The first step is to decide if your patient meets criteria for detention under the mental health act?
(see criteria below- your patient must fulfill all of these)
- It is likely that the person has a mental disorder
- It is likely that the person has significantly impaired decision-making ability with respect to medical treatment for mental disorder
- It is urgently necessary to detain the person in hospital to decide what medical treatment is needed
- If not detained, there would be a significant risk to the person’s health, safety or welfare or the safety of any other person
- The need for the certificate is urgent and detention under a Short-Term Detention Certificate would be either inappropriate or unfeasible
(If you're not sure, you should contact the on call Psychiatrist and/or the on call Mental Health Officer for advice).
Unless it is necessary to detain the patient immediately due to a current or imminent risk to their safety, or to the safety of someone else, you must try to contact the duty MHO (Mental Health Officer). They will likely want to come and review the patient.
If the MHO decides to come in and see the patient, you must wait for them before detaining the patient under an EDC. This may mean your team needs to use alternative measures to hold the patient in hospital, such as nurses holding power or hospital security until the MHO arrives (they can advise you about this).
If the MHO cannot attend, they may give you permission to go ahead with detaining a patient under an EDC in their absence.
If you have completed an EDC without MHO consent in a situation where there was no time to contact the MHO before putting the detention in place, you should still contact the MHO retrospectively to inform them of the detention. You should also document the rationale for this in the "MHO Consent” – Box B section of the EDC form.
If the MHO does attend, the two of you will decide together whether an EDC is appropriate. In most cases, you will probably need to contact the on call Psychiatry higher trainee or consultant for advice.
If the MHO does not attend and had given you permission to proceed without them, then you can make the decision to detain the patient under an EDC without an MHO review. In this case, you should contact the on call Psychiatry higher trainee or consultant for advice.
Once you have made the decision to detain the patient under an EDC, make sure you tell the patient about this. It is important to make them aware that:
- they must stay in hospital by law
- if they try to leave they will be prevented from doing so
- the maximum duration of the detention is 72 hours but it may be shorter
- the detention will be reviewed by a Psychiatrist sooner than 72 hours
Once you have decided to detain a patient under the mental health act, make sure you complete the full EDC paperwork and sign it (there is a link to the PDF of the EDC below under Resources).
An EDC needs to be reviewed by an AMP (Approved Medical Practitioner) as soon as practicable after it is completed. In order to make sure this happens, you must let your local psychiatry department know that the patient has been detained by the next day.
Once completed, the EDC paperwork needs to be sent to medical records so that it can be processed. Ask the nurse in charge on the ward if you do not know where the forms should be sent. Do not just leave the forms in the patient's notes.