To think mental health act assessments should be done by a psychiatrist known to the patient

[Coldnights]

Family friends son has just had one done but by two unknown doctors. He also has autism so would have been better being assessed by someone he know. The one in his community team has known him for five years.

In an ideal world he’d be seen by a doctor who knows him as one of the assessing practitioners, but it very much depends on who is available and services are stretched to a ridiculous degree at the moment.

MIND has information on the process here: www.mind.org.uk/information-support/legal-rights/sectioning/being-assessed/

Thank you. I’m sure they even attempted to find one that know him.

Community teams don't generally do MHA assessments, at least not in my area.

When I've had clients in crisis and their psychiatrist from the community team believes they need to be admitted, but the client won't goin voluntarily, they have always got a psychs from one of the crisis team to do the assessment.

By their very nature MHA assessments are urgent and if a practitioner knows them, great, but if not the assessing doctors and social worker can get background and collateral information.

This isn't always possible if someone needs to be assessed urgently, ideally it would be the psychiatrist who knows the patient and gp however if someone needs to be assessed for the MHA urgently in the middle of the night ,weekend ,bank holiday etc then they might not be available ,however they should be seen by their regular psychiatrist as soon as possible.

Unfortunately that just isn’t always possible. In fact, in the CAMHS I work in, it rarely is although we do try to facilitate it as much as we can. I hope your friend’s son is doing ok now.

Objective distance can be a good thing.

Closeness can lead to a physician being too sympathetic to a patient and what they say and be mislead.

Sometimes cold hard clinical work is needed to protect a person

Also there is the ongoing relationship afterwards to be considered.

Unfortunately it's usually whoever is on call if it's out of hours. It's not as easy as just getting someone in that knows him. Even if it's in hours a lot of psychiatrists will have clinics and ward rounds etc - where I am they send whoever is available as they're all capable.

You’re assuming that a person’s first contact with a psychiatrist will be when they are not in crisis. This is not always the case. My first inkling of a MH problem and contact with a psychiatrist was when I was sectioned. I had never had any MH issues before I was in crisis.

I can agree that if a person is already under care of psychiatrist that an effort should be made to contact/involve that doctor if that person later has a crisis.

Well I agree with you OP in principle. It’s also in the MHA code of practice:

“14.73 Where practicable, at least one of the medical recommendations must be provided by a doctor with previous acquaintance with the patient. Preferably, this should be a doctor who has personally treated the patient. It is sufficient for the doctor to have had some previous knowledge of the patient’s case.“

In practice there is a great deal of variation between services and areas it seems. Where I am, almost always the community team Dr (Who knows patient) would be involved in the MHA assessment. Only exception would be if they present to A&E in an emergency and then it would be liaison psych Dr and independent Dr. I’m a bit surprised it’s not like that in more areas tbh!

Thanks everyone

If your in the UK the young man should have had a community care and treatment review prior to admission. Here is a link to some support

www.autism.org.uk/what-we-do/help-and-support/autism-inpatient-mental-health-service