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8.4 Emergency situations There will be situations when urgent involuntary admission <strong>and</strong>/or urgent involuntary treatment may be needed. Actively suicidal patients or acutely disturbed patients <strong>who</strong> are violent or aggressive are examples. Here it may not be feasible or reasonable to expect compliance with substantive procedures for involuntary admission <strong>and</strong> treatment. Legislation must therefore provide for such emergency treatment with sufficient safeguards. The assistance of the police may also be required in certain situations (see section 14 below). Legislation should define what constitutes an emergency. In most jurisdictions, an emergency situation is one in which there is immediate <strong>and</strong> imminent danger to the health <strong>and</strong> safety of the person concerned <strong>and</strong>/or others. To be considered an emergency, it must first be demonstrated that the time required to comply with substantive procedures would cause sufficient delay <strong>and</strong> lead to harm to the concerned person or others. In such situations, <strong>legislation</strong> can permit immediate involuntary admission to hospital <strong>and</strong>/or immediate involuntary treatment based on an assessment carried out by a qualified medical <strong>and</strong>/or other accredited mental health practitioner operating within their scope of practice. Emergency admission <strong>and</strong>/or treatment should not be prolonged, but allowed only for a short period of time. During this time, if it appears that the person may require further involuntary care, the substantive procedures for involuntary admission or treatment should be undertaken. In many countries, emergency admission or treatment is not permitted beyond 72 hours, as this gives sufficient time to meet all the requirements for compliance with substantive involuntary procedures. Emergency treatment should not include ECT, depot neuroleptics <strong>and</strong> irreversible treatments such as psychosurgery or sterilization procedures. 8.4.1 Procedure for involuntary admission <strong>and</strong> treatment in emergency situations The patient should be examined by a qualified practitioner to determine whether an emergency exists. In particular, the practitioner should be able to justify involuntary admission, given the nature of the emergency. When the person is admitted for treatment to an accredited mental health facility, treatment should be administered according to a treatment plan drawn up <strong>and</strong> supervised by a qualified medical or mental health practitioner (<strong>who</strong>, ideally, should be different from the practitioner certifying admission <strong>and</strong>/or treatment). If the person requires involuntary admission/treatment beyond the prescribed emergency time frame, procedures for such admission <strong>and</strong>/or treatment (see section 8.3 above) should be initiated <strong>and</strong> completed within a specified time period. If the patient does not fit the criteria for involuntary admission/treatment, or if the procedures for keeping/treating the person as an involuntary patient are not completed, the person should be discharged immediately after the emergency has ended. Admitted patients <strong>who</strong> do not fit the criteria for involuntary admission/treatment after an emergency admission, but <strong>who</strong> may still benefit from treatment, should be regarded as voluntary users <strong>and</strong> only treated with their informed consent. If a person is discharged from emergency involuntary admission <strong>and</strong> not granted involuntary admission <strong>and</strong>/or involuntary treatment, it would be inappropriate to reapply emergency powers immediately to readmit the person unless there is a substantive change in the nature of the emergency, requiring the use of such emergency powers. The purpose of this provision is to prevent misuse of emergency powers to indefinitely prolong involuntary admission or involuntary treatment. Patients’ family members, <strong>and</strong>/or personal representatives should be immediately informed of the use of emergency powers. And they should have the right to appeal to a mental health tribunal, review body <strong>and</strong> the courts against such emergency admission <strong>and</strong> treatment. 60
Emergency situations: Key issues • To be an emergency, it must first be demonstrated that the time required to follow substantive procedures would cause considerable delay, resulting in harm to the concerned person or others. • In an emergency, involuntary admission <strong>and</strong> treatment should be permitted on the assessment <strong>and</strong> advice of a qualified medical or other appropriate practitioner. • Emergency treatment must be time-limited (usually no longer than 72 hours), <strong>and</strong> substantive procedures for involuntary admission <strong>and</strong> treatment, if necessary, must be initiated as soon as possible <strong>and</strong> completed within this period. • Emergency treatment should not include: > depot neuroleptics > ECT > sterilization > psychosurgery <strong>and</strong> other irreversible treatment. • Procedure for emergency admission <strong>and</strong> treatment: A qualified practitioner should examine the person <strong>and</strong> certify that the nature of the emergency requires immediate involuntary admission <strong>and</strong> treatment. a) A treatment plan should be drawn up under the supervision of a medical or mental health professional. b) Procedures for involuntary admission <strong>and</strong>/or involuntary treatment should be initiated immediately if it is assessed that the person is likely to require involuntary care beyond the stipulated time limit for emergency treatment. c) It is inappropriate to reapply emergency powers when a patient has been released following completion of the procedure for involuntary admission, unless there is a substantial change in the nature of the emergency. d) Patients’ family members, personal representatives <strong>and</strong>/or a legal representative should be immediately informed of the use of emergency powers. e) Patients, their families <strong>and</strong>/or personal representatives have the right to appeal to a mental health tribunal <strong>and</strong> courts against emergency admission <strong>and</strong> treatment. 