psych business
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K
Joined: 09 Sep 2011
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| Post subject: psych business |  |
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< In effect a manual split from an unsplittable thread. I won't try to quote absolutely everything and will do this in stages. Hence "under construction" for now. [Update: the split is now complete.]>
| watt price tully wrote: | Funny to be posting this here but it relates to the jobs theme. In the last 5 years and more our workload has increased exponentially, through the roof.
ED used to get say 140-150 presentations and that was considered a lot.
Now we're getting 200-280 per day.
Mental health presentations have gone through the roof
The number of staff employed has not been commensurate but some of the supports have improved and become more streamlined.
The EFT has increased but we can't get staff to fill the positions.
In the last 2 years about 6 more staff have been employed and only one remains of those 6.
Having said that we recently got a young guy who has some good expernece & he seems the goods. We also have 2 young women on our bank staff who are also very good.
The workload is just so full on and we have had too much micro management as the reasons for people leaving.
I've been at this workplace for 18 years. I don't need the promtions now as I've worked in senrior management and policy and enjoy what Im doing most of the time (the politics) like any job is the hard part |
| K wrote: | ...
Why have these presentations gone through the roof? Are these voluntary presentations or involuntary? |
| watt price tully wrote: | ...
ICE, Police, Overseas students, police, ambulance, alcohol, both voluntary and involuntary (in Vic sinc 2014 in the new Mental health Act called Compulsory Patients, lack of Crisis Teams (CATT services), inceased population, increased homelessness, cutting goverment housing, better reporting, more people being banged up then released throuugh the magistrates courts on orders, police etc. Mental Health Triage being more defensive, GP's not bulk billing, GP's panicking.... off the top of my head. Some GP's find it quicker and easier to send people to the ED for an assessment whether they are acute or not rather than call the mental health triage number: one classic is you have a person who reports they have been feeling suicidal for years. They have no plan or intent. The GP still sends them in rather than call the triage number where a person can be assessed and if required a crisis team can see them the next day, the day after etc. depending on what the triage clincian ascetains on assessment.
To the list add:
* Less skilled and less staff in care facilities
* DHS disability not giving a phuk and bad behaviour being referred to mental health: eg. there is a Cummunity REsidential UNit nearby.One male resident was given two eggs for breakfast while the person in question only got one. Thy get pissed off & state they want to kill themselves and run onto the street. Police are called, then ambulance, the person may or not be restrained, the person may or not be be injected by the paramedics. Paramedics then look at the psrons medication box and a GP has prescibed a low dose anto psycotic. The person is then tken to the ED. The paremedic then makes a huge asumption: necause the person has been prescribed an anti-psychotic they handover to the ED triage nurse the prson is suicidal and has schziophrenia. The Traige nurse duly writes this down. it is now documented that the situational crisis that it was has become 34 year old male history of schizophrenia tries to suiciee after running into traffic. WE then either see it on the system ot get a referral through pager or telephone. Do out checks & not no sych hx of schizophrenia.
Yes years of training!- refer back to the ED Dr & say this is not acute psychiatry there's a problem we need to fix the problem but this is Social work not acute psychiatry. In the language "the person has learned maladaptive ways to communicate their distress". Mind you what do you do when the person or place refuses to go back or refuses to have them back? These type of issues I handball back to the Dr to sort & suggest options. What do you do when the person say assaults their parents or care providers? |
TBC
Last edited by K on Thu Aug 23, 2018 1:05 am; edited 1 time in total |
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K
Joined: 09 Sep 2011
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| K wrote: | ...
What has changed in this new 2014 Mental Health Act? ... |
| stui magpie wrote: | the 2014 mental health act, when combined with the updated charter of human rights makes dealing with people who present with potential mental illness problematic.
... |
| K wrote: | ...
I wasn't intending to do this, but I've now found the Charter of Human Rights and Responsibilities Act 2006, " incorporating amendments as at 1 July 2014". It surely can only strengthen patient/victim rights, though, not hand more power to (e.g.) police... |
| stui magpie wrote: | | They very much strengthen the rights of the person over the authorities and clinicians. |
| K wrote: | ...
