The tragic events of this Thursday have reverberated around the country: a young woman with her life ahead of her, killed in an apparently random attack on a city bus in the early morning build up to rush hour. No-one could fail to be moved by the impact this will have on those who knew and loved Christina Edkins and I want to add my condolences to those expressed by West Midlands Police and thousands of others. There are no words.
On Friday evening, the police announced that the suspect who was arrested just over 24hrs before had been sectioned under the Mental Health Act. This has prompted various reactions in the press and on social media – not all of them in light of what is actually occurring here. So this post seeks to explain how and why such decisions are reached when any investigation involves suspects who may be suffering from mental health problems; and it seeks to explain the implications of someone being sectioned and what may happen next.
Before I do so, I want to point out that I am not involved in this investigation and have no more access to information concerning it than anyone who has followed the details released to the media. This outline is not specific to the particular case: it hopes to outline how custody officers and investigating officers approach the decisions that the law requires them to take.
POLICE CUSTODY PROCEDURES
The police must always attempt to establish whether anyone in custody may have a history of mental or other health problems and whether this has any bearing on their detention in custody or upon the investigation – this is a legal requirement. If need be, a police surgeon can call upon trained mental health professionals from the NHS to advise further and this includes whether or not it may be appropriate for the suspect to be detained in hospital for assessment or treatment under the Mental Health Act 1983. If someone is arrested for any offence, their mental health is directly relevant to the potential for them to be held responsible for their actions – which means we have understand their mental health issues to properly investigate.
Whilst assessments in custody are undertaken to reach these decisions, the person being detained will be deemed unfit for interview – this is really important to how legal decisions are made. People suffering from mental health issues are known to be especially ‘suggestible” – this means prone to making false confessions or false denials when being questioned by experienced detectives. Police interviews can also seriously impact upon an individual’s health and make issues worse: both could have profound legal implications should the investigation lead to a trial at a later time. There are various safeguards in place for people in custody who are deemed ‘vulnerable’ and someone with mental health problems is covered by these.
So in some investigations where a suspect needs admission to hospital under the Mental Health Act, the lack of being able to question them means there is insufficient evidence to charge them with an offence. Even if there is enough evidence, it can still be necessary to delay any charge decision to establish whether or not it “is in the public interest” and to ensure the courts can take their decisions in light of any health issues.
MENTAL HEALTH AND CRIMINAL JUSTICE
“Diversion” is the word used when a person in contact with the criminal justice system is brought into contact with the mental health system. It does not always mean someone is moved from the criminal justice system to the mental health system. It means the two systems start to operate alongside each other and this is done for several reasons –
- With more minor offences, it may be that the whole response to someone’s minor offending is best addressed by just ensuring they receive appropriate health care.
- With more serious offences, it will be important to fully understand the nature and extent of someone’s mental health problems, because it will be relevant later if that person is charged with any offence.
- Someone’s mental ill-health can affect how a trial is conducted and will be relevant to sentencing if the person is found guilty – any court will need to make decisions about “fitness to plead” or “fitness to stand trial” and psychiatric assessment is key to this.
- Any jury that may be involved in a trial may have to reach decisions about “insanity” or “diminished responsibility” and psychiatric assessment will be key to this, too.
So where any offender is ‘sectioned’ under the Mental Health Act and admitted to hospital, there are various things to say –
- Someone being ‘sectioned’ means one of two things – either, the person requires assessment and treatment for suspected mental disorder; OR they need treatment for known mental disorder.
- This does NOT mean that the investigation is over – West Midlands Police policy states that where suspects are diverted, the investigating officers will not end a criminal investigation until after the hospital have assessed the patient and the officers have liaised with them to understand the legal implications of that assessment.
- This does not mean the suspect has a known mental health history – the fact that someone was ‘sectioned’ does not mean that they are previously known to mental health services OR that they have previously been ‘sectioned’ before.
WHAT HAPPENS NOW
Whilst there are cases every year where suspects who have been ‘sectioned’ after arrest do not face formal prosecution, this is always for comparatively minor offences like shoplifting, criminal damage or assault. Where more serious offences have been alleged suspects who are ‘sectioned’ are assessed and treated in hospital until they can later be questioned by the police. After questioning, and dependent upon the evidence in the case supplemented by the medical information, the police and the Crown Prosecution Service can then take their normal decision about whether to prosecute the person concerned.
