Alcohol and s136 Mental Health Act

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.

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10 thoughts on “Alcohol and s136 Mental Health Act

  1. i would say alcohol is a factor in the majority of Sec136 cases we are involved in without causing too much of a problem a AMHP can still assess and if impossible to interview in a suitable manner use evidence from others involved in the case, of course there will be cases where we get it wrong but that happens when alcohol is not involved as well. No one from any services is infallible when you’re dealing with complex life situations which rest quite often on opinion rather than facts

    1. “Without causing too much of a problem a AMHP can still assess and if impossible to interview in a suitable manner use evidence from others involved in the case.”

      Any chance you could slowly work your way around the country and explain this to your colleagues. We’ve understood this for years, but I’ve personally been patronised several times for having the temerity to suggest it.

      1. As a working AMHP in W Yorks, most of the detained people that do get referred to me by officers, are usually intoxicated (or are asking for help but get detained on S136 anyway)
        I cannot do a comprehensive assessment on someone who is intoxicated, as the alcohol can affect someones thoughts and judgements in a very dramatic manner, however once they are sober, the story is more often than not, one of remorse for putting themselves in a situation under the influence of alcohol, where they or others could have been at risk.
        Subsequently they are then discharged home without any follow up being needed, apart from information being given about the “safe” use of alcohol, rather than binge drinking etc.
        Perhaps if the police were to use other powers, such as an arrest for Drunk and disorderly / breach of peace?? repeat offenders might think twice about how much they are drinking / being antisocial?
        Thanks
        Don

      2. I don’t disagree as have said so many times. If you look at my blog on whether to “arrest for s136 or for an offence” you’ll see that I say so but where MH or NHS services need to improve is in recognising that it is legitimate, legal and sometimes necessary to detain under s136 when people are intoxicated if we KNOW that they have an established MH history. The issue is then one of keeping that person safe and properly monitored until they can be assessed by an AMHP and it is a both medically and legally, a far more complicated debate than saying “take them to the cells”.

        Not least, this is because of the prevalence amongst this country’s death in custody figures of intoxicated mental health patients AND because of laws which point out that we use cells too often where there are NHS Place of Safety services available, but unwilling for less-than-valid reasons. Only last week, the shift which preceds by own detained a young man under s136 at 6pm whilst intoxicated. His MH history made s136 perfectly appropriate. Even 8hrs after arrest, he was still over double the drink-drive limit – we know this because they insisted upon breathalysing him. It was nearer fourteen hours after arrest, at 8am, that he was assessed by an AMHP who kept saying, “Should never have been brought here: should have been in the cells.”

        Why? – there was no-one else needed the 136 suite at that time. There were nurses nearby and a far more appropriate environment in which to keep the young lad. When I saw him at 3am despite being twice the drink-drive limit, there was little doubt in my mind that this man could have engaged in an 136 assessment quite meaningfully, because his history of alcohol dependence meant that he was barely affected by what remained in his system and I’ve seen psychs and AMHPs do such assessments before, without waiting for someone to be forced into total sobriety (with all the dangers that holds for alcohol dependent patients.) Interesting to discuss this stuff with AMHPs whose work specialises in dual-diagnosis because they tend to characterise AMHPs who are not such specialists as mis-informed.

  2. Are you saying that assessments of patients under the influence of alcohol can be done?? I’ve never had a single patient dealt with whilst drunk even slightest! Mh Practitioner always insists on sober patient! Apologies if I have misread this. Cheers

    1. Sorry I think I missed the point! Must stop reading an get some sleep! Mornings not good. Police damed if we do an damed if we don’t! H

    2. Depends on circs. If you check other comments you’ll find one form @444blackcat about considering it, if necessary. MH professinoals often quote Ch4 to the Code of Practice MHA to justify not assessing til sober, but actually, the code does allow for the urgent need to do assessments before then. @444blackcat’s comments seem to suppor that it is possible. In fairness I can give one example in my career of MH assessment under s136 going ahead when patient was visibly under the influence. Psych / AMHP felt it justified.

      My only point is this: it is possible. Not always desireable, but possible.

  3. I have attended a house where the occupier was completely three sheets to the wind and was coming out with every kind of bizarre statement known to man. I wasn’t the first officer to arrive but I was asked to go along as the officer who had popped to see the occupier was hugely concerned for the female occupier. Apparently I have a knack for talking to everyone and seem to be able to communicate with people with MHI very well.
    As I said she was completely drunk and rambling and making randomly daft observations and and and ……… THEN she said she wanted it all over.
    Our Sgt appeared and agreed she was drunk but custody was not the place for her.
    Being me I rang the community health team and asked if they could shed some light. They didn’t know this person and didn’t want to see this person if intoxicated.
    I rang the Dr who thought this person had got the drinking under control as he hadn’t seen this person.
    This person needed help but was being failed.
    Alcohol was an issue but it was to block out the life that this person could no longer cope with.
    What annoyed me most was that it was the Police were expected to pick up the pieces when what this person needed was help that we can’t give but are expected to find.

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