Well, the Charter of Human Rights and Responsibilities Act basically does not mention health and literally does not mention mental health. It does seem, though, that police would struggle legally to force people to do anything just for appearing to have a mental illness, let alone actually having one, a judgement police have no authority (or skills) to make whatsoever. (The Mental Health Act, which I'll comment on in a later post, does not address police; it addresses registered "health professionals".) Unless the victim has actually committed some offence, I really do not know on what basis they can cart someone off to the ER involuntarily, as WPT's post suggests they may be doing. (The same applies for ambos.) I'm wondering if they are bending the laws (or worse) here.
What the Charter does mention is stuff related to criminality:
e.g.
"21... (2) A person must not be subjected to arbitrary arrest or detention.
(3) A person must not be deprived of his or her liberty except on grounds, and in accordance with procedures, established by law.
(4) A person who is arrested or detained must be informed at the time of arrest or detention of the reason for the arrest or detention and must be promptly informed about any proceedings to be brought against him or her."
I don't see anything in Section 21 addressing whether a person arrested or detained must be read their rights... I kind of hope this is stated somewhere else, i.e. that they have the right to know their rights.
[Footnote: Rules do vary by state and country, of course, but that variation is presumably in their equivalent Mental Health Act, not in their equivalent Charter of Human Rights.] |
TBC |
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K
Joined: 09 Sep 2011
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| stui magpie wrote: | being detained or deprived of liberty doesn't just mean gaol, it also covers involuntary admission to a psych ward. There's all sorts of hoops you have to jump through and i's and t's to be dotted and crossed, all of which is designed to protect the individual but also serves to make it more difficult for clinicians and cops dealing with people who show signs of psychosis.
Cops can't tell if someone is off their nut on drugs or just off their nut, so they drag them to an ED for a mental health assessment. |
| K wrote: | ...
I'm wondering if the cops actually know the law. If they do, another possibility is that they bend it by verbally persuading people who are probably scared and don't know the law to "accompany them voluntarily" to the psych ward. I find this all rather disturbing.
... |
| stui magpie wrote: | ...
I think it's perfectly legal in the majority of cases. The cops get called to an incident where someone is acting up, potentially posing a threat to themselves or others. Under the mental health act (IIRC) that's grounds for an involuntary admit to a pysch ward, if that is supported by a Psych assessment.
So the cops have a choice. They can leave the person alone and they may suicide or harm others, they can take them to the watch house and lock em up for 4 hours, putting resources into watching them, or take them to an ED for a mental health assessment which, as WPT has indicated previously, takes time and skill. You can't just plug em into machine or run a scan.
Health services operate within the law and the charter but sometimes it's necessary to push the boundaries to ensure the safety of staff and other patients.
It's a classic case for mine of the people who framed the legislation and charter not giving due consideration to the unintended consequences. |
| K wrote: | ...
The "posing a threat" part is very iffy. I mean, if the patient has actually e.g. assaulted someone, then it seems clear there's ground to act, so we're not talking about that sort of thing.
... An assessment order can only be given by a registered health professional. Let's concentrate for the moment on well-intentioned cops. It may be the cop's intention to take the person to a place where there is a registered health professional who can legally make an assessment order, but this means the cop has had to restrict the person's freedom before a health professional has had a chance to make an assessment that could possibly justify such a later action. Not kosher, as far as I can see. |
| stui magpie wrote: | ...
Now you need to check the Crimes act. Both the Crimes act and mental Health act would over rule the charter to the extent of any inconsistency and the Police have the right to detain you by placing you under arrest.
... |
TBC |
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K
Joined: 09 Sep 2011
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WPT noted:
"The process is entirely legal.
Police are pretty well versed these days about the pertinent parts of the Mental Health Act, 2014 that relate to section 351. To work with a clinician they should be doing an inservice first. In their basic training a lot of time is put into mental health. The police have a huge job.
