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Approved Mental Health Professional Report Guidance
Status DRAFT
Version Number and Date Final Version March 2014
Issue Date 30th June 2014
Author Steve Dawson, Sarah Bennion, Karl Gluck
Owner Margaret Willcox
Signed off by Margaret Willcox
Date 15th March 2014
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Issue Number
Date Author(s) Principal Changes
1 15/10/2008 Wendy Gerrard
Updated/reviewed previous policy to ensure compliance with amended Mental Health Act 2007.
2 August – November 2012
Steve Dawson
Reviewed policy and updated terminology. Final review Sarah Bennion and Karl Gluck March 2014
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AMHP Report Guidance This document is used primarily to provide the record of an assessment carried out by an Approved Mental Health Professional (AMHP) under S13 of the Mental Health Act 1983/2007. It can also be used to record a request for AMHP advice or consideration of extensions, transfers and revocations of orders under the Mental Health Act (MHA), particularly when it is necessary to enter data on to ERIC. This would apply when the MHA form for potential signature requires the signatory to state that they are acting on behalf of the local social services authority. All headings in italics are required for entry of information on to ERIC, the Gloucestershire County Council recording system. Further headings are to support compliance with the Code of Practice (4.94 – 96) and the expectations established by the Mental Health Act Commission regarding all aspects of a situation, which should be considered within the context of a MHA assessment. The AMHP Report is needed at the time of admission by the admitting hospital ward, copied to the responsible Mental Health Act Administration (Health Records) Department. A copy should be forwarded to the relevant Social Care Specialist for supervision purposes. Locality admin workers aligned to Social Care Specialists are responsible for ensuring that the AMHP report is inputted onto ERIC and to check that there is a copy on RIO. AMHPs are responsible for ensuring that relevant teams (2gether NHSFT, Care Services, Learning Disabilities) have access to a copy of the report and are aware of any outstanding action that might be required.
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Person Referred:
Record the full name that would be entered on to Mental Health Act forms in the event of a person being detained under the Mental Health Act, including all forenames etc.
Preferred Name/Otherwise Known:
The name, that the person prefers professionals to use, or other names, that the person is known to have used.
Address:
Permanent address, that would be entered on the MHA form. If the person has no address, enter No Fixed Address. Do not use a hospital address if the person has already been admitted from being homeless in the community. If the person is from outside the locality, endeavour to confirm their status in their home locality. Please ensure that the postcode is entered as this allows entry of all addresses on to ERIC whether in or out of county.
Current Location:
Where the person is at the time of the MHA assessment.
Date of Birth:
Please be accurate as the date of birth is frequently used in conjunction with the name to identify if there is an existing ERIC record. If an incorrect date of birth is entered, it could lead to a duplicate record being set up.
GO, EGT, PRN, NHS, NI Numbers:
PRN, NHS and NI numbers can all be entered on to ERIC for reference.
Contact made to AMHP by:
Enter the name, contact details and relationship of the person seeking the MHA assessment or advice.
Referral Source:
Is most likely to be Gloucestershire County Council (from e.g. EDT), Health Visitor/GP/District Nurse, Other Health, Police, Nearest Relative. See list of “Referrals Sources” for the full list. Date of this Assessment Request And Time: These are required to confirm that the assessment is completed within the expected standard or time limit set for example by Section 136.
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Relationship to Service User:
This may be a personal or professional relationship.
GP Name, Address, telephone Number:
Enter the details of the GP with whom the person is registered. If they are not registered this should be noted. If the GP is not known at the time of the assessment, this should be noted as an action point on page 8. If the GP is does not participate in the MHA assessment, the AMHP should advise them of the outcome.
Previously Known to Local Social Services Authority:
Having accessed ERIC through the Customer Service Helpdesk if necessary, please circle as appropriate and insert the PRN if known.
Referral Reason:
Circle Advice, Mental Health Issues or Assessment under the Mental Health Act. This allows consultation with an AMHP to be recorded if an assessment is not undertaken. Details of Service User’s Household/Personal Network:
To identify others, particularly children, living at the same address. Identify people who live at different addresses if they offer significant support and care. Please ensure that all addresses include the relevant postcode.
