NHS England/Improvement’s updated guidance on the impact of COVID-19 on the use of the Mental Health Act and supporting systems recognises that the requirements of social distancing and personal protective equipment during the pandemic introduces a number of barriers to MHA assessments.
The guidance dedicates an entire section to the implementation and application of technology when setting up assessments and supporting AMHPs and local authorities in ensuring assessments are carried out lawfully.
Note that virtual assessment provisions are specific for this period of crisis only and personal assessments should be returned to across the board as soon as possible.
So, when is a video assessment suitable?
The guidance clearly states that, even during the crisis, it is always preferable to carry out a MHA assessment in person. Decisions should be made on a case-by-case basis and clinicians must always consider the risks and benefits of undertaking a MHA assessment in person, compared to a video assessment, make an informed decision and document the decision.
The guidance recommends that the use of digital technology is well governed both clinically and at Trust board level.
Video assessment may be considered where:
- there is significant risk of harm via transmission to the person and/or staff. This will be the case if the person assessed is showing COVID symptoms, if PPE is unavailable or may cause significant distress to the person assessed and where social distancing measures are not possible at the assessment location;
- there is a significant risk of harm due to delaying assessment and/or subsequent intervention due to limited availability of staff, including staff who might be shielding or other inability of external staff members to access the assessment location; and
- the minimum quality standards and safeguards are met to ensure that a meaningful and high-quality assessment can occur in a safe environment.
Note that clinicians must always take account of the degree of the person’s presentation when deciding if a virtual assessment is appropriate.
Minimum standards of technology and environment
In order for a video assessment to be considered, there must be robust technology in place and a suitable environment that can enable a high-quality personal assessment to be conducted.
The minimum standard video assessment should ensure that body language and facial expressions of the person being assessed and staff can be accurately observed; that a consistent and uninterrupted connection is maintained; that a calm, professionally appropriate environment can be maintained and kept free from distractions, interruptions, or unnecessary people and that the technology used is secure and capable of maintaining patient confidentiality throughout.
Note that the assessment must not be recorded.
The guidance recommends that a joint decision with the person assessed should be made where possible. Staff should take into account the person’s views, ask whether they are familiar with using digital technology, support them in voicing any concerns and discuss the decision fully with the person assessed, their family or advocates and explain the process, reasons for the approach and instructions to them.
A further barrier which the guidance offers support on is the possibility of an assessment starting remotely but being unable to be completed due to the person’s behaviours. To mitigate for this, a contingency plan should be drafted in advance.
In any case, staff members conducting the assessment must be fully satisfied that the assessment has provided a satisfactory basis before giving a medical opinion under section 12 of the MHA. The medical judgment should consider whether the circumstances of the video assessment itself affected the responses given or the person’s engagement with the process.
The guidance sets out specific considerations by setting for:
- Place of safety
- Mental health hospital
- Acute hospital
- Police station
- Prisons and immigration removal centres
Finally, a helpful checklist can be found at Annex E with regard to the use of technology.