Should the police remain at a place of safety once they have arrived at the location? – to be clear at the outset, I’m referring to the psychiatric place of safety to which most people are removed. I am not referring to A&E when it used because of additional medical emergency or physical injury – the open nature of that environment means officers should remain until the person is either discharged entirely from s136 following assessment or transferred to the main place of safety.
There is nothing whatsoever in the Mental Health Act or the Code of Practice (Wales) to the Mental Health Act which answers this question – and everything else is guidance and opinion. This question is a sticking point in how place of safety processes work. I was chuffed to see the BLOG getting a mention on a nurses’ internet forum following which a (student?) nurse made a comment which prompts this post: “In theory the police should remain with the person until this is completed … now that we insist they remain with them until it has been decided whether or not further input is required they are reluctant.”
Of course the police are reluctant, not least because there is no legal basis at all for this claim. And even if this question is addressed morally rather than legally, it is probably fair to remark that the public would wish to see their police deployed in way that means they are not remaining with patients in hospital pending assessment unless the patient poses a risk to staff where it’s obviously vital that the police protect their colleagues in the NHS.
But it is clearly understood that because of the extent of assaults on NHS mental health professionals – 68% of all assaults on NHS staff are on MH professionals – support from the police is needed in some cases.
Here’s the problem: responses to undertake assessments of patients who are removed to a place of safety are often measured in hours and half-days. Average response time to the place of safety in my home area (not my force) is over eight hours and the mental health provider refuses to allow the police to use the facility at all unless the chief constable agrees that two officers will remain at that location with the patient throughout the entire duration. That PoS facility has no nurse to meet, greet and triage the patient and so the irony of the arrangements is that if the police had removed the person to the cells, they would have been seen by a police doctor within 90 minutes (average) – the place of safety facility in my home area quite effectively delays access to necessary healthcare.
And of course this comes at a cost. When you have two large towns covered by four police officers at night and two of them are twenty-five miles away ‘guarding’ a non-resistant mental health patient – the PoS cannot be used for anyone who is violent – it means there is, for example, less capacity to respond to calls to Accident & Emergency that drunk patients are being aggressive towards staff.
One police force in the north of England were kind enough to share with me a copy of the legal advice they had received from a barrister on this very point. They sought counsel’s advice on their obligations to remain and he was very clear: “None whatsoever, in law, unless remaining there is necessary to prevent crime or protect life.”
So what’s the way forward?
As ever, local protocols should reflect the core roles of each agency and the Royal College Guidelines. Parliament did not make it an obligation upon the police to remain in all situations, the Code of Practice implies there will be some situations where the police do and some where they do not, and the Royal College Standards clearly envisage the police leaving even in some situations where patients are ‘disturbed’. Ultimately it all comes back to proper commissioning and resourcing of Place of Safety facilities which sits with PCTs.
In time-honoured tradition I prefer the compromise that all patients removed to a PoS are risk categorised as LOW, MEDIUM or HIGH. Low risk patients are an NHS responsibility, once they police have arrived, researched background and risk and provided a full handover of information to the NHS. High risk patients are a joint responsibility – medium risks cases should be judged case by case dependent upon the professionals involved and the patient.
Where dispute remains about whether the police stay, my force operates to the rule that we stay if we asked to do so, but if the attending officers disagree with the need for it, the case is referred to managers at the time and if still unresolved, the next day for review. Working on the principle that there should be objective risk information to which nurses should be able to point to justify that request; some nurses have had feedback about inappropriate retention of the police. Equally, some officers have had feedback following an insistence upon leaving when the nurse had not agreed. This mechanism is proving over time, to build trust and lead to fewer disputes than when the process first began.
Perhaps a way of summarising all of this, it to observe that it is not for the police to staff and resource NHS places of safety because they PCT would prefer not to do so; but it is for the police to protect the professionals who work there from very real risks of assault.
AFTERTHOUGHT – just in case any healthcare professional reading this is thinking, “But I don’t have legal authority to keep the person in a PoS for assessment, only the police can do that”. Yes you do – s136(2) MHA. If patients are asking to leave, keep the door shut, if they start to get aggressive because of this, then the risks have raised at least to medium so call the police back.