Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, what guidance his Department has issued to NHS organisations on patient safety checks for patients at risk of self-harm; and what steps his Department takes to ensure such guidance is complied with.

The Department has not issued such guidance. However, the National Institute for Health and Care Excellence published ‘Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care’ in July 2004. The guidance states that: “All people who have self-harmed should be assessed for risk”. It also sets out that that: “Following psychosocial assessment for people who have self-harmed, the decision about referral for further treatment and help should be based upon a comprehensive psychiatric, psychological and social assessment, including an assessment of risk, and should not be determined solely on the basis of having self-harmed”.

NHS England will do its best to facilitate patient choice. Most mental health care is provided by a multidisciplinary team made up of a number of members. The psychiatrist may be able to work jointly with a professional of another gender or through/via that professional in order to provide acceptable and appropriate care.

The provision of such choice must be placed in the context of the management of a specific patient. The capacity of the patient to make such a choice may need to be considered. If the patient is at high risk and is assessed to lack capacity to refuse appropriate treatment then it may be in their best interest to override that particular choice.

Patients, or parents of children, may refuse treatment on the grounds religious or moral beliefs. The General Medical Council states that where this happens, clinicians should discuss their concerns and look for treatment options that will accommodate their beliefs.

Patients must provide consent prior to receiving medical interventions. Under the Mental Capacity Act (2005), where a patient lacks capacity to consent, healthcare professionals can provide treatment if they believe it is in the person’s best interests. However, the clinicians must take reasonable steps to seek advice from the patient’s friends or relatives before making these decisions.

Under the Mental Health Act (1983), people with certain mental health conditions can be compulsorily detained and treated at a hospital or psychiatric clinic without their consent, if deemed necessary.

If the person lacks capacity, which is defined as the ability to understand information and use it to make a decision, and has not previously expressed their wishes, their mental health condition may be treated without consent, as may any related conditions, such as those resulting from self-harm.

In an emergency, clinicians can provide treatment that is immediately necessary to save life or prevent deterioration in health without consent.

With regard to patient choice in mental health, since 2014, patients have been able to exercise choice in mental health on a similar basis to physical health. Patients who are referred for a first outpatient appointment, have the right to choose the provider, and a team led by a named consultant or mental health professional. The guidance can be found on the NHS England website at:

http://www.england.nhs.uk/ourwork/qual-clin-lead/pe/bp/guidance/

More information about patient consent can be found on the NHS Choices website, at:

http://www.nhs.uk/Conditions/Consent-to-treatment/Pages/Capacity.aspx