involving a difficult, but non-violent person whose past history and present diagnosis gives no rise for concern for the safety of other agencies in the assessment situation.

The PSNI may already be involved as a consequence of the need to use their powers under Article 129 and 130 of the Order. LINK TO ROLE OF PSNI