Do we really need a duty consultant?

As much as I would like to agree with Riordan’s proposal that consultant psychiatrists provide only telephone advice rather than a conventional out-of-hours service (Psychiatric Bulletin, May 2005, 29, 193-194), I am afraid he does not take into account one of the core duties when on call. This involves carrying out assessments under the Mental Health Act 1983 for which there is no alternative than a face-to-face interview. In my experience most requests come from police stations for assessments of people who have been taken to the cells as a place of safety if they appear to be suffering from a psychiatric disorder or have been arrested for an offence. Recent British Medical Association guidance (BMA, 2004) emphasises the desirability of using alternatives to prosecution, such as admission to hospital, where detainees have a psychiatric disorder and it is not in the public interest to prosecute. Without a duty consultant available to make direct mental state examinations, these patients and other urgent cases in the community would be left suffering overnight which, depending upon their risk behaviours, could result in potentially disastrous outcomes.