The Royal College of Psychiatrists chairs a multi-agency Mental Health Act group which produces guidance, standards and documents around “Section 136 of the Mental Health Act 1983 and the operation of ‘Places of Safety’.” Over the last five or six years, I have probably quoted their guidance several thousands of times when trying to push for services to improve or alter the way they operate, or in some cases to push them to exist at all.
The other organisations involved in that multi-agency group include: the Association of Chief Police Officers – representing the police; the College of Social Work – representing AMHPs; the College of Emergency Medicine and the NHS Ambulance Chief Executive Group, amongst others. It is also supported by the Independent Police Complaints Commission and the Care Quality Commission, along with equivalent organisations in Wales.
In other words, you’d imagine it to be the final word on what s136 and Place of Safety services should look like – and you couldn’t be more wrong!
Although the position on these issues has improved considerably in the last ten years, there is still a long way to go. Some counties within England still have absolutely NO place of safety provision for those detained – none whatsoever. Everyone is taken to the cells, unless they go via Accident & Emergency because of physical injury / illness. Many more still operate ‘exclusion criteria’ of various kinds which prevent some people being able to access those services, amidst ongoing presumptions that cells can be used. As you’ve read on this blog before: this should not be presumed because to do so would not always be possible, by virtue of not being safe and legal.
2013 GUIDANCE TO COMMISSIONERS
The recent publication of the April 2013 ‘position statement’ from the Royal College attracted my attention. I was keen to see what it involved and what it added to the 2011 Guidelines. Not much, although I welcome the publication because it is a useful document which presents relevant issues even more plainly than the guidelines.
In particular, I like the fact that this document is pitched at NHS Commissioners. Of course, April 2013 saw Primary Care Trusts (PCTs) in England ceasing to exist as GP-led Clinical Commissioning Groups (CCGs) take over responsibility for healthcare:
- Pages 11/12 – summary of the main problems with s136 pathways and what should be a feature.
- Pages 13/14 – a succession of questions which should prompt review of how effective PoS services are in terms of delivery.
HIGHLIGHTS
There are various statements worth highlighting and I’d like everyone to fully absorb how unambiguous this is. The challenge for us all is therefore not to keep debating, obfuscating and resisting this, but focussing upon how it can be realised –
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Nearly all individuals detained under Section 136 should be taken to a place of safety in a mental health unit – the main exceptions are those requiring urgent medical assessment and treatment and those too disturbed to be safely managed in a hospital setting.
- There must be adequate provision for the anticipated demand – this should include suitable provision to meet the needs of specific groups; in particular, those under 18 years, the elderly and people with intellectual disabilities.
- Individuals who are intoxicated should not be excluded from the MH PoS – unless they need acute medical intervention or are too behaviourally disturbed to be safely managed.
- The MH PoS must have staff on hand to receive the individual from the police without delay – there should be sufficient staff to cope with all but the most challenging behaviour, without recourse to ongoing police support.
This can actually happen – most of this happens, most of the time in the West Midlands. I’m not pretending it’s perfect, all of the time – but I am saying that in a police force where around 1,000 people are year are being detained by officers, we have in two years had just 23 + 43 people in police cells, detained under the MHA. That is 96.5% of detainees directly accessing healthcare and a more appropriate environment.
You’re not going to convince me that within that number there were no resistant or intoxicated detainees; no children – this can be done, and it does most appropriately sit with NHS Commissioners to ensure it gets delivered. As my previous experience with Commissioners in PCTs revealed people who had varying levels of knowledge and interest around mental health and its interface with the police, this document is very welcome because it effectively summarises the guidelines and makes the important parts both blunt and obvious.
The only remaining question is whether we’re going to do this, or not?
Update on 01st April 2015 – since writing this article, a new Code of Practice has come into effect in England. It doesn’t substantially alter the post but certain reference numbers have changed. My summary post about the new Code of Practice (2015) is here, the new Reference Guide is here and the full document is here. The Code of Practice (Wales) remains unchanged.
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.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 
The whole system is rotten to the core and rife with abuse – legal processes such as Tribunals are manipulated and delayed. Whether it be private sector or NHS there Is still terrible abuse going on. My daughter’s Tribunal has been delayed. I do not want to see her in hospital for the rest of her life and the team have ignored me – no one has responded to my email. You cannot go by a hospital that is classed as being Best Care Provider at all – the public have no idea what is really going on and how much money is being wasted on the delaying of legal processes and the enforced drugging and keeping custody of mental health patients under Section – the whole law is geared to protect the professionals and not the patients because a team will always stick together to cover up any mistakes. If you dare to speak out like I have done you get banned and threatened with arrest in a hospital where staff where name badges back to front. No explanation is given when someone’s face is covered in bruises except “I am happy with that!” When you talk about a safe place it makes me laugh as there is no such thing as a safe place. I am not sure that private sector care is any better either after the way I have been treated by a private hospital which I document in my blog. It is only thanks to them having a new psychiatrist that I have not gone further with legal action – you can be sure that if this new psychiatrist is replaced by the previous I shall not hesitate to document everything in my blog and even go further in this respect if I am continued to be treated in such a manner which is not according to the law under my role as Nearest Relative. I would further add that the police should take more interest in these so called professionals – many of them abuse their powers and sit there smugly smiling as though they are above the law. It is not the patients but the staff that the police should take interest in from what I have seen.
