Tracey Ostler

1. 1. detention of psychiatric patients in emergency department without Mental Health Act section

   “Lack of Psychiatric Hospital Beds in Surrey and arrangements for detaining patients assessed to require Mental Health Act section in the Emergency Department of Epsom General Hospital”

2. 2. inadequate paramedic capacity assessment for mental health crises

   “Training for Paramedics to undertake Capacity Assessments”

3. 3. absence of reviewed Mental Capacity policy for life threatening decisions

   “The Trusts policy on Mental Capacity is being reviewed to improve articulation of how to assess mental capacity in life threatening circumstances. It is not yet available. I regarded the current policy as inadequate and remain concerned about this because I have not been able to review the revised document”

4. 4. lack of multi-agency safeguarding for high-risk personality disorder

   “Ms [name redacted] suffered from a severe Emotionally Unstable Personality Disorder, this was a longstanding diagnosis, and the effects were well known to her mental health team. She was placed in the community on a Positive Risk Taking Plan. She presented a continuous and serious risk to herself in the community and was prone to impulsive acts of self harm. Ambulances were frequently required to attend her home after such acts. The disorder impacted her ability to make capacitous decisions about her own care”

5. 5. absence of safety protocol for high-risk mental health patients

   “I have not been provided with any Protocol between the services to ensure safety planning in these circumstances that would ensure that front line paramedics are made aware that they are dealing with a seriously unwell mental health patients who is at high risk living in the community”

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