Guidance note 1 - The management of students experiencing acute mental health emergencies

• The mental health and wellbeing policy of the University of St Andrews
• Guidance notes
• What constitutes a "mental health emergency"?
• The University has a duty of care for all members of its community
• GPs and health officials carry the ultimate responsibility
• Duty of confidentiality
• Responsibilities of members of staff and of students
• Responsibilities of Wardennial Staff providing Out-of-Hours (OOH) support in halls of residence
• Within 24 hours of the incident
• In summary

1. The mental health and wellbeing policy of the University of St Andrews

The University has developed and adopted a Mental Health and Wellbeing Policy (2003) which is based on the recognition that its staff and students should feel supported in their work and study.

2. Guidance notes

Accompanying the Policy are sets of Guidance notes offering practical guidance to all students and staff. These Guidance notes offer advice for staff handling referrals of students experiencing acute mental health emergencies.

3. What constitutes a "mental health emergency"?

For the purposes of this document, mental health emergencies may consist of any of the following:

• The person is considered to be an immediate danger to themselves.
• The person is considered to be an immediate danger to others.
• The person is exhibiting extreme distress.
• The person is neglecting their own health (e.g. neglecting medication, self care or failing to eat adequately) such that they are likely to trigger a crisis.

4. The University has a duty to care for all members of its community

The needs of all members of the University community who develop acute mental health difficulties have to be balanced with the need to protect the safety and ability to work of their friends and classmates. The University aims to ensure that all its members of staff including Hall staff and Personal Tutors, are not required to provide support to individuals in distress from a mental health emergency which they are not trained to give.

5. GPs and health officials carry the ultimate responsibility

It is the responsibility of the GP with whom the student is registered to provide professional support and care in incidents of mental health emergency. Staff and students in the University will support medical practitioners in whatever ways they can, but laypersons cannot be expected to replace the professional care and support that are the responsibility of the National Health Service. The purpose of these guidance notes is to define the various responsibilities of all those members of the university community who might come into contact with students who are suspected to be suffering from a mental health emergency and whose behaviour gives reasonable grounds for concern.

6. Duty of confidentiality

Everyone involved with the management of cases of mental health emergency must respect the rights of all individuals under the terms of the Data Protection Act 1998. Whilst you should certainly try to limit the information you reveal to external sources in order to protect the student's confidentiality, it is entirely appropriate to inform the services of any information which may be relevant to their evaluation of the situation.

N.B. Confidentiality is held within the institution as a whole. Therefore, although it is doubtful that you should share information with anyone external to the university, nevertheless you will have a duty to pass on information to the relevant contacts within the university considering the duty of care carried for students within our community. If there is a conflict - Duty of Care takes precedence over Confidentiality.

If a student's behaviour gives you cause for concern, do not worry about whether you are qualified to decide whether or not they have a mental health condition: your concern is sufficient cause, so contact the appropriate services, listed below, for advice. Once again, where there are serious concerns about the individual's mental or physical health or for the safety of others exposed to serious risks from that person, the duty of care takes precedence.

In short - tell your line manager within the institution if you think anyone is at risk.

Responsibilities of members of staff and of students

1. Contact 2720

Those encountering students showing symptoms of an acute mental health emergency (i.e. they are an immediate danger to themselves or others) should contact Student Services (46) 2720. This number operates during normal office hours. If the incident is to be reported outside of these hours, contact should be made with the University Out of Hours Service (OOH Service) by calling 01334 476161. An Out of Hours Janitor will offer advice on what course of action to take. They will also contact the Director of Student Support (Chris Lusk). The Director, or the Assistants in her absence, will attempt to discover the identity of the GP of the person in distress and will report the concerns to the GP. The doctor will be responsible for deciding appropriate medical care e.g. hospitalisation, arrangements for personal care, etc.

2. Have ready the following information

Callers should give

• Their own name and contact number.
• The name of the individual.
• Current location with a clear description of how to get there.
• A clear description of the nature of the behaviour that is giving cause for concern.

3. Department involved

Student Services will ensure that a member of staff attends the incident as soon as possible.

4. Remember personal safety

If the caller feels that his or her own safety, or that of other people, is being endangered by the distressed person's behaviour, then the caller should contact the local police station (Tel. No. 418900 or phone 999). Other people should be encouraged to leave the area if at all possible, and new people should be discouraged from entering the area. The caller should try to position him or herself so that they are nearer to the door than is the person in distress and so that they can both be seen by people outside the immediate area.

Responsibilities of Wardennial Staff providing Out-of-Hours support in halls of residence

1. Members of Wardennial teams to work in twos

If a member of the Wardenal team comes into contact with a student who appears to be showing symptoms of an acute mental health emergency (i.e. they are an immediate danger to themselves), then another member of the Wardennial team must be contacted: no member of the Wardenal team should try to deal with the situation without assistance. Contact should also be made with the actual Warden responsible for that Hall.

2. Achieve a calm atmosphere and remember personal safety

Other people should be encouraged to leave the area if at all possible, and new people should be discouraged from entering the area. The member of the wardennial team should seek to remain closer to the door that the student and should try to remain clearly visible to people outside the immediate area. Where other residents are involved, another member of the Wardennial Team should take them to a quiet area where they can be interviewed in confidence and record any relevant information about the situation / incident.

3. Call OOH for advice

The member of the wardennial team summoned to assist should contact the Out of Hours (OOH) Service (01334 476161) to report their concerns. The OOH Janitor will contact Student Services who will co-ordinate the GP referral and liaison with the Health Centre allowing the member of the wardennial team to focus on supporting the person in distress.

4. Have ready the following information

The following information should be given to the OOH Service.

• The caller's name and contact number.
• The name of the person in distress.
• Current location and a clear description of how to get there.
• A clear description of the nature of the behaviour that is giving cause for concern.

The OOH Service Advisor will be responsible for contacting the Director of Student Services or her Depute.

5. If it is urgent, remember the police

If it is felt that the behaviour of the distressed student is endangering the safety of other people then the police should be contact the police 01334 418900 or 999.

Within 24 hours of the incident

1. Make a record

The member reporting the incident should provide the Director of Student Services with a detailed and factual record of events as far as they can remember (avoiding any speculation about diagnoses or possible precipitants of the behaviour).

2. Co-ordination of information

The Director of Student Services will inform such other members of staff as may require to know, including if appropriate the Public Relations Office, subject to the University's Code of Practice on Confidentiality.

3. Co-ordination of ongoing support

The Director of Student Services (or her delegated team member) shall co-ordinate the flow of information concerning the person in distress and the progress of the case shall be reviewed weekly.

4. Maintaining confidentiality

Any enquiries concerning the person in distress from friends or family should be directed to the Student Services.

5. Press enquiries

Any enquiries concerning the person in distress from the media should be directed to the Public Relations Office.

In summary