Crisis Centre Ministries
Briefing Paper
Mental
Health Issues at Night
We need to be very clear about what can be done for vulnerable clients who suffer from mental health issues. While they are with us, we have a duty of care towards them (as we do for all our clients). This is especially difficult at night, when most of the usual services are unavailable. We need to act in their best interests, but we also need to protect the general public and ourselves if there is any risk.
It will probably be helpful if you read these guidelines in the light of the Out of Hours Vulnerable Mental Health ‘real life story’.
The term ‘sectioned’ is usually refers to the process by which someone is detained under section 136 of the Mental Health Act. In general, clients cannot be sectioned unless they pose a risk to themselves or to others.
The EDT (Emergency Duty Team) will not come out unless the client can be sectioned. If they do come out, there is no guarantee as to how quickly they will be able to arrive – it depends on their workload and how urgent they understand the situation to be.
If the client can be sectioned and there is an urgent need, it may be better to contact the Police and ask them to take the client to a ‘place of safety’ (a cell in the station!) until the EDT or the Police psychiatrist can make a formal assessment about whether to detain them under the Mental Health Act.
If the client cannot be sectioned, you will need to get more information from them in order to be able to help. It can be difficult, but try to get answers to the obvious questions. There will probably be others, depending on their story, but this list is a good start.
Who is your GP? Which surgery do they work at? When did you last see your GP, and what happened then?
Do you have a CPN (Community Psychiatric Nurse)? If so, what is their name, where are they based, and how do you contact them?
What prescribed drugs are you on? When did you last take your medication? When are you next due to take some? Do you have an adequate supply? If not, how much do you have left, and how long will it last?
You should contact the GP’s surgery and speak to the client’s GP if possible, or if not, one of the other doctors in the practice.
If the client needs to go somewhere, trust your instincts. In general, nobody should be alone with the client, either in the shop, or the street, or in a car. If you don’t have enough people, ask if an ambulance can come and collect the client. In the last resort, order a taxi (but the taxi driver may well not be too impressed!) and keep a receipt. Unless the client goes in an ambulance, at least one CCM person should go with the client to their destination.
If it is open, you can send the client to the NHS drop-in in Broad Street.
At any time, you can send the client to the BRI, who have duty psychiatrist.
The client can be admitted to a mental hospital on a voluntary basis: this avoids the need for them to be sectioned. However, before this can happen, you will have to get them to the hospital. The hospital staff will then have to decide (a) whether their need is great enough to justify admittance, and (b) whether they are treatable. Simply being vulnerable and homeless is not enough.
Write up what happened, with just a brief summary on the Client Contact sheet, and give the details to a member of staff or put them through the letterbox for the office.
The next day, we need to contact the CPN and let them know what has happened, so you need to say if you will be doing this or if someone else needs to.
If the client returns and needs accommodation during the working day, The Hub is best placed to help as they have access on site to Social Services, Health Link workers and the Homelessness Team (City Council).
The Homelessness Team would probably accept this client as ‘Part VII’ (being in priority need), so he would be placed in accommodation, most likely a B&B. The long-term options would include supported housing. It is a good idea to contact Second Step who specialise in housing people with mental health issues. If the client has ‘dual diagnosis’ (both mental health and a drug problem) then Stonebridge Park is an option, but it has a waiting list.
There is a lack of out-of-hours provision for vulnerable people, which has long been a bone of contention – especially since the loss of the HMII funded ASW and CPN.
With the re-organisation of the PCTs there should be a mental health assertive outreach team coming on line, but we are as yet unsure of their remit and whether they will be offering 24-hour cover. It is possible they will be working primarily with those who are already in accommodation, which would not help much in the situation that triggered this briefing paper.