Approved Medical Practitioners - Mental Health (Care and Treatment) (Scotland) Act, 2003 Training Manual

Section 5. Emergency Detention Certificate ( EDC) - Section 36

It is worth noting that the 2003 Act intends that the STDC be used in preference to an emergency detention certificate ( EDC) whenever possible. Any fully registered medical practitioner may complete an EDC (i.e. not just AMPs).

Criteria for granting an EDC

• It is likely that the patient has a mental disorder.

• It is likely that the patient has significantly impaired decision-making ability with respect to medical treatment for mental disorder.

• The doctor must be satisfied that significant risk to the patient or others exists, which would be ameliorated by detention under an emergency certificate.

• The doctor must be satisfied that the need for the certificate is urgent and that detention under an STDC would be either inappropriate or unfeasible.

It is worth noting that the first two criteria listed above contain the word 'likely'. This means that the medical practitioner needs to be satisfied only on the balance of probabilities. The meaning of the new criterion of 'significantly impaired decision making ability' is explored in Appendix 2.

Terms of the EDC

An EDC:

• Lasts 72 hours

• Allows transfer to hospital within 72 hours, then detention for up to a further 72 hours; transfer between hospitals can occur within the 72 hours

• Must be given to hospital managers to authorise detention

• Should have the consent of the MHO, whenever possible

• Allows medical treatment to be given in an emergency

• Can be served on a child of less than 16 years; if no child and adolescent in-patient services are available, the Mental Welfare Commission must be informed

• Carries no right of appeal.

The same doctor who completes the medical examination must complete the EDC.

What is a medical examination?

The medical examination for an EDC involves:

• A face-to-face assessment

• Mental state examination

• Basic physical examination

• An assessment of risk and of decision-making ability.

Occasionally, it is not possible to perform a complete examination, such as when the patient is in a police cell.

The doctor must sign the certificate on the day of examination, or within four hours (whichever is the greater time).

The doctor who grants the EDC should arrange the patient transfer, or delegate the transfer arrangements. He or she also has a responsibility to ensure the certificate is passed on to the receiving hospital's managers.

Ideally, the medical assessment should be joint, involving a doctor and the MHO. It is permissible for a doctor to grant an EDC without MHO consent, but only in exceptional circumstances, such as:

• The patient being in immediate danger or trying to abscond

• No MHO being available.

A MHO can seek a warrant (Section 35) from a sheriff allowing a person to be detained for three hours to enable a medical examination into mental disorder to be carried out. Should removal to a place of safety be required, a Section 293 warrant can be sought.

If it is likely that a period of detention longer than 72 hours is required, then an STDC should be sought as soon as possible. The EDC is revoked upon granting a short-term certificate.

An AMP can revoke an EDC under Section 39 if the detention criteria are not satisfied. The hospital managers have a duty (under Section 38 (2)) to arrange an AMP review of an EDC 'as soon as practicable'.

Comparisons of the conditions and effects of EDCs between the 1984 and 2003 Acts are shown in Tables 8 and 9.

Table 8. Emergency detention - conditions

2003 Act Part 5 (Section 36-43)	1984 Act (Section 24-25)
Likely that the patient has a mental disorder	Likely that the patient has a mental disorder
Decision-making ability likely to be significantly impaired	No mention of decision-making ability
Matter of urgency to determine medical treatment	Admission to hospital urgent necessity
Risk to health, safety or welfare of patient, or safety of others if not detained	Risk to health or safety of patient or for protection of other people
Short-term detention would involve undesirable delay
Consent from MHO where practicable	Consent of relative or MHO where practicable
Certificate issued on same day as medical examination or four hours between examination and certificate	Recommendation on same day as examination

Table 9. Emergency detention - effects

2003 Act (Section 36-43)	1984 Act (Section 24-25)
Removal to hospital within 72 hours	Removal to hospital within three days
Detention for up to 72 hours	Detention for up to 72 hours
Detention ends when short-term detention imposed	Detention lasts for 72 hours unless discharged prior to this
Duty to inform nearest relative or person residing with patient, named person, Mental Welfare Commission and local authority if no MHO consent obtained	Duty to inform Mental Welfare Commission and nearest relative
No new emergency detention immediately after expiry	No new Section 24/25 immediately after expiry
Power to suspend
No appeal	No appeal
No compulsory treatment except where the treatment is urgently required (Section 243)	No compulsory treatment