This if the first in a series of short posts which aims to bring together all the blog posts which will allow policy leads in police forces or police BCUs to set about reviewing, revising and delivering proper procedures and training on various protocols which are requierd: in this case on Places of Safefy, usually folllowing detention under s136 MHA.
If you are a police officer charged with ensuring proper s136 arrangements in your area – either establishing them, or reviewing what you’ve got – you need to look at certain things proactively. Not to do so, will increase costs and risks, it will potentially contribute to suggestions of law breaking – whether civil, criminal or human rights – and may attract the attention of the Coroner should the worst occur.
You will probably find a predictable list of barriers to ensuring that arrangements work for a person detained so let’s remember, that ss136 / 297 are not about the police OR the NHS, it’s about the person detained.
I could list these issues as subjects or questions / obstacles, but either way you’ll face the following issues:
- “It’s too expensive at a time of public sector cuts to put the proper arrangements in place”: No, it’s actually cheaper to do it properly.
- “OK, but violent people need to be taken to the cells”: Maybe, but let’s first make sure the violence is not attributable to something clinical.
- “Children can’t be brought to this Place of Safety”: why on earth not?
- “A&E is not a place of safety”: It can be and often it needs to be. There is no opt out clause for them to exercise.
- “People who have had drugs or alcohol can’t be assessed, so take them to the cells”: That may be extremely dangerous, so let’s make sure it isn’t before we think about that.
- “OK, but the police will have to stay at the Place of Safety until the assessment has completely finished”: There is no legal basis for this at all, it should only happen where there is ongoing risk to NHS staff.
- “Why are you calling an ambulance every time, that just delays things”: we need to ensure that what we think is a mental health matter isn’t something else or masking something that means the person needs to go to A&E.
- “Sorry, we just can’t do it like this”: that’s up to you, but we know what’s right and we know our legal responsibilities whether or not you agree. We are obliged to resist attempts to do it in a way which does or could break laws.
- “The police don’t use this power correctly, you need to sort it out”: quite possibly mea cupla.
- “We need to make sure your police officers are trained properly”: we do, and your mental health professionals.
It’s also important within these discussions that things within the gift of the police to influence which sometimes contribute to or directly cause the NHS to adopt positions implied above, are understood.
- Why don’t the NHS understand that violence can be clinically attributable?
- Well of course, they actually do! But many A&Es and PoS services have some very bad experiences of the police leaving extremely challenging patients with them without thought as to the risk this leaves them with. So they resist: and this is to be human.
- Why wouldn’t the NHS understand that drugs and alcohol can mask other problems?
- Well of course, they actually do! However, in addition to the point about violence, there is a legitimate expectation upon AMHPs that MHA assessments are delayed until individuals can be meaningfully interviewed, wherever possible.
- The debate about where someone should be managed until an AMHP agrees to assess them should be clinically lead, balancing any ongoing risks of the alcohol, with the risks to their mental health of being held in a cell block.
- Why don’t the NHS have resources to ‘staff’ a PoS properly so the police can leave?
- Well, often such resources can be de-deployed from other functions, but if the police are using s136 fairly indiscriminately and not arresting for criminal offences, including drunkenness offences where this would be more appropriate; it makes that so much harder for the NHS.
Everything is linked to everything else, but this is a flavour of how to address the barriers and obstacles I faced doing this work across many areas over several years. The best advice I can give to any professional, regardless of which organisation they work for, is try to put history out of your mind and design things afresh; look at everything from the opposite point of view
This stuff is perfectly do-able if you have the will to make it happen. And it’s cheaper this way and it’s better for patients which is more important than anything else.