Who takes the decision?
Any physician is able to take this decision; it
need not be a specialist in either emergency medicine
or psychiatry. Suspicion based on duly established
clinical criteria (such as risk of suicide at-tempt, loss of impulse control, manifest aggressiveness,
history etc.) is sufficient for forcible transfer
and admission. The functions of the physician
in these situations are: – To issue a provisional
diagnosis of psychiatric or mental disorder, the
only cause considered here. – To determine that
the characteristics of the situation correspond to
an emergency. – To decide whether to use physical
restraint, and chemical sedation which the
physician will prescribe. – To write the required
report.
– To give instructions, to both healthcare staff
and law enforcement officers or others involved.
– To decide on involuntary transfer and emergency
internment, to be confirmed by a psychiatrist
or the duty physician of a reference hospital.
– To decide on the most appropriate manner of
transporting the patient: with a family physician
or members, type of ambulance or even a mobile
ICU. It is categorically not recommended to transfer
such patients with others. It should not be forgotten
that this is an involuntary emergency
transfer to a reference hospital (or psychiatric centre).
– To care for the patient, monitoring vital
signs, especially if heavily sedated – To indicate
whether law enforcement officers should or
should not escort the ambulance, or accompany
the patient if there is a risk of violent behaviour or
escape, since the physician is also bound to “help
and protect the people involved and ensure the
conservation of material at risk”.
If the intervention takes place within a municipality,
the Municipal Police will be called in; if the
destination or the intervention is outside the municipal
boundaries, other supra-municipal forces
will be required (the Civil Guard, National or Autonomous
Police forces). – To report to the duty
judge within 24 hours, for subsequent custody
and control over the freedom of the patient. The
judge may solicit the relevant reports from the
admission centre and the forensic physician as to
the state and evolution of the patient, and will
decide within 72 hours, not about patient discharge,
but whether the patient is unnecessarily deprived
of his freedom because of the internment; for
this the judge will solicit all the relevant reports
(psychiatric, forensic, social services etc). Patient
discharge corresponds to the physician responsible
for treatment, and such discharge must be
made known to the judge.