Nature of Referral and Brief Description of Events Leading to Referral:
Should include reference to any use of the MHA such as S136, S5 (2), S135, S13 (4) and PACE, to indicate the permitted time within which the assessment must be concluded. The brief description is to identify the reasons why the assessment is being requested. Any Indication of Potential Violence or Other Hazard?
The Customer Service Helpdesk or CACD or CYPD locality clerk can be contacted to identify if there is a service user history and if there is a warning indicator already on ERIC. Additionally existing health records or the referrer may indicate the nature of potential risks. The ERIC “Warning” list is attached for reference (Appendix 2). Any decision regarding the addition of a case warning should be made in consultation with the Social Care Specialist/Line Manager. If it is decided that a warning should be recorded on ERIC, the service user must be advised of this, giving the reasons and when the decision will be reviewed. The addition of a case warning is achieved by the AMHP completing the ERIC case warning document, forwarding it to the Social Care Specialist/Line Manager for signature and passing it to the appropriate clerk for entry on to ERIC. A draft of the “ERIC Case Warning Document” is attached to Appendix 2 Are there children to be considered? By considering this question at this stage, the assessment can be planned in a way that takes account of the needs of the children.
Language Normally Used:
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This flags up if there is a need for an interpreter. Contact the Social Care Specialist if this is the case to agree any funding and invoicing issues.
Ethnic Origin:
Please identify from the attached “Ethnic Origin” list. The Children and Young People’s Directorate and Community and Adult Care Directorate are required to provide statistics on ethnicity that contribute to the national and local profile of people who are being assessed and detained under the MHA. Religion:
Please refer to the attached “Religion” list.
Culture: Most assessments will be for people whose culture is British. Please use the attached list to reflect the person’s description of their culture. This list changes from time to time.
Is there any particular action needed to ensure that the person is interviewed in a suitable manner, please detail the steps needed and taken here:
Please comment here on needs such as arrangements for the care of children, the need for and arrangements made for the use of an interpreter.
Details of Apparent Nearest Relative:
Please enter the Apparent Nearest Relative’s full name and address including postcode, which is needed to enter them as an Interested Party on ERIC. Please refer to the attached “Interested Party Type” list.
Details of steps taken to identify nearest relative and justification for the decision:
This section would be completed with reference to S26. If there is more than one person who could be regarded as the nearest relative, please use this section to explain how the decision has been reached for inclusion on the MHA form. If it is not practicable to communicate with the nearest relative, the reasons should be recorded. If there is good reason to think that a patient considers their relative to be unsuitable and would like them to be replaced, note this as an action on page 8.
Assessing Doctors:
Please identify which of the doctors is S12 (2) approved by circling “Y” or “N” for each doctor. Under Section 12(2A) if the registered medical practitioner is an Approved Clinician, they are to be treated as if approved under S12 (2). Refer to “Guidance on Medical recommendations and Conflict of Interest” to confirm compliance with the 2008 Code of Practice to the Mental Health Act. If the assessing doctor has an NHS or independent hospital address, use their office address. If the doctor completing the assessment is a locum or contactable only through their home address, the address identified on the AMHP Report should be care of the
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locality Social Care Specialist, with the associated phone number to allow any queries to be forwarded appropriately. The doctor’s fee request (Form SS17) would show the address for payment, which you are asked to clarify, including the postcode, with the assessing doctor. The doctor’s fee request should be sent to the locality Social Services finance department, copied with the AMHP Report that is sent to the Social Care Specialist and copied for the confidential section of the case file.
Other Professionals Involved:
This is intended to provide contact details for professionals who have been consulted because of their specialist knowledge of the patient or for an advocate or interpreter who might be needed to assist at the assessment and following hospital admission.
Previous Contact with the Psychiatric/Mental Health Service:
Such information is likely to be provided through access to the health and social care files, discussion with the relevant mental health service, GP or the personal network of the service user. Background Social and Other Health Circumstances:
The AMHP takes a leading role in describing how the person’s cultural background and social and family circumstances or physical ill health could be contributing to their presentation and how these circumstances impact on options for care and treatment in the community.
Current Situation: Describe the context of the assessment.
