MPs call for investigation into how psychiatric patients are being detainedBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5135 (Published 15 August 2013) Cite this as: BMJ 2013;347:f5135
All rapid responses
This doesn't surprise me in the slightest. It is an open secret amongst general adult psychiatrists that there is a national bed crisis. On two occasions in the last six months I have been told by our bed manager "there are no acute beds in the whole COUNTRY".
In these circumstances it is very difficult to get an out of area bed for an informal patient. Most Psychiatric Intensive Care Units already seem to have adopted a policy of only accepting detained patients, and it looks like some general wards are now following suit.
It is not right to section someone just to get them a bed, but is it right to leave an unwell patient in the community for lack of a local bed?
One thing is certain - we have lost too many psychiatric beds and the system is under enormouse strain. The DoH needs to look at this urgently before it breaks altogether.
Competing interests: No competing interests
Gould suggests the Deprivation of Liberty Safeguards (DoLS) were designed to protect vulnerable patients.(1) This is not so.
The DoLS do not allow clinicians or carers to do anything in a patient's best interests that they could not have done under existing legislation. Furthermore, they do not provide patients with any additional safeguards in terms of statutory second opinions or independent tribunals.
The sole purpose of DoLS is to ensure hospitals and care homes are compliant with Article 5 of the Human Rights Act 1998, which states "No one shall be deprived of his liberty save in the lawful detention of persons of unsound mind, in accordance with a procedure prescribed by law."(2) Although the existing Mental Capacity Act provided for legal detention, there was no clearly defined procedure for this.
So the "safeguards", with their six statutory forms, stand simply to protect local authorities, NHS trusts and other institutions from prosecution. This may not be unreasonable, but let us not pretend that protection of the vulnerable was the aim.
I remain, Madam, your obedient servant,
Dr Rich Braithwaite
Isle of Wight NHS Trust
St Mary's Hospital
Isle of Wight
1. Gould M. MPs call for investigation into how psychiatric patients are detained. BMJ 2013;347:f5135
2. Humans Rights Act 1998 c42. http://www.legislation.gov.uk/ukpga/1998/42/contents
Competing interests: RB has received payments for assessing patients under the Deprivation of Liberty Safeguards.