Introduction

Approximately 10% of all admissions to the Emergency Department (ED) involve patients having a mental health crisis.  With the ever increasing numbers of patients requiring mental health input, it is important that we understand the law that underpins our treatment (RCEM, 2018).

These patients can be challenging to manage for many reasons. To ensure that we protect our patients and ourselves it is crucial that we have an understanding of how the Mental Health Act (MHA) works.

Overall since 2013 in England and Wales there has been an upward trend in the number of patients who are being brought into the hospital environment detailed under Section 136 of the MHA

26137 (2013/14)

23602 (2014/15)

28271 (2015/16)

(NPCC, 2017).

It is important to remember that some patients with a history of mental health problems come to the ED for a review of their physical health needs; physical health needs always take precedence over mental health needs

Other patients may need to be detained under the MHA (‘Sectioned’) whilst in the ED because of the severity of their disease. It is important that we, as EM doctors, understand how we can support this process.

This module aims to take you through some of the elements of the MHA most relevant in the ED. The case studies used aim to help you develop a clearer understanding of the different Sections of the MHA and when and how they become relevant. This module focusses on the MHA in England and Wales. There are similar underlying principles in the Scottish and Northern Irish version of the MHA, but the differences are not discussed here.   If you are working in Scotland or Northern Ireland, you should check that legislation as some of the differences have a significant impact on patient management.