The NHS publish figures each year about the use of the Mental Health Act 1983. Apart from sounding the standard warnings about official statistics, they are worthy of further analysis as they suggest a rise in the use of s136 Mental Health Act of around 135% over the last six years. This blog post arises from a query and a blog post by social work lecturer Dr Martin Webber from the Institute of Psychiatry. (For those on Twitter, Martin is well worth a follow for a range of social work / mental health tweets from an academic point of view and someone with practice experience.)
The NHS reports that in 2006/7 there were 6004 detentions and that in 2010/11 there were 14,111.
So let’s start here >>> I know that these figures are ridiculously way off. I have personally counted s136 detentions in my own force for every calendar and financial year since 2004. These numbers for West Midlands Police were publicly released several times because of Freedom of Information requests – that was originally the reason I had to go and count them. West Midlands Police have historically detained between 950 and 1050 people per year for the whole period since 2004. It cannot be the case that one force alone accounts for 15% of national use. When you remember that Greater Manchester Police use the power to broadly the same extent (similar sized forces and populations) and that the Metropolitan Police detain around one-quarter of all s136, you start to release these numbers are way out. So there’s the first problem with offical data.
We know that the Independent Police Complaints Commission did research published in 2008, using data gathered during 2005/06. They found that of 18,500 detentions that they could establish, around 11,500 were detentions in police cells.
You should read Martin’s post for yourself not least because he links to proper research which is highly welcome given the anecdote I’m putting out on this policeman’s blog: he examines possible reasons behind a believed rise in the reported use of s136 Mental Health Act. I think there is every reason to believe that we are counting the numbers more accurately and that there has been a rise. I recently heard a senior officer explaining that there are around 25,000 detentions per year! We clearly need to know more about this, but s136 MHA is one of the few parts of the MHA that does not, by law need to be recorded. It is also true that the Care Quality Commission, whilst commenting on s136, do not drive the accuracy of the data requirement. I suspect strongly, that the numbers gathered within the NHS report reflect health data, or predominately health data. I know from work done whilst working for ACPO on MH that when one properly understands the s136 demands that are being generated for police custody alone, it is the majority of the demand in most areas.
Martin’s perfectly sensible explanations, in summary, include:
- Increased mental health awareness and training of police officers – better identification of MH problems leading to greater use of the power.
- Better recording systems – in the NHS and in the police and jointly.
- Corresponding decline in the number of available psychiatric beds over the same period – and presumably, of shorter periods of detention as an inpatient because we know that average length of stay has declined.
To this, I would add:
- The introduction of Supervised Community Treatment - we know that some patients who would previously have remained detained in hospital now can be released because there is the potential for a legal mechanism to recall them without waiting for another “crisis – admission – release – relapse” cycle. We know that some of those have been detained by the police under s136.
- The battle against exclusion criteria is being won, slowly but surely – many PoS providers are being obliged to acknowledge that previous reasons for excluding service users from assessment are not valid, often because they are not safe. This is linking, in my view, to altered police behaviour around the use of s136.
I would like to make one point about disposal from s136 detention. What happened to those detained. Martin cites articles examining disposal pathways and notes that most people who are detained s136 are not subsequently admitted to hospital. I once found this fact thrown at me as a reason to suggest that West Midlands Police needed to “sort itself out” regarding the way that the power was used because ‘only’ 40% of people detained in one of our boroughs were admitted as inpatients – to be honest, I’ve never known of ANY area where most s136 detentions lead to admission. That 60% of people in that borough were not admitted at all was evidence, apparently, of misuse of the power.
I asked the question, “How many of that 60% were signposted to their GP, the Community Mental Heath Team or another healthcare professional?” It turns out that the answer was “Two thirds” but it took a fair bit of getting that out of them. In other words, of those detained s136: 40% were admitted to hospital; 40% were referred to a healthcare professional and 20% were released without further action.
So four out of five people had an unmet healthcare need.
So there is much to do on s136, not least around achieving accurate recording procedures which consistently combine police custody and health service data. We also then need a realisation that if you record the demand correctly, you can design a system and a service to meet that demand. Currently, we’ve got no idea what is going on because we know that the data and the activity is insufficiently understood. But for this remark at the end of his post, I could quite happily track down Martin Webber and hug him: “Mental health services should either accept police officers in their ranks as allied mental health professionals and provide them with full support and training, or provide mental health crisis services which genuinely meet the needs of their local population.”
Something about “Street Corner Psychiatry”? – Hear, hear!