5

GP/Medical Practitioner considers need for medical recommendation

The GP/medical practitioner must interview the patient as soon as possible and consider whether or not a medical recommendation should be made on the grounds that the patient 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

What are the criteria for admission for assessment?

Article 4 (2) states that an application for assessment may be made in respect of a patient on the grounds that –

(a) He is suffering from mental disorder of a nature or degree which warrants his detention in a hospital for assessment (or for assessment followed by medical treatment); and

(b) Failure to so detain him would create a substantial likelihood of serious physical harm to himself 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.

If the patient is medically fit for discharge, the GP/medical practitioner should consider alternatives to detention, including assistance from the local 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 safety is not available in the community". If the patient is medically unfit for discharge the assistance of the local liaison psychiatry service should be considered.

In most situations, and if the nearest relative has declined to make the application or hospital staff have been unable to contact or identify the nearest relative, a request for the duty ASW to attend will be made at the same time as that made to the GP/medical practitioner. This allows for a joint assessment and/or consultation in relation to the need to make an application for detention for assessment.

The GP/medical practitioner and ASW should consider whether a separate or joint interview with the patient 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 patient 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 patient 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 patient 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 patient 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 patient's disturbed behaviour and the urgency of the patient's needs. If these particular concerns exist the interview should be postponed.

The patient 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 patient 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