Record of Interviews and Discussions:
As noted on the AMHP Report form, please identify the location, whether by phone, those present and communication or culturally specific issues addressed. 1) Nearest Relative:
Include the views of the Nearest Relative regarding their relative’s current mental health, the use of the Mental Health Act and whether they have expressed an objection to detention under the Act. Record if the assessment has been convened as a result of a request by the Nearest Relative, for an AMHP to consider the patient’s case. If the Nearest Relative as defined under Section 26 of the MHA wishes to delegate the nearest relative functions, record this with an action plan on page 8 of the AMHP report. If it has not been possible to consult or inform the Nearest Relative regarding the assessment, record this with an action plan on page 8.
2) Referred Person:
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Record the referred person’s wishes and views of their own needs and any past wishes or feelings that they have expressed, including advance statements. Include their views regarding hospital admission if this is recommended. If they are assessed as lacking the capacity to reach a decision regarding admission to hospital, clarify if there is a valid and applicable advance decision and or there is an attorney or deputy appointed to make decisions on their behalf. See “Guidance on Deprivation of Liberty Safeguards”
3) Recommending Doctors:
Record whether the doctors assessed jointly or separately, they had previous acquaintance with the patient, there was a potential conflict of interest, whether appropriate medical treatment was available and whether medical recommendations were completed and if so, on what grounds.
4) Other Professionals:
Record consultation with people working for statutory, voluntary, or independent mental health services and non-specialist services that have contact with the patient.
If the patient is under 18 years of age, record participation in the assessment by a professional allocated through the Children and Families Directorate (C&FD)
5) Other Relevant Person(s) or Agency:
Record consultation with relevant relatives, carers and friends observing the articles of the Human Rights Act, Data Protection Act and the patient’s wishes as appropriate from 1 – 5.
Identified Risks from Current Knowledge:
To Patient’s Health: Focus on risks to their mental health if the patient is not admitted to hospital. Risks to their physical health associated with their mental disorder may also be noted such as self-neglect, inability to look after themselves. To Patients Safety: Focus on behaviours associated with their mental disorder, which could place them at risk such as suicidal intent, self harm, self-neglect, impulsivity, recklessness
To Other Persons: Identify the nature of risk, such as physical, psychological, sexual, financial, noting any forensic history. Summary of Assessment, Including Justification for Decision:
Identify the stages of decision making relevant to the age of the patient (notably under 16 years and 16 to 18 years) (Chapter 36 CoP), their mental capacity (Chapter 4 CoP), whether the grounds for detention are met with respect to mental disorder and risk
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(Chap 4 CoP), the availability of appropriate medical treatment (Chapter 6 CoP) and services which offer an alternative to hospital admission, even if the grounds for detention are present. Alternatives to Detention Considered:
Demonstrate awareness of services for all care groups and document liaison with those services and the outcome. Liaise particularly with the Crisis and Home Treatment Teams when available to the care group.
Method of Conveyance and Any Difficulties:
Comment particularly on delays and responses that are detrimental to the service user, carers or assessors. Report as an untoward incident to support service development, particularly if there has been non- compliance with the Conveyance Joint Protocol Decision and Alternative Care Arrangements: Was the person admitted to hospital, detained under the Act accepted into Guardianship or placed on Supervised Community Treatment Order?
Please tick the box if “Yes”. Which section was used by you? Use the box to identify Section 131, Section 2 and Section 3 with the start date and time of the section. Service Type:
Identify all sections of the Act which relate to the assessment:
If a warrant of entry is sought under Section 135(1), identify the provider and location of the place of safety (which could be a hospital, police station, social services premises or any suitable place where the occupier is willing to receive the patient) and the statutory start date (when the warrant was used) and end date (when the assessment was concluded).
If the AMHP applies for a warrant under Section 135 (2) enter the statutory start date (when the warrant was used) and end date (when the person was taken to the place where they were required to be.
If an application is made under Section 4, identify the provider and location of the admitting ward and the statutory start date (the date of the application). The end date is dependent upon the second medical assessment. If the second doctor recommends detention under Section 2, the change of status will take place on the date of that recommendation. If the second doctor does not recommend detention, the patient remains on Section 4 until the expiry of the 72 hours or until reviewed by his Responsible Clinician. (See Draft Policy “Section 4 Mental Health Act 1983/2007 Admission for Assessment in Cases of Emergency”)
If a patient is admitted informally, identify the provider and location of the admitting ward and the start date (the date of admission). The end date should be entered as the same date to prevent the case remaining open indefinitely on ERIC.