9. Staff requirements for determining mental disorder There is international consensus that clinically qualified experts must base their assessment of mental disorder on objective evidence. Legislation (or regulations) should • define the level of experience <strong>and</strong> skills required to determine mental disorder; <strong>and</strong> • delineate the professional groups permitted to do so. 9.1 Level of skills There should be a system of accreditation by which practitioners <strong>who</strong> are part of the process of determining mental disorder are independently accredited as having demonstrable competence in this task. This accreditation should be: • codified in law; • require the accredited professional to have achieved a level of competence established by the relevant professional organization or certifying body; • require the accredited professional to underst<strong>and</strong> relevant mental health <strong>legislation</strong>. In countries where it is not possible to achieve all of these requirements, it must be stipulated in the law that a process be put in place to guarantee that practitioners <strong>who</strong> determine <strong>who</strong> has mental disorders have the competence to do so. 61
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WHO RESOURCE BOOK ON MENTAL HEALTH,
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All rights reserve
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Technical contribution and<
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Nacanieli Goneyali Maria Grazia Gia
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Leen Meulenbergs Harry I. Minas Alb
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Harvey Whiteford Ray G. Xerri XIE B
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5. Rights of users of mental health
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4.1.3 Sanction, promulgation <stron
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For whom is this R
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This chapter covers five main areas
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3.2 Violations of human</st
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3.5 Promoting access to mental heal
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health legislation
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Page 41 and 42: Mental disability is not synonymous
Page 43 and 44: Mental Disability Mental Incapacity
Page 45 and 46: Definition of “mental ill health
Page 47 and 48: Example: Mental health in primary c
Page 49 and 50: Another means of promoting communit
Page 51 and 52: MI Principles: Access to informatio
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Page 57 and 58: mentally ill offender. Countries ma
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Page 71 and 72: as an inpatient or outpatient. This
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Page 97 and 98: 15.4 The post-sentencing (serving s
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Page 103 and 104: In countries where women are detain
Page 105: Kenya The Mental Health Act (Act No
Page 108 and 109: Figure 2. Process of mental health
Page 110 and 111: ) Qualitative information from focu
Page 112 and 113: When examining another country’s
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Page 122 and 123: 4.1.2 Debate of draft legis
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5.2.4 Developing information <stron
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Human resource iss
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Rosenthal E, Sundram C (2002). Inte
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Declaration of Hawaii (1983). Appro
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Bibliography Araya R et al. (2001).
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Introduction and h
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2) Does the legislation</st
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C. Access to mental health care 1)
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3) Does the legislation</st
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E. Rights of families or other care
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G. Voluntary admission and<
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) there is serious likelihood of ha
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• Patient lacks the capacity to m
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2) Are all the criteria and
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O. Special treatments 1) Does the l
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3) Does the law specify a restricte
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R. Oversight and r
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3) (iv) Maintain registers of accre
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• the right of patients a
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3) Does the law allow for people <s
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2) Does the law provide for “reas
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3) Does the law ensure that all min
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AZ. Offences and p
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• Inter-American Convention on th
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Civil and Politica
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5. A patient shall never be invited
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Principle 15 Admission principles 1
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Principle 20 Criminal offenders 1.
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Annex 5. Extract from the Declarati
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5. Organ Transplantation: The role
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Restraint & Seclusion: If condition
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Rights of Recipients Summary in Eng
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PART C TAKING PERSON TO APPROVED ME
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I base my opinion on the following
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Annex 9. Example: New Zeala
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Who can make an advance directive?
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