I’m not sure what training NSW paramedics are getting on the Mental Health Act 2007 (NSW) but it does seem to be at odds with what the Act says.  Today’s question asks

… in regards to writing a section for a patient in circumstances where a doctor is escorting the patient during a transfer with the treating paramedic. In the event that a section is required because a patient needs to be sedated and/or restrained whilst in transport which clinician should be writing the section? I am unable to find any documentation on this and would assume that the higher clinical level would be the responsible clinician in that case, however it is most likely that any medications being administered are the responsibility of the paramedic.

As I’ve noted in earlier posts, the Mental Health Act 2007 (NSW) s 20 says:

An ambulance officer who provides ambulance services in relation to a person may take the person to a declared mental health facility if the officer believes on reasonable grounds that the person appears to be mentally ill or mentally disturbed and that it would be beneficial to the person’s welfare to be dealt with in accordance with this Act.

Why is that important?  Because s 81 says:

(2)  A person authorised by this Act to take a person to or from a mental health facility or other health facility may:

(a) use reasonable force in exercising functions under this section or any other provision of this Act applying this section, and

(b) restrain the person in any way that is reasonably necessary in the circumstances.

(3)  A person may be sedated, by a person authorised by law to administer the sedative, for the purpose of being taken to or from a mental health facility or other health facility under this Act if it is necessary to do so to enable the person to be taken safely to or from the facility.

The implication of both s 81 and the place of s 20 within that part of the Act dealing with involuntary treatment is that the treatment and transport can be provided even if the patient does not consent to the treatment.

But the idea of ‘writing a section’ rather than recording the observations that caused the paramedic to form the view that treatment was required and that ‘no other care of a less restrictive kind, that is consistent with safe and effective care, is appropriate and reasonably available to the person’ (s 12) is not referred to in the Act.

Section 19 says:

A person may be taken to and detained in a declared mental health facility on the basis of a certificate about the person’s condition issued by a medical practitioner or accredited person. The certificate is to be in the form set out in Part 1 of Schedule 1.

An accredited person is a person accredited by the Secretary of the Ministry of Health for that purpose.  Ambulance officers could be accredited but I doubt they are given the presence of s 20. Action under s 19 certainly sounds like a traditional ‘schedule’ that is there is a prescribed a ‘Medical certificate as to examination or observation of person’ to be completed that allows the person to be taken and detained. When completing that certificate the doctor or accredited person must certify that he or she:

(a) has personally examined or observed the person’s condition immediately before or shortly before completing the certificate, and

(b) is of the opinion that the person is a mentally ill person or a mentally disordered person, and

(c) is satisfied that no other appropriate means for dealing with the person is reasonably available, and that involuntary admission and detention are necessary, and

(d) is not a designated carer, the principal care provider or a near relative of the person.

They are also required to note ‘The following medication (if any) has been administered for purposes of psychiatric therapy or sedation…’

The problem is that the question I have been asked:

In the event that a section is required because a patient needs to be sedated and/or restrained whilst in transport which clinician should be writing the section?

Doesn’t make sense.    If the paramedics have been called to transport a person who has been examined by a doctor or accredited person and a ‘Medical certificate as to examination or observation of person’ has been completed then it is up to the doctor to identify what medication has been given.    If the doctor is travelling with the patient and he or she wishes to prescribe or administer medication then he or she can then do that and would need to record that.  If, on the other hand, the paramedics take the view (whether the doctor is there or not) that in compliance with the clinical practice guidelines and the patient’s condition they want to administer sedation then they could do that and record it.    Where the doctor is travelling with the patient, then ideally the decisions in the ambulance are made with consultation between the practitioners (paramedic and medical).

But the question of who completes ‘the section’ just doesn’t make sense.  If the paramedics have formed no view of the patient’s mental state but are transporting him or her because the doctor has completed the form then of course it’s the doctor who has completed the ‘Schedule’ and is responsible for the evidence in it and the opinions that are relied on to detain the person.

If, on the other hand, assume the patient has attended his or her GP and the GP has formed the view that the patient is mentally ill and has called for an ambulance but has not completed any paperwork, then the ambulance crew when attending may take the view that it ‘appears to be mentally ill or mentally disturbed and that it would be beneficial to the person’s welfare to be dealt with in accordance with this Act’ then the ambulance officers can transport the person to hospital under s 20.  In that case the paramedics have to record their observations and treatment as they would with any patient.