The Royal College of Emergency Medicine (RCEM) issued a position statement on Right Care, Right Person in March 2024. It is re-produced in full, below only in case it subsequently is removed or amended in the future. Quite incidentally, I’ve realised since starting this website, I’ve often linked to things because they represent a position at a certain point in time and in a few years, when I may want to refer back to this particular position at this specific time, the document has been removed because of update or amendment and I can no longer read the text of things. RCEM are adept at this: they issued guidance in 2022 on Acute Behavioural Disturbance, specifically eschewing the idea this concept amounted to a diagnoseable condition, yet their original edition, published in 2016 referred expressly to it as an “illness” … I digress!
The position statement is brief – and so I will be.
I wanted something more substantial and specific. Something which doesn’t play with the history that brings us to this point. In acknowledging “much police time is wasted in a crowded urgent and emergency care system” the document also states, “the police will be needed at times.” This seems somewhat obvious and gets towards the idea of RCRP having a ‘threshold’ to help assess the legalities in play for police involvement – RCEM make no mention of whether they accept or do not accept the threshold, bearing in mind there is an argument it’s incomplete and given an ethical argument that policing is not and never was just about doing what the law demands.
The statement gives us 10 recommendations, many of which are not for or about the police, but they do lend weight to the argument the police have put forward about how omissions in commissioning appropriate health services has brought us to where we are. I could have done with more acknowledgement about that failure over the last decade in particular, to deliver on the Crisis Care Concordat, to which RCEM was a signatory organisation. But it includes everything from s136 suites in sufficient number for the population to safe spaces and security services in Emergency Departments to cope with those occasions where patients are removed to ED.
It was curious to see RCEM note a “measurable drop in detentions under s136 of the Mental Health Act” and indeed in the last published figures (for 2022/23) do show a five percent reduction on the previous figures (for 2021/22) in overall usage. That said, it was the first drop in a long while and use of the power is significantly up over the last fifteen years, for example. And whilst the numbers of overall s136 detentions are down, the actual number and proportion going initially to ED is rising, significantly!
- 2021/22 – 9,964 to ED of 36,594 detentions overall.
- 2022/23 – 12,910 to ED of 34,685 detentions overall.
That’s a rise of around 3,000 an an increasing proportion from 27% to 37%! (Home Office statistics.) There’s no way such a rise at a time when usage fell is about much other than NHS infrastructure to cope with demand.
So there it is: as always, I want more specific consideration of this. All my experience on this tells me: detail matters.
Oh … and NHSE and ICBs don’t employ AMHPs and can’t unilaterally increase their numbers – individual NHS trusts can directly employ them but I wonder how many have even considered it? … most areas are struggling to recruit, train and retain AMHPs so I’d have to just wish them good luck with that if they tried.
_____________________
Right Care, Right Person: RCEM Position Statement
22 March 2024
Background
A number of Police Forces around England are implementing a change management process in the way they respond to people with mental health problems. This is based on a collaboration in the Yorkshire and Humber region. This essentially is raising the threshold for police involvement in mental health incidents. It is accepted that much police time is wasted in a crowded urgent and emergency care system that is particularly difficult for people with mental health problems. This approach is being adopted by a number of police forces.
Consequences
There are risks for emergency medicine staff. Staff, especially nursing staff are exposed to increased levels of violence and aggression. The police may be reluctant to go and perform welfare checks on high risk patients who abscond from emergency departments. Already there has been a measurable drop in the number of detentions under Section 136 on the Mental Health Act, suggesting that some patients in mental health crisis are not being responded to appropriately. In addition, agitated people are being left by the police in understaffed emergency departments and being sedated as a way to protect the patient and staff. Right Care, Right Person is beginning to be identified as a contributing factor in Prevention of Future Death notices issued by Coroners.
The RCEM Mental Health Sub Committee and Council have considered this and made the following collaborative proposals.
- NHSE and ICBs should define how many section 136 suites are needed per head of population and commission them.
- NHSE and ICBs should commission a section 12 approved Dr service and increase the number of AMHPs. RCEM accepts that some patients in mental health crisis need emergency department care, but all too often lack of section 136 capacity means that people end up in the wrong place.
- Where patients need to come to an Emergency Department, there should be dedicated space to observe MH patients (different from an assessment space) with properly commissioned security services with training in trauma informed care, mental health and safe restraint, this would allow police to leave more often but will never be as good an option as a locked 136 suite.
- People under the age of 18 should be excluded form [sic] Right Care, Right Person.
- A legal framework for restraint by hospital security services should be developed.
- Both the Police and Emergency Medicine Service should use the RCEM Best Practice Guideline on Absconding Patients.
- There should be full coverage of mental health ambulances to go out to patients in crisis. These have reasonable results, but police will still be needed at times.
- Where RCRP goes ahead, there should be collection and scrutiny of near misses and a commitment to review policy and provision.
- There must be an independent evaluation of the implementation of RCPC [sic].
- A recognition that there are cases where police powers are needed and cannot be provided by anyone else – e.g. pinging phones to help locate a person.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2024
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 