I’ve got a feeling I’ve written about this before, several times … but never in one post. It has become necessary because of various things written over the last few weeks about s136 MHA and purported rises in its use. I wrote recently about a 135% reported rise in the use of s136 MHA, reported in official NHS figures.
Dr Martin Webber started the debate off, I responded to add support and some more perspective to his sensible questioning of the figures and his views about why they may have come about. Since then, I’ve been reading various comments about that debate. The latest came to my attention just now and it includes another remark about the “low number” of people who are detained under s136 MHA and then admitted to hospital as a result.
Let me be totally clear: whether or not someone is admitted to a psychiatric hospital following detention by the police under s136 is not the only relevant indicator of whether the s136 authority was used “appropriately” in the first place.
Here are just a few scenarios:
- Person arrested s136 and sectioned under the MHA or admitted to hospital informally – can we all agree that this suggests the police were correct to use s136 in the first place?
- Person arrested s136 and assessed and then referred to or re-referred to a community mental health team. This could either be their CMHT, a Home Treatment Team or Assertive Outreach, depending on the circumstances and the patient and previous contact with the NHS – can we all agree that if the officers felt compelled to detain immediately to mitigate a risk to others OR to ensure that persons best interests, this suggests appropriate use of s136?
- Person arrested s136 after acting in a way which was consistent with a lay person’s perception of behaviour that could be attributable to mental disorder and after assessment is referred to a health care professional. This could include their GP for lower level mental disorders or to other kinds of healthcare professional … for example it is not rare to hear of patients with epilepsy or diabetes being detained s136 and then the nature of the health problems leading to a non-mental illness orientated health referral. Can we agree, that if the officers were acting in good faith in thinking a person was suffering mental disorder from their behaviour and presentation at the point of detention, that this was appropriate use of s136 because the legal criteria for detention were met?
My favourite story ever, was the undiagnosed diabetic in Dudley who would have died had officers not detained him s136. Had they left him as a slightly vague sounding guy having a pint in the sun, he would have collapsed there some while later. As it happened, because he was “inappropriately” detained because of his diabetes, he collapsed into the arms of paramedics who had been called to the s136 detention and then rushed to A&E where his life was saved, according to the A&E consultant who treated him. Ask those officers about his presentation that influenced their detention decision and they are describing things that many people argue are potential indicators of mental disorder.
So when would detention NOT be appropriate?
Well, if detention were illegal in the first place, it would be inappropriate. I’ve written before about mental disorder and emergencies in private premises. Where officers manufactured the presence of someone outside their private dwelling so that they could be detained under s136, it would be illegal and inappropriate.
What else? – well, officers detaining individuals where they did NOT have a reasonable belief that the person concerned was, in fact, suffering from a mental disorder. I’ve heard healthcare professionals and AMHPs representing that officers have locked up drunk in the High Street for bizarre behaviour where it is far more likely that alcohol is the source of their unusual conduct or presentation
What of these figures about admission, then?
I’ve read in the articles linked above, that “as few as 25%” of people detained were admitted. Am I being too protective if I assume that the other 75% are implied to have been inappropriately detained because they were not admitted? What I want to know, is how many of those 75% were both of the following:
- Detained by the officer knowing that the detention was illegal or not really necessary.
- Detained by the officer whilst presenting in a way where it was unreasonable on the part of the officer to suspect that the person was suffering from mental disorder.
This very debate took place in one borough of my force several years ago. The consultant psychiatrist concerned was disturbed that “just” 40% of those detained were admitted. I asked how many of the remaining 60% were referred to a mental health or health care professional OR were acting in a way where it would be a reasonable ‘shout’ for a lay person to suspect that they were suffering from a mental health problem. He didn’t know … nor was he prepared to find out actually, he insisted those were irrelevant issues.
Irrelevant?! A person detained s136 and referred to a CMHT for non-acute mental illness or to their GP was not relevant to determining relevant usage by the police?! It subsequently became necessary to do a larger piece of work in another area of my force where we found the following outcomes.
- Approximately 40% were admitted under the MHA or informally.
- Approximately 40% were referred to a healthcare professional for an identified, unmet need.
- 20% were released without any further action -
Of this later category, half were behaving or presenting in a way were NHS staff agreed that it would have been a reasonable presumption on the part of the officer that the person was mentally ill. In other words, 90% of people were appropriately detained and in 10% of cases, it was questionable.
Now! – shall we devise a series of exercises about what is a crime and test the NHS? I’ve got a series of examples involving fairly hideous badness, none of which are crimes. At the heart of this is the question of how trained we want our police officers to be as almost quasi-psychiatric nurses.
We need to raise the standard of this debate and we need far, Far, FAR more research.