Patients in the community

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7086.988 (Published 05 April 1997) Cite this as: BMJ 1997;314:988

General practitioners need guidance and training

  1. Julie K Johnston, Deputy mental health act administratora
  1. a Maudsley Hospital, London SE5 8AZ

    The Mental Health (Patients in the Community) Act 1995 introduced a power of “supervised discharge,” with important implications for psychiatrists, social workers, community psychiatric nurses, and general practitioners.

    About 7% of psychiatric admissions (about 5000 at any one time) are compulsory. Figures from the Department of Health suggest that up to two thirds of these patients could be suitable for community supervision.1 There are three possible roles for general practitioners: making a recommendation in support of an application for supervision, acting as a patient's “supervisor” in the community, or influencing decisions about a patient's care in the community.

    Supervised discharge has been described as a hybrid between the care programme approach and the legal power of guardianship, which already existed under the 1983 Mental Health Act.2 Its aim is to tackle the problems of those “revolving door” patients who are over 16 years old; detained in hospital under sections 3, 37, 47, or 48; at substantial risk of serious harm to themselves or others; and more likely …

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