You are the SHO looking after yesterday’s on-call admissions for your team. One of these admissions is an 18-year-old woman, Ms Clayton, with no previous psychiatric history who took an overdose of paracetamol yesterday. This was small (16 tablets) and her levels were undetectable 6 hours post overdose. She denies intending to kill herself and says she was “confused”. Today the nurses report she has been verbally aggressive and swearing at staff and thinks they are trying to poison her. She wants to go home with her mother.
Her mother has asked to speak to you with regard to taking her home. The mother feels that this was a one-off issue which won’t happen again – her daughter is far too sensible. Ms Clayton has not yet been assessed by a psychiatrist.
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This is a scenario of speaking to a relative who wants to take her young daughter home following an overdose, who is currently medically fit on an Acute Medical Ward. It started well with a good introduction and identification of both the candidate and the relative and asking the relative for the reason for the discussion. Consent is taken for granted here, but this could be acknowledged as the patient is an adult and their permission would be needed to speak about her medical issues. The mother clearly wanted to take her daughter home straight away and the candidate acknowledged and sympathised with this and promised to return and deal with her concern but gained her permission to talk through her daughter’s condition and her mother’s understanding of it first. This is clear acknowledgement of a cue, but a statement that there may be a process to go through first before it can be addressed fully. The mother’s understanding of what has happened and need for the mental health assessment is expertly explained. The candidate again demonstrates empathy for the daughter’s situation, but then explains the seriousness of what could happen if the correct process is not followed. He also explained the positive outcomes of the daughter receiving potential treatment and certainly support for both the daughter and the parent. He put across a very persuasive argument which changes the mother’s mind. He emphasised that they should work together for the good of her daughter. He also offered to push through assessment as much as he could but acknowledged that he could not guarantee when the psychiatric assessment would be. He explained very well the implication of detaining her daughter against her will until she has had a formal assessment by the experts, which would be under the Mental Health Act. The candidate finished with an excellent summary including a clear action plan going forward.
Holding a patient under common law - Keywords phrases.pdf