Dr. Aideen Brides:

As the Senator and Professor Sadlier noted, this happens at a moment of crisis. It is an extremely fraught scenario when somebody requires an involuntary admission. It usually starts with a phone call from a family member. Thankfully, as a GP, we will often know the patient and the family and we might even know the scenario is coming. To think we would have to delay the process to allow another person to become involved is beyond comprehension.

I might give two examples. I have a patient, a lady in her 50s, who manages to hold down a job for two years at a time while attending psychiatry services. She might then stop attending and taking her medication, and it is often somebody she works with or a family member who will call us and say she is starting to slip. She will isolate herself in her house and become extremely paranoid. Thanks to the family member contacting us in a timely manner, we can get her to hospital for a period. She is usually in hospital for only a few days but it is enough to get her well. This involves a degree of communication and negotiation, as was mentioned. The encounter can sometimes be turned into an opportunity to encourage the patient to be admitted on a voluntary basis. If, however, we have to sit there in a stressful environment and wait for somebody else to arrive, that just will not happen.

In another case, I was working in psychiatry as a senior house officer as part of my GP training. There was a case where somebody in their early 20s was on the other side of a bedroom door, in possession of several knives. We did our best to encourage them and coax them out of the room, hoping they would not harm themselves, but we could not know what was going on behind the door. As soon as we got the chance to encourage the person to come out so we could get them to a place of safety, we took the opportunity. I have heard of GP colleagues travelling in cars to hospital with patients who need involuntary admission. I heard of one such example where the person travelled with a shotgun on their knees. We do what we need to in these circumstances to get the patient to a place where he or she will be safe. If it involves more legislation and designated officers who may not be available for 24 or 48 hours, that will not be in the patient's best interest.