Professor Anne-maree Kelly1
1Western Health, Australia
This study aimed to determine the characteristics, precipitating circumstances, clinical care, outcome and disposition of patients brought to the Emergency Department (ED) under section 351 (police detention and transport) powers of the Mental Health Act 2014 (Vic) (MHAV).
441 patient encounters were included; median age 34. 84% of patients were co-transported with ambulance. The most common primary reason for detainment was suicide risk/intent (67.6%) followed by abnormal behaviour without threat to self or others (21%). In ED, parenteral sedation was administered in 10.9% of cases. Physical restraint was applied in 17.5%. In 18% of cases, patients were placed on a compulsory assessment order under the MHAV. Sixty-seven percent of patients were discharged home. A subset of patients had recurrent s 351 presentations, with 18 patients (4%) responsible for 22% (96/441) of all events.
In summary, most patients brought to ED under s 351 of the MHAV had expressed intention to self-harm, did not require medical intervention and were discharged home. It could be questioned whether the current application of s 351 is routinely consistent with the least restrictive principles of the MHAV, especially as there is no apparent monitoring or reporting of its use. Further work exploring less restrictive or traumatic processes to facilitate mental health assessment of these patients is warranted.
Biography:
Professor Anne-Maree Kelly is a senior emergency physician and research academic at Western Health, The University of Melbourne. She is also an adjunct professor at the Australian Centre for Health Law Research, Queensland University of Technology. Her interest in patient autonomy, patient safety and clinical decision-making in ED, led her to explore the interface between ethics, law and medicine. Her health law/ethics research interests include patient consent to use of medical records for research, balancing duty of care and trespass to person for ED patients exhibiting violence/aggression and outcome of involuntary detainment and transfer to ED under Mental Health Act powers.