Managing patients with deliberate self harm who refuse treatment in accident and emergency departments

Abstract

Managing patients with deliberate self harm who refuse treatment in accident and emergency departmentsEducation and debate p 905 Advice and procedure require correctionEditor-In their lesson of the week on managing patients with deliberate self harm who refuse treatment in the accident and emergency department Hassan et al recommend that doctors must be fully conversant with the law on assessing capacity to consent to treatment and its application. 1 It is equally important in these difficult cases to be familiar with the application of the Mental Health Act 1983 or Mental Health (Scotland) Act 1984, which Hassan et al seem not to be. They state: "If the overdose is considered to be a consequence of a mental disorder then the patient can also be treated medically for the overdose under the terms of the Mental Health Act." This statement is reiterated in their proposed algorithm, recommended for use at accident and emergency departments. This is simply not the case.The Mental Health Act is for the treatment of mental disorders. It does not authorise the treatment of a physical disorder even if it arises as a consequence of a mental disorder. Therefore the Mental Health Act is of no help in the immediate medical management of patients presenting with deliberate self harm and refusing treatment, other than to permit detention in hospital if the patient is considered to be suicidal as a result of mental disorder.Treatment for the overdose will remain under common law based on assessment of competency to refuse treatment and the need to preserve life.The Mental Health Act states that treatment can be administered only if a patient is not capable of giving informed consent, provided that it is in the patient's best interest, is urgently necessary, and is in accordance with a practice accepted at the time by a responsible body of medical opinion skilled in the particular form of treatment in question. 2 A study by the MacArthur group found that only a minority of psychiatric patients had significant impairment in ability to provide valid informed consent for treatment. 3 The advice of Hassan et al and their algorithm require correction.

‘I can actually talk to them now’: qualitative results of an educational intervention for emergency nurses caring for clients who self‐injure

“…Self‐harm is a common health care issue, accounting for 20% of all Australian hospital attendances and 7% of admissions (Berry & Harrison 2007). Self‐harmers are more likely than the general population to become suicidal and there is growing understanding of the issues that impede recovery and reduce care (Hull & Haut 1999, Hurry & Storey 2000, Isacsson & Rich 2001).…”

Duty of care in the emergency department

“…The Mental Health Act is therefore of little assistance in the initial management of this scenario. Hull and Haut (1999) agree that there is no doubt that this type of presentation to the ED arises as a consequence of mental condition, however medical attention is the priority rather than treatment of any mental illness or disorder.…”