ANYWHERE can be a Place of Safety under the Mental Health Act as long as the occupier is temporarily willing to receive the patient. This is stated in s135(6) of the Mental Health Act. Of course, the Act also declares that hospitals and police stations are places of safety (PoS); and the Code of Practice requires a joint protocol to exist which indicates which PoS should be used and in which circumstances. So if a hospital A&E department agrees to accept someone for assessment, treatment – in what sense are they still not a Place of Safety? It’s wordsmithery.
I’m not going to recall the story of an officer who once removed someone to a GP’s surgery to find the doctor happy to help and let his surgery be used. Or the child who was taken home and assessed there once officers were happy it was clean and safe.
Of course, ideally, A&E would be used for medical emergencies and treatment of physical injury only; a psychiatric or dedicated PoS would be used for more or less everything else; and a police station only as a last resort. But what if the middle option doesn’t exist at all; or it doesn’t work properly? What if the police know, that resort to the cells may well be medically risky and potentially illegal?
We should remember: regardless of domestic law and local protocols, whatever ends up happening MUST survive contact with articles 2, 3 and 5 of the ECHR. There have already been successful human rights based challenges around s136 and more are pending (MS v UK). Statutory regulators have given direction to police forces that their acquiesance to inadequate local NHS arrangements would constitute a human rights breach in certain circumstances. We also know, that attempting to get direct access to healthcare would make the difference when trying to decide whether or not officers were negligent.
Some people are potentially too ill to be in a police station, but not ill enough to be in A&E.
I can give multiple examples of incidents where officers have ‘done as they were told’ by their NHS areas who wrote protocols saying things like “The police station is the place of safety” or who documented such gems of clinical clarity as “people arrested under s136 who are violent or intoxicated should go to the cells”. Such cases have ended very badly indeed, worst of all for patients. We all know, alcohol can mask other problems and resistant behaviours can be symptomatic of all sorts of things.
BUT(!) before my colleagues in A&E point out – quite rightly – that A&E is (usually) not ‘designated’ as a PoS; that it is not equipped to act as a place of safety; that it is unsuitable as an environment and should only be used if patients have got additional medical problems or injuries that indicate A&E is appropriate. I have this to say:
- You could say all of that about police stations – few Chief Constables WANT their police custody blocks used as a PoS and there is probably more public material against the use of police stations than against the use of A&E.
- The word ‘designated’ only appears four times in the whole Code of Practice and never in chapter 10 which discusses PoS protocols – the word doesn’t appear in s135(6) MHA at all.
- Legally, there is no such thing as a designated or a non-designated PoS.
- We know from published research, that approximately 15% of people who go to A&E have mental health problems.
- We know that 5% of people who go to A&E are there JUST because of mental health problems.
- We know that A&E have psychiatric liaison services, called by various names, but all who provide psychiatric assessment, including formal assessment for admission, if required.
- So let’s not pretend that A&E do not do mental health.
- We also know, that in some NHS areas, the managers of A&E Services do not know who the managers of MH services are, even though their frontline operational staff have daily contact and have to improvise integrated care pathways into secondary MH services where necessary.
I also understand that if areas had a properly commissioned, staffed and overseen PoS service then such tensions as I’ve seen which appear to exist between A&E and the police may not exist at all. In the absence of such a facility, or in the absence of being able to access it, police officers have been forced into various dilemmas, especially those of us who read Chapter 10 of the Code of Practice (Wales) and the Royal College Standards and then wondered why our experience bore no resemblance to this Nirvana described within.
Problematically, when A&E say “we’re not a place of safety” they are often undermined by their own decision-making. If one arrested an elderly, female dementia patient and removed them to A&E asking for help from the NHS whilst explaining that the cells are full of howling drunks, robbers and rapists and that you’d really rather not subject your octogenarian to that environment, you’d probably get in. <<< Real example. So you are a PoS on some occasions? OK, now I’m really confused: on what basis are we picking and choosing? Do these decision survive contact with Equality Impact Assessments?! Strikes me they probably wouldn’t!
This whole blog post is a TOTAL AND UTTER RED-HERRING because instead of A&E and the police getting at each other, not supporting each other; arguing about the minutiae of legal terminology neither are qualified to handle and contorting the Act and Code to support their particular point of view, the actual point is busy being missed: properly commissioned, established and resourced Places of Safety in dedicated facilities which operate to nationally agreed standards.
Other debates are white noise.
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