This is crucial – this is no different than for any other suspect who is ill or seriously ill when arrested by the police. If someone had a serious heart problem or a broken leg that required an operation, the criminal justice system would take a slight pause to ensure that treatment and care, before then proceeding as normal based upon the evidence. The process is no different where offenders are suspected to have mental health problems, which can be equally serious.
And where things happen in this order, it has various advantages for the justice process:
- If a person had appeared in court whilst still ‘unfit’, they would not be able to enter a plea and the trial would have been delayed anyway – remember the case of Nicola Edgington who was sentenced last week? This trial was delayed for many months because she was unfit to appear before the court.
- After someone’s first appearance, a court has no power to remand a person directly to hospital for treatment and assessment, so understanding the nature of someone’s ill-health and ensuring proper treatment would be delayed compared to the approach of ‘diversion’ before charge.
- By the time of any appearance in court, much more is known about the offender’s mental health history and this allows the court process to proceed far more efficiently, if after assessment and treatment the evidence is there to support charges being brought.
PUBLIC OPINION
Various reactions to the news that the suspect had been ‘sectioned’ were understandable – this incident has shocked many of us who have understood the details of it. Obviously a key role for the police is to bring to justice those who commit offences and temporarily diverting an offender for a serious offence so that the investigators can better understand the impact of someone’s mental health on the incident, is a part of this investigation process – it may also mean that if a suspect is eventually questioned once ‘fit’, more evidence is secured for any trial that may occur.
To those who have argued in response to the decision that it appears to be all about safeguarding a suspect and not prioritising the victim, I would say this: let the police gather as much evidence and information as they can to take the best decision possible. That will help ensure that justice is done.
UPDATE 12/03/13 – West Midlands Police have been given the authority to charge Phillip SIMELANE with murder.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2013
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
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Mental Health Cop 
A lot of people in this situation I feel play the mental health issue they are advised by the solicitor that is fighting the case for them!
If he has a mental health history then this is where I have an issue!
Have a look inside these hospitals, the patients are left to do what they like, they see a doctor once a week,the nurses lock themselves away in an office & you can’t tell distinguish the patients from the nurses!
If he has got a history then I blame the system….. It’s called care in the community this in my opinion is an absolute joke. The so called care workers or social workers- you need a social worker to get sectioned these people have not got a clue
They are not ensuring that people are well before they let people back into communities…. Blame the health authorities not the person more & more tragedies like this are going to happen again & again because the people In the system are not doing they’re job.
My poor mum has suffered since she was 15 she is now 72 & still gets ill from time to time but when she does get ill nobody wants to know, the only people that ever helps is the police so stop blaming the police for tragedies like this & start blaming the health authorities & the mental health system .
From visiting in one of the biggest hospitals in London I know these people don’t get the correct treatment & care so things need to change!
having seen the West Midlands Police tweet yesterday morning I was saddened by some of the responces. For any illness in police custody the detained MUST be given appropriate treatment. Would there be such an outcry if he had a head wound stitched up, I doubt it.
The rules are there for a reason as you have outlined in your blog to protect not just the detained and police but ultimately the public. The criminal justice system is there to protect the public also to punish and deter offenders..
There have been cases where an innocent ‘vunerable’ person has been assused and convincted of crimes such as murder, where the public outcry and ‘evidence’ at the time was condeming. When new evidence comes to light they are shown to be innocent. In the blog you state:
“People suffering from mental health issues are known to be especially ‘suggestible” – this means prone to making false confessions or false denials when being questioned by experienced detectives.”
There have been times too (sorry MHC) where the investigation was found to be flawed and conducted ‘inappropriately’ such as in the Stephen Downing & Stefan Kiszko cases. Where the ‘guilty’ party is left at large to potentially commit further offences and the innocent destroyed.
Unfortunately there will always be those who will not let reason or facts get in the way of braying for the ‘accuseds’ blood.
Stephen Downing and Stefan Kiszko whilst tragic cases were certainly pre-PACE and from completely differing times, the police have moved on leaps and bounds from then and I am confident those sorts of things would not happen again.
I cited the cases because I was familar with them (such was their impact) -rather than indicating that post PACE they would necessarily occur today or that is how police behave.
