All Change 1: New sectioning powers for nurses

I thought certain nurses could detain someone under a section of the mental health act anyway, for up to 6 hours, until a doctor arrived, who would then probably agree with the nurse that the person needs to be detained longer (since many of them don’t have a brain of their own would have had no prior dealings with the patient and would rely on the opnion of the nurse) so I don’t really what difference it makes. Or am I missing something?

Thus far I have never actually been sectioned, but in principle have always supprted the powers contained within the Mental Health Act as an appropriate means of protecting a vulnerable group (me included should it ever prove necessary). But I am totally alarmed at the prospect of being sectioned without any input from a psychiatrist.

I suspect very few other professionals will take on the added responsibilities of Responsible Clinician - possibly some band 7 nurses in the community in order to expedite things like removing sections. I imagine detaining someone will still largely be a matter for psychiatrists, but with more available professionals fulfilling the ASW role, which might lead to quicker sectioning (and thus, potentially, quicker discharge)

My therapist is a nurse psychologist specialising in CBT, so techically he could put a hold on me, and he has already told me that he wouldn’t hesitate to use it if necessary.

So it wouldn’t make any difference to me. My GP/Therapist and Consultant Psychiatrist all work closely together. If I exceed the stated dose on my box of pull-yourself -together pills, It’s not going to stay a big secret for very long.

Still, it’s probably better to be alive than six feet under.

P.S. I was sectioned in 2001 and threatened with it in 2003.

At the risk of sounding like a cheerleader for the good doctor C I think he may have a point when he (as he undoubtedly will) refers to the possibility of Psych nurses becoming “Responsible Clinicians” as dumbing down, although I personally wouldn’t choose to put it that way.

Taking someone’s liberty away is a big responsibility, perhaps the biggest there is for a mental health professional. There are only two other groups in society, that I can think of, that can routinely deprive me of my liberty (not counting my wife that is) that’s the Police and Customs officials. So I think it is only right and proper that the “medical” recommendations should be made by a sec12 approved psychiatrist and the patients own GP. After all those doctors spend a lot of time training to do their thing and are paid considerably more than most nurses so I think it is only right they should take the responsibility.

Psych nurses may not be Doctors but they are by and large trained in a clinical environment and are probably closer to the medical model than most social workers. Having an ASW make the application for detention therefore provides a useful balance to what could be perceived as a medical bias to the process so I for one would not want to take on the role of “approved mental health professional” either.

Taking someones liberty is a big responsibility I have used section 5(4) at times. I have also detained patients that want to leave but cant because they are on other sections of the mental health act (MHA) i.e. sec 2.3 39.41 et al. It took me 3 years to become a RMN. How long does it take to become a police officer? I dont know, but I think it is less than 3 years. I dont like detaining people but if it is for their and others protection I will do it. The protection issue is subjective though, but isnt everything?

z - while I think people might be prepared to take on the AMHP role, I can’t imagine the RC role being very attractive for many reasons, not least of which would be the additional risk of finding yourself dragged up in front of an inquiry should you make a mistake. The other professions - OT, psychology - have rarely if ever shown any willingness to be involved in any of the more coercive aspects of psychiatry, citing their precious “therapeutic relationship” (funny how everyone else’s is disposable though eh?), so I can’t picture them suddenly developing an enthusiasm for being RCs. MH nurses have enough crap to deal with in their ordinary role without taking on extra crap.

Oh, and section 5(4) - yep, I’ve used it a number of times. Usually in the situation where an informal patient has been trying to leave all day and has been “persuaded” to stay by the nurses who, thinking they are being kind, have not employed their holding power. This is a totally misjudged “kindness”, as the person has more real, legally-enforceable rights under the MHA than they have as an informal patient being “persuaded” to stay. Far better to detain them, which then forces a doctor to examine them and make a decision as to their continuing detention than to continually steer them away from the ward door with blandishments and out and out falsehoods.

I think Mr Man was detained under this section once, while we waited for the doctor to arrive. He was under constant observation (level 2) but had packed his things and was trying to leave the ward.

I’m glad I was persuaded to stay in 2003.

Being sectioned can be a deeply traumatic experience and in my opinion, should be avoided whenever possible.

Even worse, though, I reckon is being allegedly “informal” but having people running after you whenever you try to exercise your right to leave and never actually getting your legal status sorted out. It’s actually a form of imprisonment, highly illegal and completely wrong morally IMO.

Hi Beakie

When I was allegedly “informal” (2003) I only agreed to stay for 3 days, so I didn’t try to leave the ward again in this short space of time.

However I agree with you if someone is “persuaded” to hang about for a longer period of time (a cigarette on a stick?) it undoubtably benefits both patient and staff to have the appropriate legal status.

I’m just thinking - is it more traumatic to a) get yourself sectioned or b) complete the corresponding paperwork?