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If a patient is admitted under Section 2, identify the provider and location of the admitting ward. Enter the statutory start date (the date of admission) and the end date (28 days on)
If the patient is admitted under Section 3, identify the provider and location of the admitting ward. Enter the statutory start date (the date of admission) and the end date as (26 weeks on).
In Gloucestershire the provider for hospital admissions is 2gether NHS Foundation Trust, Rikenel, but this on its own does not provide sufficient information to advise the community services of the person’s location. Registration Type: Continue to identify all the section of the Act which relate to the assessment:
If the patient is arrested under Section 136, identify the provider and location of the place of safety. Enter the statutory start date (arrival at the place of safety) and end date (when the assessment was concluded)
If the person was detained under S3, they are also entitled to Section 117 Aftercare. Tick and enter a start date to match that for the Section 3.
If the patient is made the subject of a Supervised Community Treatment Order, keep the AMHP assessment open until the statutory start date for the SCTO (entered as the commencement date on from CT01 by the responsible clinician). Tick to show the SCTO registration and enter the statutory start date (which will also be the end date for AMHP involvement) and end date for the SCTO (26 weeks on). (See Policy Section 17A Mental Health Act 1983/2007 Supervised Community Treatment)
If a patient is accepted into Section 7 Guardianship, tick and enter the statutory start date (as entered on form G5 by the Director of Social Services as the date of acceptance) and end date (26 weeks on). (See Policy Section 7 Mental Health Act 1983/2007)
If a patient is placed under Guardianship by a court under Section 37, tick and enter the statutory start date (as ordered by the court) and end date (26 weeks on).
Patient’s Rights: In addition to the right of appeal to the hospital managers and mental health review tribunal, the detained patient also has the right to request an Independent Mental Health Advocate (IMHA). (See relevant rights leaflets) Nearest Relative information. Nearest Relative rights. Complete the associated boxes to confirm that the information has been provided in a timely way or to explain why not. Use page 8 to clarify any necessary actions. If the person is not being admitted to hospital
Tick the “No” box
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Use the space to describe the agreed alternative care plan if the person was not admitted to hospital, accepted into Guardianship or made the subject of a Supervised Community Treatment Order.
Please Detail any Alternatives to Hospital Needed but not Available: To identify service or informal support deficits.
Checklist:
Please identify actions needed and who is to be responsible for questions 1 to 5.
Any Other Further Actions Required?
Use this box to identify such issues as work needed e.g. with respect to Section 4, Nearest Relative explanation of rights/displacement, IMHA referral and who will be undertaking the tasks.
Time between Application to Detain and Admission to Hospital:
As noted on the report form, this is required by the Mental Health Act Commission.
Give Details of any Delays in the Assessment including difficulties in contacting an AMHP, doctors, advocate, interpreter, resolving potential conflicts of interest or the Assessment or Admission Process:
This helps to identify any trends in service response.
Contact Address and Phone Number for the Social Work Team Responsible for Follow Up:
This will be a specialist mental health team for the integrated Adults of Working Age but the relevant Gloucestershire County Council Department for Child & Adolescent, Learning Disabilities and Older People’s Services. A copy of the report should be sent to the appropriate team for information, follow up work and entry on to ERIC. A note or compliments slip is necessary to highlight the need for work to be done and the entry on to ERIC in addition to verbal communication directly with the recipient and faxed urgent requests. The non-integrated mental health teams (CAMHS, LD and Older People) should also be sent a copy of the AMHP Report. File reference for ERIC purposes: Identify the main location in which the case file and report will be located e.g. “2getherNHSFT, AWA, Park House”.
Case Worker Allocation:
The AMHP’s name is required for allocation purposes and the end date of the AMHP involvement is needed to close the assessment.
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Closure Reason after assessment
Tick “service offered” if a hospital admission (including S131 informal admission) is the result of the assessment and if Section 135 is used Tick “work completed” for any outcome other than those listed under “service type” Service User Group
Tick whichever service user groups apply, identifying which has priority if more than one group applies.
