Table of contents for Cynics Guide
- Job Adverts
- Cynics Guide: Psychiatric Hotline Protocol
- Define My Madness ?
- You Don’t Have To Be Mad, But It Helps
- Better Than Butlins ?
- Stop In The Name Of My Law !
- Sectioning Detrimental To Self Esteem
- Avoiding Becoming A Patient
- Cynics Guide: Staff Retention (Part 1)
- [Cynic's Guide: How To Blog]
- Cynic’s Guide: Not Taught At University
- Major And Minor Psychoneurotics
I never used this during the best part of two years of busy acute nursing. Everybody I asked to stop … stopped.
The Nurses holding power.
Section 5(4)
Under section 5(4) you can also be detained by some suitably qualified nurses (first level ones) for up to 6 hours. This is to give time for the doctor to see you to consider applying section 5(2). This time limit cannot be extended.
The criteria are -
that it appears to the nurse:
that you are suffering from mental disorder to such a degree that it is necessary for your health or safety or for the protection of others for you to be immediately restrained from leaving the hospital; and that it is not practicable to secure the immediate attendance of a medical practitioner for the purpose of furnishing a report under Section 5(2) [Doctors Holding Power].
A written record of this must be made by the nurse and given to the hospital managers, or someone appointed to act on their behalf, as soon as possible.
Nurses’ holding power
Nurses can detain patients for urgent medical examination for up to two hours under Section 299 of the Act. Once the doctor arrives, a further hour of detention is allowed. It is not good practice to immediately institute a second period of nurses’ holding power once the initial two hours has elapsed.
Both of these let nurses detain patients, already in hospital, for a brief period of time. Until a doctor arrives. Whereupon you can keep the person detained until he or she has made an assessment of the patient. In England if the doctor does not arrive in time the patient is free to go. In Scotland it looks like the holding power can be repeated, even if this is not best practice.
There is no appeal against the act in England, in Scotland you could possibly complain, after the fact, that it was not the least restrictive alternative but I suspect this would be a road to nowhere.
The conditions for use of the power are the same to all intents and purposes in both England and Scotland. A tutor explained to me once that the English get six hours as it may take the doctor longer to get to the hospital ! With hindsight I am a little confused.
The conditions are fairly standard. The person to be detained must be :
mad - preferably screaming and shouting dangerous (to know)- to self or others in hospital
Being bad is entirely optional.
Normally it is entirely up to individual nurses if they use their holding power or not. Generally with prior discussion with the rest of the team, but it is up to the nurses dealing with the situation at the time who decides. The situation should be if someone needs to be on a section they should be on a section.
Some places, I hear, the nurses won’t detain someone if a doctor (that assessed the patient three days previously) has decided they are not detainable. Get a grip !
I can recall only the one situation where I almost used this.
*fade to flashback*
Morning Shift
(one to one discussion between Ethel the patient and Paul the nurse.)
Ethel: I am very depressed, I want to kill myself
Paul: Really ?
Ethel: Yes.
Ethel in this case is not the most convincing patient. But does have an on off history of low level suicide attempts.
Handover Between Morning Shift and Afternoon Shift
Paul: Ethel says she is suicidal.
Mental: Really ?
Paul: Yes.
Mental: No, is she really suicidal ?
Paul: Probably not, but maybe.
I go off and check risk history. It is a possibility. But it was raining in the morning. Sunny in the afternoon. Shopping weather.
Afternoon Shift
(Standing at the ward exit)
Ethel: I’m off out then Mental, shopping.
Mental: I would prefer you didn’t for the time being.
Ethel: *confused* But why ?
Please remember staff actually tell one another things, especially potentially important stuff.
I don’t know why some people forget this.
To go on.
Mental: Because you said earlier you were feeling suicidal.
Here it comes.
Ethel: How do you know ?
Mental: *looks at Ethel*
Ethel: But I want to go shopping !
Anyway on it went for another while. I did not really think hard about using the Section 5(4) but it is the kind of possibility were it might have been used, if she had been more likely to do harm to herself and she was unwilling to wait to be seen by the doctor.
In the end Ethel went shopping.
She got cream cakes.
For the staff.
Lovely.
[Anyone been detained under the nurses holding power ?]
Tags: cynics guide, legal, mental health act
2 comments
October 16, 2005 at 7:57 am
Git
During my long career in acute psychiatric admissions, I used this holding power several times. In my experience, too few psych nurses use this option appropriately.
I would come on shift sometimes and find that nurses had spent all morning ‘persuading’ someone not to leave in ever more coercive ways - actually running to and from the door to prevent a patient from walking out.
For the patient, in a depressingly large number of cases, all you’re doing is delaying the inevitable. In my opinion, it’s often not kinder or less oppressive not to detain. Formal patients have more legal rights than informal ones, don’t forget. If you’re being ‘persuaded’ to come back from the door several times in a shift, you have no legal recourse. If you’re on a 5(4), you at least get guaranteed the chance to speak to the doc and clarify your situation one way or the other.
October 17, 2005 at 11:59 am
nephron
(Hi, I’m a 21yo nursing student and ex-inpatient of a psychiatric facility)
I’ve never been detained under any holding power, and the hospital I was in was entirely “voluntary” (although if you intended to leave and you were deemed to be a real risk to yourself or others you could be transferred to somewhere else).
I convinced my psychiatrist to admit me because I was acting very impulsively, and with wildly swinging moods I thought I was at significant risk of some sort of self-harm.
Later on that day, I wanted to pop down to the corner shop to get a proper coffee- and they said I wasn’t allowed to leave without an agreed person being with me, because I was deemed to be at risk of self-injury. It didn’t bother me much that I was being restricted in my comings and goings- because I understood the reason for it. I would have been much less happy if I had been put under what’s called an “involuntary treatment order” here- as to me, that would have shown that the nurses didn’t trust me to comply with a reasonable request.
If, on the other hand, someone is repeatedly trying to leave and being thwarted but not convinced of the reason, then nurses’ holding power or an equivalent may be a good option.