Answers on a postcard to the Fairie Realm Hospital……

Isn’t it the nurses that generally alert the doctors to the fact that a mental health act assessment would be appropriate anyway? In my opinion a lot of sections might be avoided or at least shortened if nurses were more actively involved…not to mention the trials and tribulations we face trying to get patients section 17 leave, “oh no sorry, your doctors far too lazy to come and see you now, you have to wait another week until your review before we can unlock the door for you!”
On the flip side i don’t think we should take on the entire resposibility for this, and doctor involvement should still be an integral part of the assessment process. The trouble is, as has been mentioned before, us nurses are the ones that tend to know the patients the best. I cant help feeling though that first it was nurse prescribers and now we are talking about registered clinicians who can section people, what’s left for the doctors to do! And will we be paid any more? I don’t bloody think so!

Flowergirl wrote “us nurses are the ones that tend to know the patients the best.”

How can nurses who never exchange so much as a word with patients possibly ‘know them best’?

In my experience, the cleaning staff sometimes know the patients best.

The wards have cleaning staff?

ooh dear ariel, i can see i touched a raw nerve. In my experience, (and i know a lot of patients who would vouch for this), the nurses are the ones who, in comparison to the doctors, do know the patients the best. I have to say i am deeply offended that you would suggest that all nurses are the same in that we don’t talk to patients…there are unfortunately some nurses that are perhaps burnt out or simply in the wrong proffession who i daresay are crap, but i feel duty bound to speak up for those of us who still hold on to the fact that we do this job because we truely want to help people. It certainly can’t be for the pay, or for the fact that we often get abused left right and centre. Please don’t tell me that i am holding onto this fantsasy in vain??!!

Am I being cynical in thinking that this is just another part of “expanding the role of the nurse”, i.e. getting nurses to do the boring jobs that stop doctors doing their proper jobs such as attending conferences in posh hotels? It started with nurses taking blood, then nurse prescribing, and now this. Where will it end? Not with nurses attending conferences in posh hotels I bet.

Where I am, the Nursing Assistants are trained to take blood, that is out of the nurses hands now!

I think it’s unhelpful to generalise.

Mental Health Nursing is just like any other profession - there are some people who genuinely care about their jobs and some people who are just there for um, the borbon biscuits?

Seriously though, as a patient I’ve experienced some brilliant nurses/psychiatrists/GPs and some not so good. That’s life, no?

One could say the same about teachers, lawyers, journalists…..

In my experience it is the psychiatrists who take the care to get to know me. perhaps I have been lucky but I have yet to meet one who didn’t treat me with respect and courtesy. (But then, since I am myself unfailingly polite and considerate - even when manic - I see no reason why they should behave otherwise).

Whereas often when I have been under twenty four hour observations I have had a nurse sit beside me, staring at a clipboard, and being entirely mute for hours at a time. Frequently they have not even had the good manners to introduce themselves or to explain why they are following me about.

One occasion was different, a really nice young nurse who spent the whole time talking with me about everything from my illness, to my husband, my job etc. It turned out she was a medical student who was working as a bank nurse to pay her way through college.

I completely agree with Lou, there are people that are good at what they do and there are people that are bad at what they do, in all walks of life.
I’m interested in what you are saying though ariel, it can be a difficult scenario sometimes when doing constant obs on a patient as some nurses feel that it would make the fact of being on obs more intrusive and stressful for the patient if they were constantly being bombarded by the nurse talking to them and asking them ‘how are you’ and ‘how are you now… any better?’
However, i always say to the patient who i am, why i am going to be with them for the next hour, and i also ask them if they want to talk or whether they just want to be quiet.
It is a strange situation that you wouldn’t find yourself in in normal life, and at the end of the day we are all human. We all have different skills, and i know that all nurses should have the ability and where-with-all to ask the patient how they would like to spend their time whilst on obs, but sometimes it is treated as merely a risk management excersise rather than 24hour therapeutic intervention. Perhaps it is not that that nurse is crap, just that they are crap at doing obs!? Sometimes i feel that a bit of education about making constant obs more therapeutic wouldn’t go amiss as i think that sometimes nurses feel awkward and even embarrassed about intruding so much on someones personal space, even if it is to prevent them from killing themselves, harming themselves or running away!

does this mean the full course that social workers do? or is there an amended conversion? if so how long is the training for?

to be an AMHP, i mean

AMHP was introduceed to the MHA in Queensland (2000). Any health practitioner (RN; SW; Psychol; OT) can apply for it IF they pass the competency test set by the clinical director.

This ‘power’ allows said AMHP approved practitioner to apply an Emergency Examination Order (EEO) anywhere in the State for assessment on anyone for any reason. (My girl thinks her ex needs one…. should I?). Ambulance or police can ‘deliver’ the person to an Authorised MH Service for examination.

An EEO is only hours long and assessment is more or less s2 MHA UK - but only lasts 3 days.

I’m a bit scatty on the detail as I’ve no interest in ‘the power’ and haven’t taken the AMHP thingy.

However, I believe, with the tsunami about to hit nursing and medical shortages globally, increasing nurses ‘powers’ is probably meant to ease the pressure by ’streamlining’ the time factor down to lowest acceptable risk.

Personally, I think an experienced RMN who has the basic ability to listen and talk sense is as good and often better than an RMO. And a real good one won’t need the AMHP powers anyhow.

Most psych’s are over rated… and I agree, the best staff are the cleaners. “Pass the mop and detention papers please nurse. I’ll sort this mess out.”