Acute behavioural disturbance: DipIMC practice questions

PHEM curriculum unit 2.12 · Theme 2: Providing Pre-hospital Emergency Medical Care

The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 2.12, Manage acute behavioural disturbance in the pre-hospital environment.

Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 6 questions on this unit.

Question 1 · Law, Ethics & Human Factors · Moderate

An ambulance crew and police attend a 40-year-old woman on a railway station platform who is distressed, talking about ending her life and refusing to move away from the platform edge. She has no physical injury. The police officer asks the paramedic about the legal position. Which statement about section 136 of the Mental Health Act 1983, as amended, is correct?

AA paramedic, as well as a police constable, may use it once a mental disorder is suspected
BA constable may use it anywhere, including her own home, if he thinks it necessary
CShe may be held at a place of safety for up to 72 hours from the time she arrives
DA police station is her default place of safety unless a hospital bed is free
EA constable may remove her from anywhere but a dwelling; the permitted detention is 24 hours

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Answer: E

A constable may remove her from anywhere but a dwelling; the permitted detention is 24 hours

Section 136(1) gives the power to a constable: where a person appears to a constable to be suffering from mental disorder and to be in immediate need of care or control, the constable may remove them to a place of safety, or keep them at one, if necessary in their interests or for the protection of others. The power belongs to constables alone, not paramedics. Section 136(1A) lets it be used in any place other than a house, flat or room where the person or anyone else is living, so a station platform qualifies but her home does not (entry to a home needs a section 135 warrant). Section 136(1C) requires the constable, where practicable, to consult a registered medical practitioner, registered nurse, approved mental health professional or other specified person first. Section 136(2A) limits the permitted period of detention to 24 hours. Section 136A prohibits a police station as a place of safety for a child and allows one for an adult only in circumstances set out in regulations, so it is not a default. The Oxford Handbook's account (a 'public place' and a maximum of 72 hours) reflects the law before the Policing and Crime Act 2017 amendments and is out of date.

Where this comes from

Mental Health Act 1983, section 136s136(1) the power“appears to a constable to be suffering from mental disorder”Open at this section
Mental Health Act 1983, section 136s136(1A)(a) not a dwelling“any house, flat or room where that person, or any other person, is living”Open at this section
Mental Health Act 1983, section 136s136(1C) duty to consult“the constable must, if it is practicable to do so, consult”Open at this section
Mental Health Act 1983, section 136s136(2A)(a) the permitted period of detention“the period of 24 hours beginning with”Open at this section
Mental Health Act 1983, section 136As136A(1) children“A child may not, in the exercise of a power”Open at this section
Mental Health Act 1983, section 136As136A(2)(a) adults only in specified circumstances“only in circumstances specified in the regulations”Open at this section
Oxford Handbook of Pre-Hospital Care
- Ch. 7 Acute psychiatric emergencies · Section 136: removal from a public place · p. 471“a formal psychiatric assessment must be carried out within a maximum of 72 hours”
- Ch. 7 Acute psychiatric emergencies · Section 135: removal to a place of safety · pp. 470–471“Section 135 allows access into the patient’s home.”

law-096 · Law, Ethics & Human Factors · Law & Ethics · Moderate · v2

Question 2 · Law, Ethics & Human Factors · Easy

A 35-year-old man with a known diagnosis of schizophrenia has a 6 cm scalp laceration after a fall. He is shouting, pacing and refuses to be conveyed to hospital. A student paramedic says he obviously lacks capacity because of his diagnosis and the way he is behaving. Under the Mental Capacity Act 2005, which statement is correct?

AHis diagnosis of schizophrenia is by itself enough to establish that he lacks capacity
BHis agitated behaviour allows capacity to be presumed absent without an assessment
CHe must be assumed to have capacity; his diagnosis or behaviour alone cannot rebut this
DRefusing care for his scalp wound is an unwise decision, and it shows that he lacks capacity
EOnly a psychiatrist or approved mental health professional may assess his capacity

Show answer

Answer: C

He must be assumed to have capacity; his diagnosis or behaviour alone cannot rebut this

Section 1 of the Mental Capacity Act 2005 says a person must be assumed to have capacity unless it is established that he lacks it, and is not to be treated as unable to make a decision merely because he makes an unwise decision. Section 2(3) says a lack of capacity cannot be established merely by reference to a person's age or appearance, or a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions. So neither the diagnosis nor the agitation settles the question. Capacity is decision-specific: under section 2(1) the question is whether, at the material time, an impairment of, or a disturbance in the functioning of, the mind or brain makes him unable to make this decision, and section 3 supplies the functional test — understand, retain, use or weigh the relevant information, and communicate the decision. Nothing in these sections reserves the assessment to a psychiatrist or approved mental health professional (AMHP). The Oxford Handbook adds that a competent refusal must be respected and recorded. Agitation and a psychiatric diagnosis are reasons to assess carefully and exclude physical causes, not a finding of incapacity.

Where this comes from

Mental Capacity Act 2005, section 1s1(2) presumption of capacity“A person must be assumed to have capacity unless it is established”Open at this section
Mental Capacity Act 2005, section 1s1(4) unwise decisions“merely because he makes an unwise decision”Open at this section
Mental Capacity Act 2005, section 2s2(3)(b) condition or aspect of behaviour“a condition of his, or an aspect of his behaviour”Open at this section
Mental Capacity Act 2005, section 2s2(1) impairment or disturbance of the mind or brain“an impairment of, or a disturbance in the functioning of, the mind or brain”Open at this section
Mental Capacity Act 2005, section 3s3(1) the functional test“a person is unable to make a decision for himself if he is unable”Open at this section
Oxford Handbook of Pre-Hospital Carepp. 30–31Ch. 1 An approach to pre-hospital care · The law and pre-hospital care: consent and capacity“The patient’s decision should be respected and recorded.”

law-097 · Law, Ethics & Human Factors · Law & Ethics · Easy · v3

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Acute behavioural disturbance: DipIMC practice questions

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