“Look here”, one of our ambulance officers said to me after I'd been wrestling with a confused patient, “next time, just let them go, don't try and restrain them – if they want to wander off and die it's not your fault”.
I nodded, “OK, I'll be sure to tell the coroner that…”.
The call was sent down to us as “Woman threatening to jump from a window”. As I'm getting past the age of talking people down from tall heights I checked that the police were also being sent to the call.
Unusually we got there before the police, and as the location was distinctly absent of anyone standing in a window, we approached the house.
We were met by an on-call GP and the mother of the patient, the GP explained that our patient was suicidal and kept threatening to take overdoses or jump from a high place, consequently he wanted us to take her into the local hospital for a psychiatric assessment.
What was unusual was that the doctor was still on scene, normally the closest we get to see of them is the rear lights of their car disappearing once they see us arrive – I often wonder if they are scared of us…
Our patient was upset, but agreed to come to the hospital, her mother would also be coming with us. As everything seemed to be calm we cancelled the police from attending.
It was all going fine until our patient suddenly decided that leaping from our moving ambulance into fast night-time traffic would be a good idea.
Needless to say, I disagreed.
So, once more, I found myself wrestling with a patient in the back of the ambulance – she wanted to run away and kill herself, I considered that she didn't have the capacity to refuse psychiatric assessment and so there was a bit of a struggle in the back of the ambulance while my crewmate called for urgent police assistance.
I'm sure that if Liberty or Amnesty International looked at my actions in a court of law I could have been prosecuted for kidnapping, but I sincerely believe that an upset suicidal patient shouldn't be allowed to kill themselves on what seems like spur of the moment decision (even though they may have been thinking about it for a long time).
Importantly I couldn't see any coroner or family member accepting any account of me not trying to stop someone from killing themselves.
I like to think that I'm fairly knowledgeable about Capacity and Consent, and while it might be argued that what I did in keeping her in the ambulance was outside the limits of the law, it was definitely within the limits of human decency.
Besides, there wasn't time to do a formal Capacity assessment when your patient wants to dance in traffic.
The police arrived and were superb in helping me transport her to hospital – they were the police who'd been running to assist us in the first place when we'd cancelled their attendance.
We soon reached the hospital with only a few more struggles, and the duty psychiatrist saw her straight away.
I ended up with sore wrists, that were eased somewhat by an icepack – but I could soon ignore them for the crack on the head that I got from the collision we had on the way to our next job.
I've never been too good at listening to our officers…
Any comments from mental health professionals on how to act when a patient who may or may not have capacity suddenly wants to kill themselves in front of you would be gratefully received. Sometimes, when looking at nursing literature, I think that the accepted thing to do would be to hand the patient a razor blade as a part of 'fulfilling their self-directed life goals'.
It's why I don't read nursing literature anymore.