Anecdotal evidence suggests that considerable difficulties are experienced in rural areas by isolated general practitioners, when detaining patients under the Mental Health (Scotland) Act1984. The aim of this study was to identify the range and extent of these difficulties in a structured way, and to identify ways of responding to them. A postal questionnaire was sent to 85 general practitioners in a sparsely populated area of Scotland to assess their experience of emergency detention.
The questionnaire response rate was 62%. Considerable difficulties were recorded from those who responded, notably their lack of support with clinical management during the delay between the patient's detention and the arrival of psychiatric staff, the lack of satisfactory places of safety for the patient during this period, and the difficult logistics of safe and satisfactory transport to hospital.
Rural general practitioners and their patients appear to be disadvantaged through lack of coordinated help in the management of inherently difficult and risky clinical situations. Even without additional resources, the process could be improved through coordinated, multi-agency action plans which take account of local conditions.