Police are empowered in Victoria by Section 351 of the mental health Act, 2014 to get a person assessed in an ED by a mental health practitioner or by a medical doctor. In the ED 99% of people brought in by police under Section 351 of the Mental Health Act are assessed by a Mental Health Practitioner whom then make a decision as to disposition that is, where they go:
For example:
Release & no follow up
Release & see a GP and to organize a referral to see a psychologist or counsellor
Released and refer to a crisis assessment team (CAT) or whatever name they have in different areas.
Voluntary admission
Place on an Inpatient Assessment Order (against their will) as it were: once known as certified, later recommended or involuntary and now known as being a "Compulsory" patient (Consumer is the current lingua franca)
That basically encapsulates outcomes post assessment.
if a person is placed on an IAO they by law must see a psychiatrist within 24 hours who then will assess the person & make a determination to basically uphold the assessment order & place the person on a Temporary Treatment Order, a Community Treatment order or change to IAO such that the patient is voluntary.
(there'e a wee bit more to it than that but in a nutshell that is it)
Working with the police means that as a mental health practitioner I can see the person of concern & assess the person in situ:
I've assessed people in train stations, bus stops, maccas, pubs, on street corners, in swank hotels, on tall buidling balcony's (I'm not a police negotiator), in a brothel on one occasion and other places!!
Victoria Police have a role in apprehending people with mental illness.
Police apprehension powers
Section 351 of the Mental Health Act 2014 sets out the powers of a police officer to apprehend a person who appears to have mental illness where the person needs to be apprehended to prevent serious and imminent harm to the person or any other person. This section replaces section 10 in the Mental Health Act 1986.
Police are not required to make a clinical judgment about whether the person has mental illness.
As soon as practicable after apprehending a person, a police officer must arrange for the person to be taken to a registered medical practitioner or mental health practitioner to be examined. For these purposes the police may take a person to a public hospital to be examined by a registered medical practitioner or mental health practitioner.
The registered medical practitioner or mental health practitioner will examine the person to determine whether to place the person on an Assessment Order.
By agreement between police and the hospital staff, police may release the person from custody into the care of hospital staff before the assessment is complete subject to the following considerations:
If there are no significant safety concerns – police can transfer care to hospital staff and the person is released from police custody. If care is transferred, hospital staff will be responsible to arrange for the person to be assessed by a registered medical practitioner or mental health practitioner.
If there are significant safety concerns – police, by agreement with hospital staff should remain until the assessment by a registered medical practitioner or mental health practitioner is complete.
Authorised persons
A police office is an authorised person under the Act. Ambulance paramedics, medical practitioners employed by a designated mental health service and mental health practitioners are also ‘authorised persons’ under the Act.
An authorised person may enter premises, apprehend people, use reasonable force and bodily restraint and transport people to a designated mental health service in prescribed circumstances, for example:
where a person is subject to an Inpatient Assessment Order, Inpatient Temporary Treatment Order or Inpatient Treatment Order and required to be taken to a designated mental health service
where a person is apprehended under section 351 of the Act and police request ambulance to take the person to a designated mental health service
where a patient is absent without leave from a designated mental health service.
Bodily restraint – use by police
If a person is required to be taken to or from a designated mental health services or any other place an authorised person, including a police officer, may use bodily restraint.
A police officer may use bodily restraint if:
all reasonable and less restrictive options have been tried or considered and have been found to be unsuitable
it is needed to prevent serious and imminent harm to the person or to another person.
Search and seizure powers
Search
An authorised person, including a police officer may search a person who is being taken to or from a designated mental health service or any other place.
A police officer may search a person before the person is transported if they suspect that the person is carrying anything that:
presents a danger to health and safety of the person or another person, or
could be used to assist the person to escape.
Before conducting the search, the police officer must explain the purpose of the search to the person to the extent that is reasonable in the circumstances.