It was not my intention to critise the police rather I was reacting to those on social media who had been doing so unfairly re senctioning the alleged Birmingham attacker (not convicted) with comments such as ‘joke, why you making excuses for him?’. Hence my final comment.
Also to reinforce the arguement that it is important that ‘vunerable’ detainees are protected
These miscarriages of justice can happen and mentally ill people are very vulnerable.
Here’s one I dealt with (post PACE) …
Woman with downs syndrome plus schizophrenia living with her mother. Mother found dead in home, beaten to death and no sign of forced entry. Daughter the obvious killer. Local ‘community leaders’ pile on the pressure to get this poor mentally ill person out of jail and into hospital. Case pushed through court ASAP. Found ‘unfit to plead’ and put on s37/41 without limit of time.
Turns out it was the (not mentally ill) brother who had visited the house, let himself in and out with his key, and killed the mother.
Absolutely crucial people are given sufficient time for treatment in order to allow them to answer charges in court and offer a defence.
Excellent response! – a mental health patient such as my daughter is put on extremely high dosage of mind altering drugs that act like LSD inhibiting the reuptake of serotonin. However shocking such incidents may be, the press report this in a biased manner. There is no mention of the danger of these drugs and why/how they get passed in the first place. It is a big money making business the pharmaceutical industry. It has long since been known that the drugs are dangerous and they are passed in a dubious manner. They can cause not only a patient but anyone as documented by Professor Healy to suffer violence and aggression whilst in a dream like state during the day someone acts out their nightmares. My daughter complained of hallucinations and voices yet she never heard voices in her head before the drugs. She was a victim of crime herself and the first cure is drugs and there is so much ignorance of what is really going on and social services/these so called professionals fail to protect someone vulnerable like my daughter and have done so time after time again. It is because of the shocking reaction of the drugs given my daughter got under mental health services – if only she had been given counselling and none of us realised just how dangerous the drugs are. The worse thing is that patients are given a life sentence on these drugs that cause terrible side effects and no one listens. It is highly dangerous to take someone off the drugs unless it is done like Dr Ann Blake Tracy says – these so called professionals have not got a clue how to take someone off the drugs safely at all. It is like coming off any drug, it has to be done with miniscule amounts on a day to day basis over a period of 1 – 2 years not by 50mg off or 150mg like the Maudsley. They deliberately caused the psychosis as by taking someone off too steeply causes them to act in an adverse manner and then they slap on a section. The care in the UK is an absolute disgrace – it is wicked and cruel and no matter how shocking such articles are that person was probably not violent at one time BEFORE going on these chemicals. They do not work for everyone – see Dr William Walsh – Nutrient Power. I am so fed up with the shocking care that I have demanded a proper assessment done by Dr Walsh to see if there are underlying health problems – for every drug there is a natural remedy as Dr Walsh said in his speech at the last Chy Sawel Conference. I do not believe in all these labels as I have a tape of laughing psychiatrists and NO I am not a Scientologist either. The real criminals are those pushing the drugs even given to children like my younger daughter who suffered severe bullying yet now is on top of the world – so much for their rotten labels and there is a label for everyone in DSM 5. iT IS ALL A BIG PROFIT MONEY MAKING VENTURE AND THE PSYCHIATRISTS ARE A BRANCH OF THE PHARMACEUTICAL INDUSTRY.
Excellent explanation of how and why the sytem works, I had a rough idea but this has made me understand better. It is just a pity that the majority of those baying for blood will not read it, and even if they did they would still dismiss it because they are not interested in the facts!
Thank you finally some information to give to people who have no understanding of MH issues. It is far better that this is all looked at now rather than the a person be released after a court case as it was not handled properly. How anyone can think that someone without MH issues would apparently stab a stranger calmly get off a bus and then stay in the vicinty.
I suppose you would have to be crazy to just get up and stab a 16 year old school girl, I personally think that he should be locked up for a minimum of 25 years and then assessed to see if he is fit to come out. People say “bring back the death sentence” but what would that solve? That puts us in the same position as the man who killed Christina.
What has happened to her is tragic, but this should be an eye opener, it’s pointless arguing about what should of happened because that is not going to bring her back to her family is it? So what we should be doing now is thinking what we can do to prevent it happening again, for example,
1) employing security on busses (one guard per bus)
2) making sure people who have a history of mental health are properly monitored.
