Intended for healthcare professionals

Practice Practice Pointer

Assessing an acutely disturbed person in the community

BMJ 2019; 364 doi: (Published 07 March 2019) Cite this as: BMJ 2019;364:l578
  1. Aileen O’Brien, reader in psychiatry and education1,
  2. Stephen Kaar, clinical research worker2,
  3. Judith Ibison, reader in primary care and partner in general practice1,
  4. Julie Chalmers, consultant psychiatrist3
  1. 1St George’s University of London, London, UK
  2. 2Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
  3. 3The Elms Centre, Banbury, UK
  1. Correspondence to Aileen O’Brien, aobrien{at}

What you need to know

  • Attempt to de-escalate the situation: listen, acknowledge the person’s feelings, reassure them that you wish to help, offer a quiet space to talk, a drink, and time to speak and be listened to

  • In rare circumstances, where there is an imminent physical risk to the person or others, use internal alarms to alert the rest of the practice, contact police, and consider evacuating the area

  • Check for the presence of physical and mental health comorbidities, the role of recreational drugs or alcohol, and acute life stressors (relationships, housing, finances, access to services)

  • Establish any risk factors, such as a history of aggression, self harm, or suicide attempts, recent psychiatric admission, or a forensic history

  • If the situation cannot be safely de-escalated then Section 136 (S136) of the Mental Health Act is a police power in the United Kingdom to remove someone to a place of safety for assessment and it can now be used in any part of a general practice or community clinic

You are urgently called to reception where a 25 year old man is shouting about the building having been taken over by demons. He appears distressed and is not responding to attempts by reception staff to communicate with him. He shouts about his neighbours, that he needs to “sort them out.” You see from his notes he has a history of psychotic episodes.

It can be difficult to know what to do when a person in severe psychological distress presents to a general practice or community clinic, particularly if they are behaving aggressively, or if they are refusing help. The person may be experiencing a deterioration in their mental health, such as a psychotic episode, or it may be related to substance use or acute social stressors. Most patients who are acutely disturbed present no danger …

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