The power to search includes:
quickly running hands over the person’s outer clothing (a‘pat-down’ search) or passing an electronic metal device over or close to the person’s outer clothing
requiring the person to remove their overcoat, coat or jacket and any gloves, shoes or hat and examining those items of clothing
requiring the person to empty their pockets or allow their pockets to be searched.
The police officer must inform the person being searched:
whether they will be required to remove clothing during the search
why it is necessary to remove the person’s clothing.
A police officer must ask for the person’s cooperation.
A police officer must conduct the search:
in a way that provides reasonable privacy for the person searched
as quickly as is reasonably practicable
if the person being searched is 16 years or younger, the search must be in the presence of a parent or, if a parent is not reasonably available, another adult.
A police officer must conduct the least invasive kind of search practicable in the circumstances.
A pat down search must be conducted by:
an authorised person of the same sex as the person searched or
a person of the same sex as the person searched under the direction of the authorised person.
Seizure
A police officer may seize and detain a thing found as a result of a search if the police office is reasonably satisfied that the thing –
presents a danger to the health and safety of the person or another person or
could be used to assist the person to escape.
If a thing is seized and detailed the police officer must make a written record that
specifies the thing seized and detained, and
specifies the name of the person from whom the thing was seized and detained, and
specifies the date on which the thing was seized and detained, and
includes any other prescribed details.
Some items, such as weapons, firearms and drugs of dependence, must be retained by police and dealt with in accordance with law (for example, the Control of Weapons Act 1990) and police procedures. Other items may be handed over to the receiving mental health service for safe-keeping so that the item can be returned to the person when it is safe to do so.
Transport
When a person with mental illness needs to be transported to or from a designated mental health service under a provision of the Mental Health Act 2014, that transport should be provided by the least restrictive means possible.
In many circumstances a person with mental illness can be safely transported by a private vehicle or in a mental health service vehicle. However, where this is not safe, Ambulance Victoria has lead responsibility for providing transport either using an emergency ambulance or non-emergency patient transport as appropriate. Police also have a role in transport, either in conjunction with other transport providers or to provide transport where a person cannot be safely transported by other means.
Information disclosure
The Act permits disclosure of information where it is necessary to lessen or prevent a serious and imminent threat to an individual’s life, health, safety or welfare or to prevent a serious threat to public health, public safety or public welfare. See disclosure of health information.
More information
The Department of Health and Human Services - Victoria Police protocol for mental health (October 2016) provides more detailed information about these issues and other common interactions between Victoria Police and mental health clinicians supporting people with mental illness.
https://www2.health.vic.gov.au/mental-health/practice-and-service-quality/mental-health-act-2014-handbook/compulsory-treatment/police " |
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K
Joined: 09 Sep 2011
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| Thanks for your note, WPT... (Actually, the police aspect was just one thing and perhaps not the main thing that caught my eye from WPT's initial comments. ...) |
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K
Joined: 09 Sep 2011
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| Mugwump (in a different thread) wrote: | | ... Judges are not trained psychiatrists. And trained psychiatrists are not very far above medieval plague doctors. ... |
This, I think, makes getting the legislation right even more important. |
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K
Joined: 09 Sep 2011
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| <Okay, I think this completes the construction of the manual split... New posts from here on.> |
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K
Joined: 09 Sep 2011
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| [In hindsight, I probably should've spread the quotes over more comments; now this first page is going to be very long.] |
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K
Joined: 09 Sep 2011
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As WPT notes, the Mental Health Act 2014 does mention police arrest. I didn't see this initially because it's way back on p.268. S. 351 says:
"(1) A police officer may apprehend a person if the police officer is satisfied that—
(a) the person appears to have mental illness; and
(b) because of the person's apparent mental illness, the person needs to be apprehended to prevent serious and imminent harm to the person or to another person.
(2) A police officer is not required for the purposes of subsection (1) to exercise any clinical judgement as to whether the person has mental illness.
(3) A police officer exercising the powers conferred by this section may be accompanied by a registered medical practitioner or a mental health practitioner.
