Approaches to people with Mental Health Illness

Question 1

Mental Health Act requirement on Ambulance Staff

Answer 1

Ambulance Staff should work under the direction of the AMHP.

AMHPs do not have to be present for informal admission (section 131).

They must be present for formal admissions (Section 2,3,4,135,136).

AMHPs do not have to travel with the patient, but if travelling separately they must give the admission papers to the ambulance crew.

The patient is in the legal custody of whoever is authorised to transport them to hospital.

Question 2

Guideline about managing potentially difficult situations.

Answer 2

Staff should never put themselves at risk, e.g. by isolating themselves with someone who is extremely psychotic, distressed and volatile.

People with a mental illness are more at risk from themselves then others.

Someone in mental distress may be extremely frightened and need reassurance.

Question 3

Dealing with someone who’s mental illness may be delusional or being influenced by hallucinations.

Answer 3

These influence can be perceived as real experiences, can be very frightening and may affect their behaviour.

Most people will react favourably to politeness; offer them reassurance, treat them with patience and dignity.

Consider other medical conditions that might explain their behaviour.

Question 4

DO NOT

Answer 4

Talk down to them or deride them.
Be in a rush or show impatience.
Ridicule a patient or enforce a delusion.
Assume that physical contact, such as putting a reassuring hand on someone, will make them feel better.
make platitudes such as “cheer up, it might never happen” or “snap out of it” to someone who is depressed.

Question 5

DO

Answer 5

Keep your own emotions under control.
Avoid arguments or confrontation.
Speak in simple terms avoiding jargon.
Explain what’s going on.
Try to take the person away from noise or crowds, or any over-stimulating environment.
Put the patients interests first.
Tell them what your doing.
Try to find out if there is someone the person trusts and ask if its OK to speak with them.
Remember that bizarre behaviour can be brought on by other medical conditions such as Hypo/Hyperglycaemia.
Assume they have capacity to consent unless you can demonstrate otherwise.
Ask them if you’re concerned they are thinking about suicide. You cant put the idea in their head and they may be relieved you asked.
If someone says they are contemplating suicide, take them seriously.

Question 6

Dealing with relatives of Mentally Ill patients

Answer 6

This can be a very distressing time for relatives, especially children. Talk to them.
They are likely to be distressed, especially if the patient has to be removed against their will.
Try to create a calm atmosphere.
Treat the patient with dignity and think of the impact your actions may have on others. Imagine how you would feel if it was a member of you’re family, or one of you’re friends.

Question 7

CPI’s (Clinical Performance Indicators)

Answer 7

1. first set of observations recorded and time logged.
2. blood glucose (BM) recorded.
3. history of current event.
4. Psychiatric history.
5. Medical history.
6. Current psychiatrist/care co-ordinator/community psychiatric nurse/care or approved social worker.
7. description of patients appearance.
8. assessment of patients behaviour.
9. Assessment of the patients ability to communicate.
10. Assessment of the patients thoughts.
11. Capacity tool used.