My heart goes out to her family and friends, this must be extremely hard for you all x
If they’ve got a mental health then why are they on streets and how many more people like this are walking the streets that we don’t now about ? Can someone gaurantee mine and everyone else’s safety when we leave our house ?
FIRSTLY EVERYBODY HAS MENTAL HEALTH (yes I am shouting) it is just that 1 in 4 of us have a mental health issue. MHC has started a casual stigma link on twitter but it is not for this kind of comment. The idea that all people with mental health issues are dangerous to others is absurd.
Why does it matter so much – well I would suggest those who follow the idea look at the many excellent sites on rethinking mental health and ending stigma where they can read about the effect of prejudice. Hoever, I know full well that they would not look at it and many would say they are not prejudiced anyway.
We must have been responding together! – see my reply, also.
Mark,
These are serious questions for you, I’m not just choosing to argue – Who are “they”? What do you mean “like this”? –
If by “they” you mean “people with potential mental health problems” then estimates vary but it could be suggested that there are around 15 million people (in the UK) with mental health problems today. These vary in nature of course and there are around 20,000 people per year detained under the Mental Health Act – mostly because they pose a risk to themselves. I am more likely to kill me than I am to be killed by a mental health patient. If by “like this” you mean, carrying knives and posing a risk to your safety – the answer is, by definition, we don’t know because most of them aren’t carrying it overtly. What I do know is, the vast majority of them will not be mentally ill.
No-one can guarantee your safety on a whole range of issues: reckelss drivers, drunken men or from threats within the homes of the UK like domestic violence – all of which are far more likely to see you killed than the risk posed by someone who may have mental health problems.
Now, NOTHING that I’ve written above is intended to minimise the importance of ensuring where the police or mental health services know about certain risks to individuals or to broader public safety that they shouldn’t be doing everything they can to minimise those risks, including by detention under the MHA and / or prosecution, as appropriate. But as far as we know from media at the moment, the suspect (who has not yet been charged) was not known by mental health services. Maybe we’ll learn more in the future and you’d be quite entitled to point to previous cases and where they went wrong, but this is an ongoing inquiry, far from complete and no-one yet knows all of the answers to what needs to be learned, if anything, from this case. There are organisations like “Hundred Families” who are actively lobbying to ensure that learning from previous cases which it could be argued has not been absorbed, gets taken on board and reflected in different policies, practice and training.
Does that answer your questions?
In VERY PLAIN ENGLISH this “alleged offender” will stay in the secure”custody/care” whilst it is decided if he’s either too “ill” to be charged or not.
NOTHING will happen to him.
The Crown Prosecutions (CPS aka criminal Protection Society !) decide based on the evidence gathered if they can persue (or NOT) a prosecution
The likelyhood is the “alleged offender” may be detained at a relevant mental institution until some “dogooder” health professional/ doctor etc says he’s fit to be released to KILL again!!! ( maybe years from now)
Its care in the community, they are in the community and NOBODY cares!
I’m speaking from 30yrs plus practical/ daily / professional police experience.
Its happened before and will happen again.
SORRY but its true.
A young girl stabbed to death in Centenary Square by the Bham Hippadrome a few years ago on a nice summers sunny day. This incident was but a few years & hundred yards away and of a similar nature.
NUFF said
It’s not nice out there !
No – the alleged offender will remain in secure care until he’s fit enough to be questioned by the police. Whilst it is true to point out that the man responsible for killing Rose Ross was then detained in a hospital, you manage not to mention that the fact that he was prosecuted for murder and then convicted of manslaughter (on the grounds of diminished responsibility.) He was given a sentence by the court that is as consequential for his personal liberty as any that can be given in UK law.
I fully understand the reasons why people are incensed to hear of cases like Nicola Edgington who was released after a homicide and killed again. Even more so because we know that things went awry in how services handled her discharge (no referral to MAPPA and potentially other things we are yet to learn about). I’m not going to defend any part of that OR try to argue that “these things are very rare” because rare or not, that misses the point. I do think it is relevant to point out something that implicitly sits just below what you seem to be arguing, which is that what may yet happen is in your opinion some kind of second-best fit that leaves the public at risk.