The AMHP signs and dates the report. The AMHP’s name should be entered in block letters. If the AMHP is working from home, they should use the address and phone number of the locality Social Care Specialist who would make contact regarding any queries. The AMHP Report is intended to be countersigned by the 2getherNHSFT Team Manager or Gloucestershire County Council Team Manager so that they are aware of the work, possible need for follow up by their team and to arrange for input to the ERIC system. The form may alternatively be signed by the locality Social Care Specialist. The AMHP should tick the boxes related to all destinations to which copies have been sent. “Other” could be used to identify when the AMHP is retaining a copy to support the re-approval process. When the assessment has been entered on to ERIC the report should be scanned into electronic case notes (ERIC/RIO).
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Appendix 1
Referrals Sources in ERIC
Anonymous Archive Retrieval Community Agent Community Social Worker Court Education Family Fuel Boards General Public Gloucestershire Social Services Health Visitor/GP/District Nurse Housing NSPCC Nearest Relative Neighbour/Friend Other Other Health Other Local Authority Other Statutory Organisation Police School Self Supporting People Village Agent Voluntary Organisation Withheld
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Appendix 2 ERIC – “Warning” List
Beware of dangerous animal
Consent to share refused
Missing Person
Potentially violent patient sch
Previous Concern
Refer to complaints service
Risk to children
Risk to self
See Case File/ERIC warning
See Keyworker Before Visit
Should Not Be Seen Alone
Unable to Hear Telephone
Will Not Deal With Men
Will Not Deal With Women
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ERIC Case Warning Document
PRN Surname First Name Address Case Warning Reason Reason for Case Warning
Worker Name
Team
Locality
Authorising Manager
Date
Clerical Input
Date
Review Date
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Additional Information
Date of Update / Additional Information Worker Name Team Locality Authorising Manager Decision to remove warning Worker Name Team Locality Authorising Manager Date Clerical Input Date
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Appendix 3
ERIC – “Ethnic Origin” List
Asian or Asian British
Black or Black British
Chinese or other Group
Mixed Parentage
Other Ethnic Group
White
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Appendix 4
ERIC – “Religion” List
Agnostic
Atheist/None
Baptist
Buddhist
Christian
Christian Scientist
Church of England
Church of Scotland
Free Churches
Greek Orthodox
Hindu
Jehovah’s Witness
Jewish
Methodist
Mormon
Muslim
Not known
Other
Pentecostal
Plymouth Brethren
Protestant
Quaker
Rastafarian
Roman Catholic
Russian Orthodox
Seventh Day Adventist
Sikh
Spiritualist
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Appendix 5
ERIC – “Culture” List
African Vietnamese
African Indian White and Asian
Any other Asian background White and Black African
Any other Mixed background White and Black Caribbean
Bangladeshi White Irish
Black-African
Black-Caribbean
British
Caribbean
Chinese
Filipino
Indian
Irish
Japanese
Not Stated
Other Asian
Other Black
Other Cultural Background
Other Ethnic origin
Other European
Other Mixed Parentage
Pakistani
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Appendix 6
ERIC – “Interested Party Type” List
Activities worker District Nurse
Adult Mental Health Worker Drugs/Alcohol Worker
Adult Placement Carer (LD) Educational Advisor
Advocacy Worker Educational Psychologist
Agency Foster Carer Educational Social Worker
Agency Social Worker Educational Welfare Officer
Appointee Ex-Cohabitee
Area Reintegration Manager Ex-Husband
Assistant Education Officer Ex-Partner
Aunt Ex-Wife
Barnardo Worker Executor
Barrister FSS Worker
Befriender Family Intervention Project Worker
Bereavement Worker Father
Boyfriend Father-in-Law
Brother Father’s Partner
Brother-in-Law Father’s Friend
Carer First Responder
Child Action Worker Foster Carer
Child / Adolescent Psychiatrist Fostering Officer
Childminder Fostering Team Manager
Children’s Centre Manager Friend
