8(E). Rapid clinical and risk assessment on admission


When a person is admitted to hospital the process is often bureaucratic, unnerving and overwhelming for the person concerned, particularly where admissions are involuntary. Established institutional cultures may lead to the use of coercion early on admission with people initially being admitted to locked and/or highly staffed units with greater restrictions pending assessment. Front loading the assessment process with senior clinical involvement at an early stage should allow for a triage system upon admission. The intention of this is to prevent the need for restrictive or coercive practices. It also allows for the timely management and support of people presenting with high levels of behavioural disturbance, removing the requirement for implementing coercive measures in place of providing individualised support.

Front loading is already common in mental health care systems where inpatient beds are a precious and expensive resource.88 It has a beneficial effect for people admitted to institutions and lowers overall costs. It has the additional benefit of ensuring that treatment and support can be started quickly in order to minimise the length of admission. Whilst ensuring senior clinical involvement may require making changes to the overall staffing arrangements at hospitals, improved clinical outcomes, a focus on establishing community transition, and shorter admissions are likely to lead to a reduction in overall resources required.

88 Michael I. Harrison, Implementing Change in Health Systems: Market Reforms in the United Kingdom, Sweden, and the Netherlands, (UK: Sage, 2004).

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