...
(5) As soon as practicable after apprehending a person under this section, a police officer must arrange for the person to be taken to— ... to examine the person in accordance with section 30 to determine whether to make an Assessment Order." |
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K
Joined: 09 Sep 2011
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| I don't see it specified what the police must (e.g.) tell the person apprehended, so I assume it's the same as for an arrest in a criminal setting. [Jumping ahead a bit, I'm concerned about whether people under these laws can be treated no better than, and maybe much worse than, alleged criminals. (e.g. This is a serious issue for sentencing of people convicted of murder.)] |
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K
Joined: 09 Sep 2011
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In the next section, S. 353, on "Power to enter premises", it does say:
"On gaining entry into the premises, an authorised person must, to the extent that it is reasonable in the circumstances—
(a) identify himself or herself to the person who is to be apprehended; and
(b) explain to the person why he or she is to be apprehended; and
(c) give the person the details of the place to which he or she will be taken." |
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K
Joined: 09 Sep 2011
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But now I'm concerned about the broadness of this section (S. 353): it's not just "police" but "an authorised person".
WPT noted who this could be. In the Act definition, it says:
"authorised person means—
(a) a police officer; or
(b) an ambulance paramedic; or
(c) a registered medical practitioner employed or engaged by a designated mental health service; or
(d) a mental health practitioner; or
(e) a member of a class of prescribed persons."
I don't know what (e) could mean, so I'll ignore it for now.
How do you feel about (b), (c), or (d) smashing their way into someone's home??
[I don't think in practice a reasonable ambo would want to do that, of course.] |
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K
Joined: 09 Sep 2011
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The next section, S. 354 ("Search powers"), again uses "authorised person" rather than just "police":
"(2) An authorised person may search a person to whom this section applies before the person is taken to or from a designated mental health service or any other place if the authorised person reasonably suspects that the person is carrying any thing that—
(a) presents a danger to the health and safety of the person or another person; or
(b) could be used to assist the person to escape.
(3) Before searching a person under subsection (2), the authorised person must, to the extent reasonable in the circumstances, explain to the person the purpose of the search."
... |
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K
Joined: 09 Sep 2011
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And S. 355:
"(2) The authorised person must inform the person to be searched of the following matters—
(a) whether the person will be required to remove clothing during the search;
(b) why it is necessary to remove the person's clothing.
(3) The authorised person must ask for the person's cooperation."
I suppose search is less extreme than breaking into someone's home... maybe... but surely legislators should at least reconsider the wording of S. 353. Did they really mean it to suggest these powers for non-police? Do they really want any risk of encouraging medico to play police --- or police to play medico?
[I repeat that I don't think e.g. a rational ambo would actually want to play policeman, but laws are supposed to prevent irrational actions.] |
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K
Joined: 09 Sep 2011
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For comparison purposes, police powers in general:
"A police officer can only ask you to give your name and address if they have a reasonable belief you:
• have committed an offence
• are about to commit an offence.
...
The police officer must tell you what offence they think you have committed."
"The police officer must give you their details if you ask. Ask for their name, their rank and the police station where they work. You can also ask for these details in writing. ...
The police officer can be fined for not giving you their name, rank and police station. You need to complain for this to happen."
"They must tell you your rights before they ask you questions. ... [Y]ou do not have to answer any other questions. ...
However, if someone was using your vehicle and the police officer asks you for that person’s name, you have to give it. If you don’t, the police could charge you with a summary offence."
"A police officer usually needs a warrant to enter and search private property such as your home.
The police officer may enter your property without a warrant when ... " [List of fairly serious scenarios follows.]
"You can refuse to have a photo taken of your face or any other part of you."
"18 and over – the police officer can take your fingerprints and, if you refuse, they can use reasonable force to get them."
Victoria Legal Aid, September 2017
[Comment: it sounds like they can wait to read you your rights until just before they start questioning you, but they have to tell you they are arresting you and why at the time of the arrest.] |
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