Reference HampsonHampson (2011) placed little emphasis on the initial physical assessment of detained patients. Peer-group feedback for on-call Section 12 doctors involved in these assessments in the West Midlands indicates a significant shift towards the senior psychiatrist in the responsibility for basic physical health assessment. One example was an individual with a fractured skull – identified by the assessing senior psychiatrist. The role of the psychiatric trainee in the assessment process remains uncertain. As Hampson states, it seems that very few patients are transported by ambulance. This misses an early opportunity for medical screening by paramedics and diversion to acute medical or surgical units where appropriate. Thus, the senior psychiatrist may well now be the first medically trained individual to screen patients for potentially serious non-psychiatric medical conditions resulting in behavioural disturbance. Sadly, it is recognised that senior psychiatrists may not be rehearsed in acute physical assessment (Reference GardenGarden 2005). Also, the facilities and equipment allowing appropriate examination can often be limited.

Although it must be celebrated that reform and progress have occurred in the move away from the routine use of police custody suites in assessing mentally disordered individuals, the practical effect on physical health assessment of these individuals has been the loss of screening by a forensic physician. As Hampson points out, these professionals may not routinely be Section 12 approved but it remains the case that they can be more able at recognising non-psychiatric (in some instances, life-threatening) conditions (Reference Grace and ChristensenGrace 2010). With the development of Section 136 assessment suites, a broader training impetus should be placed on physical health assessment skills for medical and nursing staff working in them. Thus, while progress is to be embraced, it may be time for senior psychiatrists to dust off the stethoscope and revisit acute physical assessment skills. In a complex multiagency situation, we should also show leadership in insisting that the patients’ physical healthcare takes primacy and that the standards of this are appropriately monitored.