Medical treatment and assessment of need

A&E staff should undertake an assessment of the person's medical and psychological needs and provide any necessary medical treatment and mental health care.

If a person has been brought to A&E by the police, under powers conveyed by Article 130, A&E staff should ensure that the person is seen as a matter of urgency. Police are required to remain with the detained person until he has been medically examined by the person's GP or other medical practitioner and an ASW and any necessary arrangements have been made for the person's care and treatment. For this reason police should not be unnecessarily delayed in A&E. LINK TO Patients with Mental Health Needs in the Acute Sector - Learning Lessons

In other situations a person with similar needs will present or be brought to an A&E without the assistance of NIAS.

When the person is deemed medically fit A&E staff may make a referral to psychiatric services. Staff should follow the local agreed protocol in relation to their initial assessment of the person's mental health needs and referral processes.

However, if the doctor in A&E believes that the person is in immediate need of admission to hospital for assessment before psychiatric services can attend, the person's GP/medical practitioner and the ASW/nearest relative should be contacted and a request made for their urgent attendance at A&E to consider the need for compulsory admission to hospital.

In cases of urgent necessity only, a doctor on the staff of the A&E Emergency Department can make the medical recommendation but only if it has not been possible to contact the person's own GP or another doctor in the practice or it is not practicable for either doctor to attend. It is important to note that Form 5 can not be used in this situation as the person is not an inpatient.

What happens if the person insists on leaving A&E before a medical recommendation and application can be made?

Where A&E staff are concerned that a person is mentally disordered and may be at risk of causing serious physical harm to himself and/ or others, consideration should be given to preventing that person from leaving in his "best interests" until the appropriate assessment can be carried out. This may require the assistance of security staff within the hospital or in exceptional circumstances, the PSNI.

The order does not permit the use of Form 5 to prevent a person leaving an A&E Dept.

All action must be both necessary and proportionate.