Children’s Centre Worker General Practitioner
Children’s Guardian General Practitioner Secondary
Children’s Advocate Girlfriend
Civil Partnership Grand-Daughter
Cohabitee Grandfather
Community Family Worker Grandfather (Step-Maternal)
Community Learning Disability Nurse Grandfather (Step-Paternal)
Community Paediatric Nurse Grandfather (Maternal)
Community Paediatrician Grandfather (Paternal)
Community Psychiatric Nurse Grandmother
Community Social Worker Grandmother (Step-Maternal)
Connexions Personal Advisor Grandmother (Step-Paternal)
Counsellor Grandmother (Maternal)
Cousin Grandmother (Paternal)
Daughter Grandson
Daughter-in-Law Great Grandparent
Dentist Great Nephew
Deputy Head Teacher Great Niece
Designated LAC Teacher Half-Brother
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Half-Sister Personal Advisor
Head Teacher Physiotherapist
Head of Year Placement Support Worker
Health Visitor Play Therapist
Hospital Paediatrician Playgroup Supervisor
Hospital Teacher Police Liaison Officer
House Parent Police Officer
Housing Officer Power of Attorney
Husband Primary Link Teacher
IMCA Prison Worker
Keyholder Private Foster Carer
LAC Team Manager Private Fostering Coordinator
Lawyer Probation Officer
Lead Advisory Teacher Programme Supervisor
Learning Support Worker Prolific Offenders Unit
Legal Assistant Psychiatric Social Worker
Legal Representative Psychiatrist
Locality Development Worker Psychologist
Lodger Psychotherapist
Manager Reintegration Tutor
Manager Early Years Centre Residential Social Worker
Midwife Respite Foster Carer
Missing Person Contact Risk to Children
Monitoring Development Officer Safeguarding Child Team Member
Mother Safeguarding Child Dev. Officer
Mother-in-Law School Nurse
Mother’s Partner School Safeguarding Officer
Mother’s Friend Self Funded Provider
Nanny SENCO
Neighbour Senior Practitioner
Nephew Sister
Niece Sister-in-Law
None Skills Development Worker
Nurse Social Work Deputy Team Manager
Nursery Manager Social Work Team Manager
Nursery Nurse Social Worker
Nursery Worker Solicitor
Occupational Therapist Son
Ophthalmologist Son-in-Law
Orthodontist Special Educational Needs
Other Special Educational Needs Coordinator
Other CAMHS Worker Special Guardian
Other Educational Special Guardianship Worker
Other Health Specific Foster Carer
Outreach Worker Step-Brother
Partner Step-Daughter
Pastoral Care Worker Step-Father
Pastoral Head Step-Granddaughter
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Step-Grandson Wife
Step-Mother YIST Worker
Step-Sister YOS Worker
Step-Son YOTO-Comm. Psychiatric Nurse
Surgeon YOTO-Connexions Worker
Teacher YOTO-Drugs Worker
Teens in Crisis YOTO-Probation Officer
Unborn Child YOTO-Programme Officer
Unborn Sibling YOTO-Social Worker
Uncle YOTO-Victim Liaison Officer
Warden Youth Worker
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Appendix 7
APPROVED MENTAL HEALTH PROFESSIONAL REPORT N.B ERIC Information In Italics Person Referred: Date of
Birth: Preferred Name/ Otherwise known Gender:
As
Address: Tel No:
Post
Code:
Current Location: Marital Status
Lives Alone Yes No
Contact made to Date of this AMHP by: assessment Request &
Start date of AMHP involvement
Time: Address: Tele No: Referral Source Relationship To S. User
GP Name Address
Tel no
Previously Known to Local Social Services Authority Y/N
Referral Reason: Advice/Mental Health Issues/ Assessment required under the Mental Health Act
N.I. Number
NHS Number
PRN Number
EGT Number GO Number
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Assessment Legal Basis: MHA 1983/07 Assessment Type: AMHP
Details of Service User’s Household/Personal Network Name Address Tel No Relationship to
Service User PRN – enter if person known to SSD
Any indication of potential violence or other hazard? Yes No
If YES, give details: Refer to the Eric “Warning” list. If you consider an entry should be changed or added to ERIC, discuss with the Social Care Specialist / Line Manager and complete the “ERIC Case Warning Document” in line with the associated GCC guidance if appropriate. Are there children to be considered? Yes No If yes – (see page 8) Language normally used: Ethnic Origin: Religion Culture
Nature of Referral and brief description of events leading to referral.
