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1.3 Case studies 21

The nature of mental health problems is such that patients are often disorganized
so may miss appointments, deliberately or accidentally lose prescriptions and med-
ication, forget instructions, and make unreasonable demands on medical staff. They
may drop in on clinics unexpectedly. In a minority of cases, they may be a danger to
themselves or to other people. They may regularly change address or may be home-
less on a long-term or short-term basis. Where patients are dangerous, they may need
to be ‘sectioned’—confined to a secure hospital for treatment and observation.
Users of the system include clinical staff such as doctors, nurses, and health visi-
tors (nurses who visit people at home to check on their treatment). Nonmedical users
include receptionists who make appointments, medical records staff who maintain
the records system, and administrative staff who generate reports.
The system is used to record information about patients (name, address, age, next
of kin, etc.), consultations (date, doctor seen, subjective impressions of the patient,
etc.), conditions, and treatments. Reports are generated at regular intervals for med-
ical staff and health authority managers. Typically, reports for medical staff focus on
information about individual patients whereas management reports are anonymized
and are concerned with conditions, costs of treatment, etc.
The key features of the system are:

1. Individual care management Clinicians can create records for patients, edit the
information in the system, view patient history, etc. The system supports data
summaries so that doctors who have not previously met a patient can quickly
learn about the key problems and treatments that have been prescribed.

2. Patient monitoring The system regularly monitors the records of patients that
are involved in treatment and issues warnings if possible problems are detected.
Therefore, if a patient has not seen a doctor for some time, a warning may be
issued. One of the most important elements of the monitoring system is to keep
track of patients who have been sectioned and to ensure that the legally required
checks are carried out at the right time.

3. Administrative reporting The system generates monthly management reports
showing the number of patients treated at each clinic, the number of patients
who have entered and left the care system, number of patients sectioned, the
drugs prescribed and their costs, etc.

Two different laws affect the system. These are laws on data protection that govern
the confidentiality of personal information and mental health laws that govern the com-
pulsory detention of patients deemed to be a danger to themselves or others. Mental
health is unique in this respect as it is the only medical speciality that can recommend
the detention of patients against their will. This is subject to very strict legislative safe-
guards. One of the aims of the MHC-PMS is to ensure that staff always act in accor-
dance with the law and that their decisions are recorded for judicial review if necessary.
As in all medical systems, privacy is a critical system requirement. It is essential that
patient information is confidential and is never disclosed to anyone apart from author-
ized medical staff and the patient themselves. The MHC-PMS is also a safety-critical