This page answers some of the questions raised in episode three of the second series of Hospital.

What is a place of safety?

When people are in crisis they are at their most vulnerable. It is essential that they receive the care and support they need as quickly as possible, in a place they can feel safe, and that they are supported by people who understand their needs. Under section 136 of the Mental Health Act 1983 (MHA), someone who appears to be experiencing a mental health crisis in a public place can be taken to a place of safety for an assessment of their mental health. In all but exceptional circumstances this should be in a health based place of safety.

Who manages the psychiatric liaison team and what does the team consist of clinically?

The liaison team based at an acute hospital site is managed by the local mental health trust. The team consists of mental health nurses and psychiatrists. The team provide mental healthcare to people being treated for physical illness in general hospitals, whether they attend outpatient clinics, are admitted to inpatient wards or present to the A&E department. Staff at the hospital can refer a patient to the liaison team 24 hours a day to help detect mental health problems early and provide the necessary support.

Why can’t staff from the psychiatric liaison team admit a patient into St Mary’s?

Patients are admitted to St Mary’s for a range of conditions that require inpatient medical or surgical care. The hospital does not have mental health inpatient facilities. Should the liaison team believe that a patient should be admitted to an inpatient facility for their mental health condition they do this by referring to the appropriate mental health care facility.

What is a 12 hour breach?

Once a doctor makes the clinical decision to admit a patient from A&E into an inpatient ward this must be completed within 12 hours. If this admission goes over this deadline this is known as a 12 hour breach (or trolley wait). In March 2017 alone we had four 12 hour breaches in the St Mary’s Emergency Department; these all related to patients waiting for admission to a mental health inpatient facility.

Why are private ambulances used in the transfer of mental health patients?

When a patient is in the Emergency Department requires a non-emergency transfer to another health facility this is not an emergency requiring a ‘blue light’ ambulance so a private ambulance must be ordered. All private ambulances have the right staff and equipment in situ in order to safely transfer a patient to the most appropriate mental health facility for their needs.

You see a member of staff be subjected to violence. How does the Trust protect its staff from abuse?

We have a duty to provide a safe and secure environment for patients, staff and visitors. Violent or abusive behaviour will not be tolerated and we have stringent policies and procedures in place that outline the action that we take to protect staff, patients and visitors. We have a 24/7 onsite security presence at all of our hospitals.

If a member of staff is verbally or physically assaulted we provide a range of support. This includes CONTACT (our staff counselling service), Schwartz rounds open to all staff to allow space for reflection on key issues, occupational health referrals, health and safety risk assessments following an incident to prevent one happening again, partnership work with our mental health trust colleagues who can provide additional training to staff and where required temporary changes of duty.

Who makes the decision on the health and social package for each individual patient?

If a patient requires additional health and social care support to be able to be discharged from hospital this package of care is recommended by the complex discharge team. If additional support is required agreement of the funding of that support sits with the commissioners.

What are your consent processes?

We follow agreed consent protocols before a decision is made to include footage of a patient and we provide input throughout the editing process. We have specialist consent protocols for vulnerable patients.

A member of staff references a ‘cage’. What is this?

There will be occasions where a patient requires high security transfer to a mental health facility and the colloquial term cage refers to an ambulance that has a sealed unit in the back where a patient could be placed for the journey. There will still be a clinical member of staff with that patient in the back of the ambulance.

When is it appropriate to restrain a patient?

Restraining a patient is always the last resort and is only carried out to ensure the safety of that patient, other patients in close vicinity and staff caring for them. There are clear protocols in place to ensure that any restraining is carried out only when absolutely required and with minimal force used.

Need further information or support on the themes explored in this episode?

Mental health

NHS Choices

Time to Change - mental health help and support



Alzheimer's Research UK

Alzheimer's Society

Age UK

YoungDementia UK