At the very heart of some of the most difficult s136 cases lies the following problem: some individuals detained under this legal authority cannot be managed by the police alone in a cell – the medical risks there are just too great.
But equally, it is true that they cannot be managed by the NHS alone, whether that be in a psychiatric place of safety or within Accident & Emergency, if that were necessary. The safety risks to NHS staff are just too great.
A (now retired) senior officer once said something which I’ve repeated many, many times since: “I don’t want to have a discussion about whether we’ll be having a nightmare in custody managing acute medical risks; or you are having a nightmare in hospital with resistent patients. I want to talk about how we support each other, in the most demanding of cases. Both of us, in the same place, at the same time, having a nightmare together – it’s simply a discussion about whether it’s your place, or mine?”
Well, it is much easier to put cops in NHS buildings to protect and secure an environment than it is to put NHS staff with equipment into a custody office. Let’s face it: the latter is impossible in a reasonable timeframe, if possible at all. As the NHS A&E consultant who put together the RED FLAGS pointed out, with some agitated behaviours the necessary kit to properly medically manage that small number of individuals who may be at serious risk, could not be taken to police custody anyway.
The debate about whether the police should stay in a place of safety is a particularly difficult one: I’ve seen it written down in joint operating protocols that only the police can keep someone detained under the Mental Health Act in a Place of Safety anyway. I’ve also heard it argued by mental health professionals and barristers that this is nonsense – certainly the Royal College of Psychiatrists guidelines say the police should leave patients within the care of the s136 suite (even if they are disturbed, which is not realistic in most areas.) It remains true, though that the police service have an obligation to prevent crime and this remains true within psychiatric units.
(NB: A&E is different – is was simply never designed to act as a PoS and is there for s136 detentions only where the management of acute medical risks and / or injury is necessary. In my view, the police should remain with patients who need A&E until such time as the patient is either transferred to a proper s136 suite or the cells; or until they are discharged from s136 entirely – whichever happens first.)
So again – as with a lot of this stuff – it comes down to teamwork across the agencies. But a starter for ten in partnership discussions around s136 MHA is that someone people are too complex in terms of their needs and their presentation to be either a police or an NHS responsibility. We have to learn to work together putting the patient’s needs first and sometimes, we need to do it quickly.