There are a few ways in which s136 MHA is either misused or perceived to have been misused. I’d like to briefly discuss s136 and alcohol so police officers that may consider this when putting together local policies or making operational decisions:
I’ve heard it argued that s136 should never be used when someone is ‘drunk’ or even when there is any alcohol involved. Firstly, nothing in law supports this: it would be legal to do so if the arresting officer genuinely believes that the criteria for s136 are met, notwithstanding alcohol. It raises the question of how reasonable it is for an arresting officer to suspect that someone is suffering from mental disorder when the presentation is clouded by alcohol. That’s fair enough – we’re not psychiatrists. Therefore training is key.
Well, if there is reliable third-party information about mental illness, in addition to an officer’s first impressions, this would validate thinking about s136. I have in my mind a scenario in which the police are called to a known service user, or one in which police intelligence checks are undertaken at the scene of an incident and they highlight ‘markers’ or previous arrests / detentions which imply a history of mental disorder. It is important to remember that the police do come across MH patients who abuse substances – in fact, that’s one of the reasons that it is the police who come across them. I’ve been told a few times by dual diagnosis specialists how important it is that their patients are not discriminated against or excluded from services purely because of their presentation.
Of course, this raises the issue of how and where someone is managed until such time as an AMHP can conduct a meaningful mental health assessment with a DR, but that’s a seperate discussion for later.
Finally on this point, it would be important for local monitoring of s136 to understand the assessment outcomes where s136 is used, including specifically where the detainee was intoxicated. One police force I worked with – not mine I’m glad to say! – used s136 fairly ‘casually’ where alcohol was concerned and the NHS there stated that over 85% of those arrested went home with a hangover, in need of a bacon sandwich and had no mental disorder at all. This was putting significant unnecessary pressure on the MH s136 service.
On the other hand I can think of at least one incident whereby if an intoxicated mental health patient – he could barely stand – had been detained s136 he may not have died in a police cell.
TRUE STORY FROM A PSYCH NURSE – once upon a time a man was detained s136 whilst intoxicated after hanging off a motorway bridge threatening to jump. He was assessed after 18hrs of sobering up (in the cells!) and admitted to hosptial s2 MHA. Two days later he started asking questions such as “Where am I?” and had suddenly appeared less disoriented. It turns out he’d been taking certain anti-nicotine medication and had sunk two bottles of red wine during a family meal against the advice surrounding use of this anti-nicotine drug. Result: temporary condition of appearing mentally disordered even to healthcare professionals so it necessitated detention in hospital under the MHA.
My advice to police officers around s136 and alcohol is this: You should question your own ability to tell whether someone’s presentation whilst intoxicated is alcohol or mental illness because sometimes trained psychiatrists can not be certain. If there is nothing pointing to mental illness other than you own observation of behaviour, you should be careful – you must believe that the person is suffering from mental disorder for the arrest to lawful; but if you have good objective information that someone has a history of mental health problems or you have no other choice at all and / or do believe that all of the criteria are met, to use s136 is lawful despite what may be said later by someone who did not have to take the decision.