General Principles FORENSIC PSYCHIATRY

68 Psychiatric And Mental Health Services Operational Policy a Admissions To Psychiatric Hospitals: • Patients who are admitted voluntarily shall sign Form 1 of the MHA 2001. • When a voluntary patient needs to be detained further, the medical oficer shall sign Form 2 to enable detention for a further one month. • Family members, relatives and friends can request for a patient’s admission upon signing Form 3. The medical oficer assigned can then admit the patient by signing Form 4 and this admission must be conirmed by the Head of Department Medical Director or any person assigned for such by signing Form 6. This detention is valid for one month. • Any patient brought involuntarily by members of public or police or social worker can be admitted to a psychiatric hospital by the medical oficer of the hospital by signing Form 5. This admission is valid for one day and must be conirmed by the Medical Director Head of Department by signing Form 6 within 24 hours. • An admitted patient who requires a further detention after one month will have to be examined by two different medical oficers one of whom must be a psychiatrist and if deemed that further detention is necessary, Form 7 must be signed by these two doctors. b New cases who need admission will require a thorough diagnostic workup. When CPGS are available, this should be adhered. c Patients who had relapses should be reviewed and audited as to the reason for relapse and appropriate treatment instituted. d Management of all inpatients should follow the biopsychososcial approach. e Management of acute cases should follow recommendations as given in the relevant CPGs. f The inpatient services should be a multidiscipline team consisting of psychiatrists, medical oficers, nurses, assistant medical oficers, pharmacists, psychologists, counselors, occupational therapists and health education oficers. g The responsibilities of the inpatient team include: • Conduct daily ward rounds. • Provide inpatient medical procedures include prescribing medications, perform investigations, provide counseling, perform ECT, restraint and seclusion as indicated. 69 Psychiatric And Mental Health Services Operational Policy • Arrange for appropriate referrals. • Provide for psychiatric care for patients from other disciplines when referral made refer to Appendix. • Provide a discharge summary and plan. Discharge plan should include: o Medications to be taken. o Type of follow up outpatient, Health centre, Community psychiatry unit. o Date of follow up. o Other interventions needed and their dates and location e.g. place and type for psychoeducation, family intervention, job placement etc. h Where possible, family members should be involved early in management for all patients who are admitted. i Rehabilitation services that should be incorporated early as inpatient include patient and family education and illness management. j For all patients admitted, the individual care plan should be initiated. k ECT shall be done only in psychiatric hospitals. It can be an outpatient or inpatient procedure. The practice of ECT is regulated by MHA 2001 and this must be adhered to. The minimum requirement is to have three areas for ECT including reception, treatment and recovery area. l There must be adequate equipments in the ECT suite and this is deined in the above regulations. Please also refer to Appendix. m Restraints and seclusion can only be done in psychiatric hospitals. n Restraints and seclusion must be seen as an emergency procedure and the requirements of the regulations of MHA 2001 must be followed. Basically, at all times, the basic human rights of the patients detained involuntarily must be respected. o All psychiatric hospitals must set up a hospital based community psychiatric team. The main aims of this team would be three fold i.e. to prevent readmissions, to facilitate early discharge and to help divert patients from being admitted. p This team must be multidiscipline in nature. For further details on function and operations of this team, refer to hospital based community based psychiatric services policies.