⚠ TIME-CRITICAL — IMMEDIATE PHYSICAL THREAT TO LIFE ⚠
Source Note
This tool is built from NICE NG225 (self-harm) and the Mental Health Act 1983 s136 process (national statute + NHS England / RCEM guidance). It is not JRCALC-sourced and has no NWAS-specific pathway confirmation. Treat local disposition detail (HBPoS location, GM crisis line numbers, NWAS S136 SOP) as pending Greenroom verification.
Patient Context
Age band
Presentation type
Immediate Physical Threat Screen
Per NICE NG225: physical treatment of self-harm consequences is never conditional on psychosocial assessment or willingness to engage. Treat the physical threat first.
Time-critical — physical treatment takes priority
Manage per relevant JRCALC pathway (airway/haemorrhage/toxicology/trauma) before returning to this tool. Conveyance to ED is indicated regardless of MH presentation or capacity/willingness to engage with psychosocial assessment.
Capacity — Legal Note
The Mental Capacity Act 2005 does NOT apply to mental health treatment decisions. MCA capacity assessment is for decisions about physical treatment. A person's capacity to refuse physical care (e.g. wound treatment, wearing a c-collar) is assessed via the existing mca-assessment.html tool — use that tool if a physical treatment refusal is in play.
Distress, low mood, or a mental health diagnosis does not itself mean a person lacks capacity. Capacity is decision-specific and time-specific.
(R (Sessay) v South London and Maudsley NHS Foundation Trust — MCA cannot be used to detain/treat for a mental disorder; MHA is the correct framework.)
This Presentation
→ Complete MCA capacity assessment for the physical treatment decision separately, alongside this tool.
Mental State Examination
General clinical framework (not JRCALC-specific) — using MSE domains means the receiving clinician (AMHP, crisis team, liaison psychiatry) hears your assessment in the structure they're trained to listen for, rather than needing to decode ambulance narrative. Tap what applies, add detail in free text.
Risk Assessment
Structured gestalt, not a numeric score. Document what was actually assessed — omit anything not explored rather than guessing.
Method / means (if disclosed)
Protective factors present
Clinical narrative / gestalt
History
Previous self-harm / suicide attempt(s)
Known mental health diagnosis
Has a crisis / care / safety plan
Known to CMHT / crisis team / recent service contact
Current alcohol/substance use — factor in presentation
Recent significant life event / precipitant identified
Medications / substances taken (name, approx quantity, time)
Section 136 / Police Involvement
S136 — key pointsConveyance should be by ambulance on the principle that a health-based condition should have a health-based response; police accompany based on presenting risk. Patient remains in police custody until a Health-Based Place of Safety (HBPoS) accepts responsibility. Clinical judgement during conveyance is made by paramedic staff.
ED vs HBPoS — red flag principle
Where the person has a physical health need requiring emergency treatment (per red-flag criteria — e.g. significant overdose, ongoing injury, reduced GCS), convey to ED rather than HBPoS. HBPoS staff have a right of refusal if physical needs cannot be met on-site.
Local GM HBPoS site(s) and NWAS s136 SOP not confirmed — check Greenroom.
Officer(s) name/number recorded, accompanying to destination confirmed
s136 paperwork / detention time confirmed with police
Aware rights have been explained to patient (police responsibility)
Disposition
Per NICE NG225: where no urgent physical care is needed, discuss with the person whether an alternative service (crisis team, GP, community MH) is appropriate, weighing immediate safety concerns and actual availability/accessibility of that alternative right now.
Disposition reasoning
Safety net / safeguarding
Not left alone — trusted person present or arranged
Means restriction discussed (medications, ligatures, other access)
Crisis line / out-of-hours contact given
GP / CMHT informed or informing arranged
Dependent children/vulnerable adults in household considered — safeguarding referral if indicated
PRF Summary
Generated from assessment. Unassessed items omitted.
Documentation checklist
Capacity considered (physical treatment decisions only)
Risk assessment documented
Pertinent negatives documented
Verbal handover given to receiving clinician/HBPoS/police