Delivering Effective s136 Policy

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.

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6 thoughts on “Delivering Effective s136 Policy

  1. Hi, autistic with learning difficulties, please do not be angry.

    Why do police put s136 on CRB even if there was no crime committed e.g. person was suicidal and ambulance service sent police rather than respoinding themselves, despite not history of crirme or violence (has actually happened to someone I know very well)?

    Why also do section 2 and 3 end up on CRBs sometimes?

    Why, when someone has been violent, but only under influence of hallicunations, (for example, thought spies were coming to torture and kill them, and has established diagnosis that police know about) does CRB say that they were violent without giving any context, i.e. that they were ill. This causes people to be refused jobs.

    I’m not asking this to criticise you at all, I find your blog very interesting. These are genuine questions that I would really appreciate your perspective on as I have no-one else I can really ask. Local police station didn’t know what I was on about when I tried to pose these questions.

    Thanks

    P.S. Please don’t publish my personal details (name, email etc)

    1. Hi, thanks for the questions and be assured I’m not angry; I’m more than happy to answer them and help.

      There is no rule that says s136 MUST be disclosed on a CRB check and I’m told that forces vary in whether they include routinely or apply some kind of discretion. In fairness, sometimes police arrest s136 even where there is an offence being committed at the same time but they form the view that s136 was more appropriate. If they believed that the ‘offence’ was relevant to the disclosure, they may choose to include it. Or not.

      I’m afraid I’m less clued up as to why / when / whether mental health detention would be disclosed, because such information is not routinely held by the police. Many people have had detention under the MHA without coming anywhere near to the police and we never knew, nor did we need to know. Again, I’m not sighted specifically on the amount of information which would be disclosed around violence but agree with you that context is key to understanding and I fully appreciate that it can cause people to be refused jobs.

      Not connected to mental health, but I would give an example: a man sued my Chief Constable some years ago because my force disclosed on an enhanced CRB check that he had been arrested and charged with two offences which were both dropped before he came to court. Therefore he was never convicted. The man argued ‘innocent until proven guilty’ etc., and stated that the disclosure should never have been made, because he was never convicted. It sounds right doesn’t it, and he won his case. However, the Chief Constable appealed the decision, because he had argued that the disclosure being about behaviour relevant to predictions of risk in the job and the trial not going ahead for reasons that were unconnected to the strength of evidence, he was entitled to disclosure. He won the appeal.

      Maybe you should write to your MP about this, as I imagine they’d consider taking it up. Let me know if I can help anymore.

      1. Thank you, that is really useful and I really appreciate you taking the time to reply.

        I will write to my MP about it as I know it has been an issue for some people I know with mental health issues and also is a source of anxiety for many others pursuing their first CRB checks.

        Many thanks,

        Apples

  2. Hi a question; Can a place of safety be used by the hospital itself as an emergency bed for an inpatient either sectioned or informal? I am asking because a local trust is using the 136 suite as a “bed” thus making the place of safety unavailable to the police officers. My friend is a police officer and part of a Mental Health triage team an part of his role is to phone around and check availability of 136 suites and it is a constant “we have a patient in there” and on several occasions it has been an informal patient. I train staff in all health and social care and believe this to be an illegal practice but am struggling to find the legislation to support it. any advice and or information will be greatly appreciated.
    Chris

    1. I’ve heard this kind of thing on a few occasions. There was one particularly ironic incident in the south-east of England where a PoS service had existed for some years but had always refused to allow the building to be used as a PoS for under 18s. Then one time when the CAMHS service was full and no bed existed, they used the PoS to accommodate the admission of a child for several weeks. Obviously the police wondered how it could be unacceptable to use the place for 72hrs (max) but it was acceptable to use it for weeks on end!

      I’m led to believe that using a PoS is frowned upon massively, often registered as a SUI in the trust and could well be a breach of registration regulations around inpatient units. That all said, it would require the CQC to know of it and investigate it and I’m not sure whether they are aware of the occasions where this happens.

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