Involuntary admissions under the Mental Health Act 2007 (New South Wales): A comparison of patients detained by ambulance officers, medical practitioners and accredited persons in an emergency department


  • Dawn Cutler, MBChB, Registrar; Mechelle Smith, MBBS, FACEM, Staff Specialist; Timothy Wand, RN, NP, DAS (Nurs), MN (Hons), PhD, Nurse Practitioner, Mental Health Liaison; Timothy Green, MBBS, FACEM, Director; Michael Dinh, MBBS, FACEM, Staff Specialist; Robert Gribble, MBBS, FRANZP, Head of Consultation–Liaison Psychiatry.



The Mental Health Act (MHA) 2007 (New South Wales [NSW]) is used to transport to, detain and treat individuals in a mental health facility. Patients are frequently taken to EDs under the MHA or detained in the ED for a mental health assessment. In NSW, medical practitioners, accredited persons, police and more recently ambulance officers, are authorised to write certificates under the MHA. There is an absence of research on the use of the MHA in NSW EDs. The primary research question for this study was: ‘What is the involuntary admission rate for persons detained under the MHA in an NSW tertiary referral ED?’


After gaining ethics approval, the research team prospectively collected the MHA certificates written for patients in the ED over a 3 month period from February to May 2011. The research team reviewed the MHA certificate and medical records to characterise demographics, outcome, length of stay in ED and certificate suitability. Outcomes of interest were involuntary psychiatric admission or any inpatient admission, and were compared between the different professional groups completing the certificate.


The involuntary admission rate for patients certified by ambulance officers under the NSW MHA was 27%, compared with a 60% involuntary admission rate when certified by medical practitioners or accredited persons. The mean average length of stay in the ED for patients certified under the MHA was 10 h. Seventy-five per cent of patients presented out of hours.


Ambulance officer certification was a poor predictor of involuntary psychiatric admission in the Royal Prince Alfred Hospital Emergency Department. ED physicians should have the authority to revoke the certificate if, following assessment and treatment, the patient no longer fulfils criteria for detention under the MHA.