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Mental Health Crisis and Risk of Self-Neglect
Amina’s refusal to eat, poor sleep, social withdrawal, and declining academic performance suggest a significant mental health deterioration. These are common signs of self-neglect, which is recognised under Section 42 of the Care Act 2014 as a safeguarding concern for adults (Department of Health and Social Care, 2014). She may not be able to meet her basic needs without intervention.

Vulnerability Due to Psychosis and Paranoia
Amina’s belief that cameras have been installed in her room and that lecturers are controlling her thoughts through the internet indicates paranoid delusions, increasing her vulnerability to harm or exploitation. Psychosis can impair judgement and insight, reducing her ability to keep herself safe (NHS England, 2023).

Risk of Harm to Self and Others
The disorganised speech, paranoia, and mistrust of professionals suggest a risk of self-harm or accidental harm, which can be common in acute psychotic episodes (NICE, 2014). Amina’s distress and lack of insight into her condition increase this risk.

Limited Support and Social Isolation
Living in student accommodation and being far from her family could mean limited access to emotional or practical support. Social isolation is a safeguarding risk factor for adults with mental health conditions (Social Care Institute for Excellence, 2022).

Potential for Discrimination and Stigma
As a Black British woman experiencing mental illness, Amina may face additional barriers due to racial disparities in mental health treatment. Evidence shows Black individuals are disproportionately subject to coercive practices such as detention under the Mental Health Act (Mind, 2023). This raises safeguarding concerns about equitable and culturally competent care.

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NICE (2023) Psychosis and schizophrenia in adults: recognition and management. NG222. Available at: https://www.nice.org.uk/guidance/ng222Department of Health and Social Care (2014) Care and Support Statutory Guidance: Issued under the Care Act 2014. [Online] Available at: https://www.gov.uk/government/publications/care-act-statutory-guidance [Accessed 25 June 2025].

Mind (2023) Mental Health and Race. [Online] Available at: https://www.mind.org.uk/about-us/our-policy-work/equality-and-human-rights/mental-health-and-race/ [Accessed 25 June 2025].

NHS England (2023) Psychosis: Early Intervention Services. [Online] Available at: https://www.england.nhs.uk/mental-health/adults/early-intervention-in-psychosis/ [Accessed 25 June 2025].

NICE (2014) Psychosis and Schizophrenia in Adults: Prevention and Management (CG178). [Online] Available at: https://www.nice.org.uk/guidance/cg178 [Accessed 25 June 2025].

Social Care Institute for Excellence (SCIE) (2022) Adult Safeguarding: Types and Indicators of Abuse. [Online] Available at: https://www.scie.org.uk/safeguarding/adults/introduction/types-and-indicators-of-abuse [Accessed 25 June 2025].Royal College of General Practitioners (RCGP) (2023) Mental health care in general practice. Available at: https://www.rcgp.org.uk

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NICE Guidelines: Psychosis and Schizophrenia in Adults (NG222, 2014, updated 2023)

Key points:

Early detection and intervention are crucial.

Refer immediately to a specialist Early Intervention in Psychosis (EIP) service if psychosis is suspected — do not delay for diagnosis confirmation.

Assess for:

Presence of positive symptoms (hallucinations, delusions)

Risk to self/others

Substance misuse

Physical health needs

Offer antipsychotic medication and psychological therapies (CBTp and family intervention) after full assessment.

Involve the patient in decision-making and support shared care planning.

Referral Pathways (UK, NHS-based)

1.

Immediate (Same-day) Referral to EIP Team

For anyone aged 14–65 experiencing suspected first-episode psychosis.

Referral can be made by:

University health centre GP or nurse

CMHT (Community Mental Health Team) if already involved

A&E or crisis service (if risk is high)

EIP Services provide:

Rapid assessment (within 2 weeks of referral)

Multidisciplinary care (psychiatry, psychology, OT, family support)

Early treatment to reduce long-term impact

2.

Urgent Mental Health Crisis Referral

If Amina is:

At risk of harm to self or others

Lacks capacity to consent to treatment

Refusing food or medication due to delusions

Then:

Contact the local Crisis Resolution and Home Treatment Team (CRHTT)

Consider a Mental Health Act (MHA) assessment

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Mental State Examination (MSE)

Purpose: A structured clinical tool to assess Amina’s current psychological functioning, including her appearance, behaviour, mood, thought processes, perception, cognition, and insight.

Justification:

Essential in identifying psychotic features such as paranoia, delusions, and thought disorganisation (Royal College of Psychiatrists, 2021).

Standard tool used in primary care and mental health settings, including university clinics, to inform risk and care planning.

PHQ-9 (Patient Health Questionnaire-9)

Purpose: Screens for depression, a common co-occurring condition with psychosis, especially in the early stages.

Widely used in UK university counselling and GP services.

Helps assess Amina’s emotional state, especially given her insomnia, withdrawal, and distress

GAD-7 (Generalised Anxiety Disorder Assessment)

Purpose: Screens for anxiety symptoms, which may coexist with psychosis or contribute to paranoia.

Approved for use in NHS primary care and university mental health triage.

Useful for identifying whether Amina's fears are rooted in anxiety or delusional beliefs.

Early Intervention in Psychosis (EIP) Screening Tool

Purpose: Used to determine whether a person is experiencing first-episode psychosis, and whether they meet the referral criteria for EIP services.

Recommended by NICE (2023) for people aged 14–65 showing symptoms like delusions, paranoia, or hallucinations.

University health centres can use it to refer directly to EIP teams via local NHS Mental Health Trusts.