Mental Health Workshop College of Policing Annual Conference 30/11/2016
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1 Mental Health Workshop College of Policing Annual Conference 30/11/2016 Faculty of Forensic and Legal Medicine Royal College of Physicians Margaret M Stark LLM MSc (Med Ed) MB BS FFFLM (Founding) FACBS FHEA FACLM FRCP FFCFM (RCPA) DGM DMJ DAB
2 Objectives Faculty of Forensic & Legal Medicine Identification of vulnerability due to mental health problems Risk assessment Interagency working Competent practitioners
3 Faculty of Forensic & Legal Medicine of the RCP (London) Advancement of education and knowledge Ensuring the highest professional standards of competence and ethical integrity
4 Importance of recognising mental vulnerability Custody ensure appropriate management, need for safeguards such as an AA, fitness to be interviewed Emergency street situations Diagnosis doesn t matter!
5 Mental vulnerability v capacity (See APP, PACE, MCA) Of importance for Interviews as may not understand the meaning or importance of what is said to them (for example, in the form of questions) or of their replies. Inability to make a decision because of an impairment or disturbance in the functioning of the mind or brain.
6 FTI - R v Aspinall Mental vulnerability v capacity No appropriate adult present Problem with interviewing the mentally vulnerable without support is that any evidence obtained maybe Unreliable Misleading Self-incriminating Not sure what is in their best interests
7 Risk assessment Presentation to you (custody staff or officer in the street) Content of the RA in custody accurate and informative (takes time) Information from other sources - arresting officers, members of the public, family, PNC, etc.
8 Types obvious Mental illness Intellectual disability ASD Substance misuse ADHD/ADD/Conduct disorder
9 Types - less obvious Chronic physical illness Medication Pain Acquired brain injury traumatic/substance misuse (alcohol or other drugs)
10 Can you tell the time? (ask for demonstration)
11 Liaison & Diversion Working in partnership L&D on site Summary care records access NICHE/NSPIS System One
12 Quality standards Multidisciplinary team working nurses, paramedics, doctors ALL need to be appropriately trained (police awareness of limitations) Recruitment Initial Training and Induction Support Workplace-based Supervision by appropriately qualified clinical/educational supervisors Continuing Professional Development Service Level Standard
13
14
15 Acute Behavioural Disturbance ABD= UMBRELLA TERM
16
17 Common causes Stimulant misuse Psychiatric conditions
18 Differential diagnosis Head Injury/Seizures Hypoglycaemia low blood glucose Sepsis severe infection Hypoxia low oxygen level Thyroid storm abnormal thyroid gland functioning Serotonin syndrome THINK: ecstasy, antidepressants Neuroleptic malignant syndrome THINK: antipsychotics Heat exhaustion Anticholinergic syndrome THINK: antidepressants, antihistamines,
19 Early coordinated response required US National Institute of Justice Technology Working Group on Less-Lethal Devices
20
21 Principles of management Reduce suffering to patient psychological/physical Reduce the risk of harm to others To do no harm Limit physical restraint/pain Avoid the prone position NB European Convention on Human Rights Article 2 (right to life) & Article 3 (prohibits torture, and "inhuman or degrading treatment or punishment ).
22 Verbal de-escalation take time if possible Single person Direct clear calm voice Reduce environmental stimuli Monitor breathing
23 Wrestling Increases oxygen consumption Lactic acidosis = abnormal blood chemistry
24
25
26 ABD - Conclusions ABD is an umbrella term with excited delirium at the most extreme end Medical emergency but not always fatal Hyperthermia is dangerous - think of treatable causes Oral rapid tranquilisation in police custody (unless advanced paramedic present to assist)
27 Further Reading
28 References Stark MM. Norfolk GA. Care of Detainees. Chapter 9. In Clinical Forensic Medicine A Physician s Guide. Ed. Stark MM. Humana Press, Totowa, New Jersey, Third edition. Springer, New York Norfolk G., Stark MM. Fitness to Be Interviewed. Chapter 11. In Clinical Forensic Medicine A Physician s Guide. (as above) Stark MM. Payne-James JJ. & Scott-Ham M. Symptoms and Signs of Substance Misuse (Third edition) CRC Press, Boca Raton, FL, 2015 Vilke GM. Payne-James JJ. Excited Delirium Syndrome: aetiology, identification and treatment. In Current Practice in Forensic Medicine. Second edition. Eds Gall J. & Payne-James JJ. John Wiley & Sons, Ltd, Chichester, West Sussex, 2016
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