Is there any particular action needed to ensure that the person is interviewed in a suitable manner, please detail the steps needed and taken here.
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Details of Apparent Nearest Relative
Name Relationship Address Tel No:
Assessing Doctors Doctor 1 Doctor 2 Approved Approved Y/N Y/N Address Address Tel No Tel No Fee request Y/N Fee request Y/N
Other Professionals involved:
Name
Address Tel. No Title/role
Consultant
Care Coordinator
CRHT
Advocate
Other
Details of steps taken to identify nearest relative and justification for the decision:
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Record of Interviews and Discussions (include location, whether by telephone, those present
and any communication or culturally specific issues addressed):
Previous contact with the psychiatric/mental health service (with sources of information):
Background Social and Other Health Circumstances
Current Situation
2. Interview/discussion with the referred person:
1. Interview/discussion with the nearest relative or reasons for not consulting with the nearest relative:
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Identified risks from current knowledge
3. Interview/discussions with the recommending doctors:
4. Interview/discussions with other professionals involved:
5. Interview/discussion with any other relevant person(s) or agency:
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Decision and Alternative Care Arrangements: Was the person admitted to hospital, Yes If “No” See below detained under the Act, accepted into Guardianship
To other persons
Summary of assessment, including justification for decision
To patient’s safety:
Alternatives to detention considered
Method of conveyance and any difficulties
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or placed on a Supervised Community Treatment Order?
Start Which section Date & was used by you? Time of Section or other authorities
Service Type: Please tick Tick Provider: 2gether / Other and specify which Hospital/Ward/Other Accommodation
Statutory Start/End dates of sections used
MH Act ’83/07 Sec 135 (1) Warrant
MH Act ’83/07 Sec 135(2) Warrant
MH Act ‘83/07 Sec 4 Emergency
MH Act ’83/07 Sec 131 Informal/Voluntary
MH Act ‘83/07 Sec 2 Assessment
MH Act ’83/07 Sec 3 Treatment
Registration Type: Please tick
MH Act ’83/07 Sec 136 Place of Safety
MH Act ’83/07 Sec 117 Aftercare
MH Act ’83/07 Sec 17A SCTO
MH Act ’83/07 Sec 7 Guardianship
MH Act ’83/07 Sec 37 Guardianship/Court
Patient’s rights were explained to him/her: Nearest relative was informed of the application Nearest relative’s rights were explained to him/her
No If NO, detail the alternative care plan (Continue on Page 10 if necessary): Please detail any alternatives to hospital needed but not available:
Checklist (if YES, give details in the box below)
1. Is any action needed to protect or care for children? YES N NO
Yes/No/Why Not/ Date & Time
Yes/No/Why Not/ Date & Time
Yes/No/Why Not/ Date & Time
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2. Are there likely to be visits to the hospital by children? YES NO
3. Is any action needed to protect adult dependants? YES NO
4. Is any action needed to protect pets? YES Y NO N
5. Is any action needed to protect property? YES NO
Questions 1 + 2
Question 3
Questions 4 + 5
Any other further actions required including referral to IMHA / IMCA and by whom?
Time between application to detain and admission to hospital
(Note: the above response is required by the Mental Health Act Commission) Give details of any delays including difficulties in contacting an AMHP, doctor, police, ambulance advocate or interpreter, resolving potential conflicts of interest, or the assessment or admission process: Contact address and telephone number for Local Authority and/or Mental Health services responsible for follow up:
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File reference for ERIC purposes:
Case Worker Allocation
Approved Mental Health Professional’s Name End Date of AMHP involvement
Allocate to
Closure Reason after assessment Service Offered Work completed Service Drugs & EMI Physical User Alcohol Disability Group (for ERIC)
MH Learning Children Disability
AMHP Signature: Date Print Address Name Phone Number Team Manager of responsible community team or Social Care Specialist Copies of Report to:
Ward file Responsible Community Mental Health Team
Health Records Responsible Community Social Work Team
Social Care Specialist Other (Please specify)
ERIC Input by and Date:
Signature: Date:
