Week 9 Emergency Mx of Psychiatric Pt & Week 10 Working with Mental Health Providers

Question 1

Police are able to section a patient under the?

A. Section 351
B. Section 352
C. Section 353
D. Section 354

Answer 1

A. Section 351 of the Mental Health Act 2014

• A police officer can apprehend a person who appears to have mental illness to prevent serious and imminent harm to the person or others
• The act permits police to enter premises, apprehend people, use force and bodily restraint and provide Tx to take people to a designated mental health service in prescribed circumstances.

Question 2

What is the difference between a remote and a physical search?

Answer 2

Remote = Asking the patient to pull stuff out of pockets etc via verbal requests

Physical = Asking the person to lift up their arms and searching their pockets yourself

You must always keep the Pt informed of your intentions when searching

Question 3

What section do Ambulance personal Tx patients under?

A. Section 351
B. Section 352
C. Section 353
D. Section 354

Answer 3

D. Section 354 of the Mental Health Act 2014

The Mental Health Ac 2014 is designed to protect the patient and the health professional

Question 4

List some restraints used by the police force?

Answer 4

Hand Cuffs

Capsicum Spray

• Intense irritation of the conjunctiva and nasal/oral mucosa
• bronchospasm
• irritation of the skin, intense burning

Taser

• 50 000 volts - max current 36 milliamps
• 20-foot radius

Gun

Question 5

List some restraints used by Paramedics

Answer 5

Midazolam

• Benzodiazepine
• Short-acting CNS Depressant
• Acts on receptors adjacent to GABA, hyperpolarizing the cell to reduce action potentials

Ketamine

• Rapidly acting dissociative anaesthetic
• NMDA receptor antagonist
• Blocks the action of NMDA to cause profound analgesia and dissociation

Tourniquets/Physical Restraints

• Supportive of safety by securing the patient with dignity to the sticker
• Consider police assistance where this is required

Question 6

Which CPG does AV follow when sedating a mental health patient?

Answer 6

Agitation- CPG A0708

Midazolam
ALS = 5 - 10mg IM 
Lower doses (2.5mg - 5mg IM) Elderly, frail, weight <60kg, SBP <100mmHg, or sedation drug/alcohol involvement

ALS - Ketamine IM
< 60kg = 200mg
60 - 90 = 300mg
> 90kg = 400mg

If Ketamine not available: Midazolam up to 20mg IM
Repeat at 10m intervals (titrate to patient)
Max total dose 40mg.
Consult if further required

Question 7

What is mental illness?

Answer 7

A disturbance in thought, emotion and/or behaviour.

This population group may have difficulty with participating in daily living, maintaining relationship or work effectively

Question 8

In short, what is Schizophrenia?

Answer 8

A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behaviour, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.

Question 9

What are some de-escalation techniques?

Answer 9

• Building Rapport
• Verbal Language
• Body Language
• Keeping Calm
• Tone
• inflection
• Mirroring
• Active Listening
• Provide stability for the patient - give them confidence and empathy

Remember not every patient can be deescalated

Question 10

What is Part 3 of the ‘Section of Rights’ in the Mental Health Act?

Answer 10

Authorised psychiatrist or psychiatrist must read the statement of rights to a person and must answer questions the person may have as clearly and completely as they can.

If the person to whom the statement of rights relates is incapable of understanding the information contained in the statement or the oral explanation at the time when it would otherwise be provided, the person who is to give the statement or oral explanation must ensure that reasonable further attempts are made to provide the information or explanation at a time when the person is able to understand the information or explanation.

Question 11

Why is the community setting the prefered contemporary setting for providing mental health care?

Answer 11

This is because it involves a wide range of services. It includes support for both the family and the patient.

• Primary Care
• Mental Health Promotion
• Acute Treatment
• Community Support Services

Question 12

Case Management is provided at a community level and is the most predominant model of public sector health care.

What do these services include?

A. Crisis Intervention
B. Rx for people with acute mental illness
C. Ongoing care for people with enduring mental illness
D. All the above

Answer 12

D. All the above

Usually structured into multidisciplinary teams that provide care to specific population groups. 3 types of intervention:

1. Crisis Intervention
2. Rx for people with acute mental illness
3. Ongoing care for people with enduring mental illness

During Crisis

• Provide single point of first contact
• Generally available 24 hours
• Referrals are accepted from any source

Question 13

What are community treatment teams?

Answer 13

Provide community management and consultancy services.

Provides treatment and assists people to develop skills in self-care and independent living in their own environment

Have a crisis case management role, which means that the consumer is engaged with one mental health professional throughout the episode of care.

Question 14

Which is NOT true for mobile assertive mental health teams

A. Provide intensive and long-term support
B. Provide linkage and advocacy
C. Have close Liason with other services
D. Provide short term care

Answer 14

D. Provide short term care

These services provide intensive long-term support to people with prolonged and severe mental illness and associated high-level disability. They utilise an assertive outreach approach and operate extended hours seven days a week. MAT’s differ from continuing care services in the frequency and intensity of intervention offered and work more closely with psychiatric disability rehabilitation and support services.

Question 15

What is the Mental Health Nurse incentive program?

Answer 15

Its an incentive to provide clinical care for people in the community who have severe mental health and complex needs.

Services Include

• Case Management
• Therapeutic Interventions
• Regular review of the persons mental state
• Medication monitoring and Mx
• Provision of Information about physical health care to consumers and carers
• Provision of education

Question 16

Which of the following are a Mental Health Service?

A. Hospital at Home
B. Non-Government Organisations (i.e. Charity)
C. Advocacy Group
D. All the above

Answer 16

D. All the above

Hospital at Home

• Community-based service that provides acute mental health care in a persons home as an alternative to hospital.
• Assessed initially in the ED or by Consultation Liason Psychiatrist

Non-Government Organisations
- NGOs play a vital role in providing psychological and support services to people living with MI, including employment, accommodation, support, information, day to day residential programs and family respite.

Advocacy Groups
- Mutual support/self-help/ advocacy groups offer peer-based support, information and social action services to people with a MI and their families.

Question 17

What is consultant liason psychiatry?

Answer 17

It is the branch of psychiatry that specialises in the interface between general medicine and psychiatry, usually taking place in a hospital or medical setting.

• Provide assessment and diagnosis
• Advice on managing difficult behaviour
• Information on acute psychiatric Mx who have attempted suicide
• Recommendations
• Opinions on legal and ethical legislation
• Research