Can you do a post reguarding once someone with mental health problems (and has taken an OD) has been just handcuffed by police but not arrested or detained, taken to the hospital (A&E) then wait for security to come and restrain the person the police have just taken in. im a girl, i dont weigh much and i have no muscles. i ws restrained by 4 security men, one was sitting on my legs, two each holding down by arms and one kneeling over me pushing pressure points on my body to cause pain and to stop me struggling. i was held on my back in this position (cross position pretty much) for hours at least 8. I couldnt fight them off or move when i only had two of the restraining me via one on each side of me holding down my wrists and kneeling on my arms tho i did take the opputunity that because my legs were free and no one was sitting on them to promtly knee the guards in the back at which point another guard then sat on my legs.
As in what kind of restraints can security guards use, and for how long and how much force can they use?
Thank you for showing the public what the police have to deal with on a daily basis. Suicidal people who don’t want help and are violent. Then complain when we do intervene.
You and your bent copper mates down the freemasons lodge might think it is ok to assault someone. However the public disagrees and that is what faith in the Police is as such a low level.
Could we raise the standard of debate, please? Anywhere above “playground” level would be fine.
Richard,
Your bigoted and unhelpful comments just shows what kind of drivel the police have to deal with daily whilst maintaining their professionalism. Your nothing more than an armchair warrior who has no doubt never had to make a decision to break the law in order to save a live. But I’m sure you’ll be the first to vilifie anybody who does.
Thanks for your interesting blog.
I assume that when you write ‘police force where around 1,000 people are year are being detained by officers’ you’re writing about detentions under s136? It would useful to clarify this.
A key issue is the lack of transparency. Here’s my failed attempt at getting some s136 related data from the MPS: https://www.whatdotheyknow.com/request/mha_section_136
Try the NHS trusts. They’re more likely to have the info you require. Besides its nothing to do with transparency and more to do with how much data is recorded. You make it sound like police enjoy sectionjng somebody. It’s the last thing we want to do.
Thank you for your suggestion. I wonder what it is I wrote you found sounds like suggesting that the police enjoy sectioning someone?
It is a shame that people like you, too eagerly justify the injustices of bad psychiatry. My psychiatrist and his close colleagues have commited a fraud and then continued to force medication on me, which I now know causes brain damage, the reasons why demetia patiants and altzhiemers patients should not take as these meds as they are toxic to the memory process. I have a memory problem caused by acute pain, I’m a chronic pain sufferer, and when this excacerbates my memory fails: cortisol is released to combat inflammation, too much, and it affects the limbic system in the brain, where memories are retrieved and processed, stress does this also, Their remedy was to label me a hypochondriac and schizophrenic etc etc, and ignore what I was telling them was happening with my memory, although at that time I didn’t know about the cortisol problem and have only looked into this recently.
I had to privatly pay for an x-ray for my personal use to try to stop them declaring me able bodied, it didn’t work and the forced medication continued. My memory has been severly affected and my healthcare has been severly affected by the labels that are not correct, my new GP refuses to go against the diagnosis of quacks, all this proffessional hubris within healthcare and they have all admitted that they are abusing me, and that there is nothing that I can do.
Strange also that so many are freemasons, and no, I don’t say this because I’m mad, I say it because this is true.
If the police were do deal with THIS kind of criminality then maybe psychiatry would not have so many over zealous megalomaniacs who truely believe that they are Gods.
I have followed this blog for several months. I know doctors, psychiatrists, lawyers, therapists, social workers, civil servants, journalists that follow this blog and discuss it. Issues such as capacity, s.136, appropriate adult, are currently debated in law politics policy psychology. This kind of blog provides a unique platform for non partisan debate – and more importantly the opportunity for the judge barrister lawyer civil servant campaigner social worker funding body to map theory and experience with practicality, to understand exactly what the impediments are.
It should be treated with respect.
“Individuals who are intoxicated should not be excluded from the MH PoS”
If only! My local 136 suite still insists on breathalyzing anyone who may have had a drink before allowing admission! As if being above the statutory limit to drive a car somehow removes the MH teams responsibility to provide care… I long for the day when patient needs and common sense prevail over continual buck-passing.