Before railing against the speculative prospect of release from a secure hospital in the future, it should be borne in mind that people released from secure hospital care re-offend at a rate of 6% whilst those who are released from prison re-offend nearer the 50% mark and that those who are detained in hospital after conviction for murder / manslaughter spend, on average, far longer at the will of the state than those sentenced to prison. Why does this matter? – the risks you explicitly raise as facing us all, are far graver from other situations you’re not mentioning.
I’m sure that if the evidence exists to prosecute anyone accused of murdering another person, no police officer or prosecutor will want to see any other course taken – but let them do their job properly. If your argument is against our model of (mental)health care, this is the wrong place for your argument because this blog is testimony about the problems within it.
I’ve no problem with your reply: I am stating a simplistic answer at “Joe Public” level as I am now also “Joe Public”. Stats prove whatever you want to eg: Bleach kills 99.9% of all germs…..the other 0.01% kills you dead ! You miss the point here sorry to digress! I hope the “alleged offender” does come before the courts in due course but I’m not holding my breath. I understand the system and most Joe public clearly do not so short & simplistic answers work best when trying to explain “What Happens Next”.
Well, I think the public deserve the credit of being able to read a short article of about 1,000 words. The number of comments I’ve had suggesting it was simple and clear, on here and social media, suggest that most people think it was detailed enough to educate and inform without being overly simplistic. “Case still ongoing, will be interviewed later and prosecution considered” wouldn’t make an interesting post and isn’t what this blog is about!
By not holding your breath, one assumes you err on the side of thinking prosecution unlikely. As MHAcademic has pointed out, unless there is a lack of evidence, that is extremely unlikely in a homicide investigation. Witnesses who have spoken to the media and certain police statements can already be interpreted in support of this. Let’s watch and see.
The idea that mentally disordered people will not be prosecuted for serious offences is just plain untrue.
I have never seen a case of this seriousness where the person was not prosecuted. In the vast majority of cases the defendant is tried, convicted and sentenced. In a very small number of cases they are so mentally disturbed that the court finds them ‘not guilty by reason of insanity’ but that is, and always has been, rare – outcome would still be an s37/41.
In minor offences the CPS may well save the tax payer a lot of money in lawyers fees by not taking the case to court and just allowing the doctors/social worker to section them, but not for killing someone.
Steve – as I knew would be the case eventually, authority to charge him with murder has been given and it will happen in due course >> http://www.west-midlands.police.uk/latest-news/press-release.asp?ID=4448
A family member of mine was sectioned under the Mental Health Act last year. We sat in A&E for approximately 12 hours, when he eventually got arrested for attacking a security guard who he believed was going to hurt his mother. he was then sectioned from the police station. There was nothing keeping him in the A&E at hospital other than family members influence. He believed EVERYBODY was out to get him and he needed to ‘protect’ himself and his family against pretty much the world. I can only imagine how he would have been feeling. I believe if he left the hospital, he could have been in this same position and seriously hurt, or murdered somebody. He was under his section for 6 months, throughout this time we learned that the Mental Health System is a JOKE. Something seriously needs to be done, more funding needs to be given to Mental Health Departments to stop more tragedies like this occouring.
XX The police must always attempt to establish whether anyone in custody may have a history of mental or other health problems XX
“History” is what I question here.
Not every nutter HAS a “history”. They may be “first” offenders.
Are the U.K police expected to assess these as well?
If so EVERY drunk, or Parkinsons patient, or…or…. could be reported for the consideration of the question of sectioning… or have I mised/Missread something?
I respectfully suggest that I think you have: I’m merely pointing out that the police risk assessment process for anyone brought into custody includes trying to establish whether they are experiencing or ever have, mental ill health problems. This is to assist with ensuring safety / welfare in custody, as well as to allow it to be established whether any mental health problems will have bearing on the investigation or detention of someone under arrest.
Once again I agree with MHC which is getting to be a habit. The police have to risk acess every detainee which includes accessing risks re physical and mental health. Yes a detainee with mental health issues may have no history with MHS or any previous history but does that mean if they are showing signs of a pyschoic epidsode for example tnat should not be taken into account and approprite safeguards put into place.
I would suggest that your phrase ‘Not every nutter HAS a “history”. They may be “first” offenders.’ is not an entry for #casualstigma too.