In Immediate Need of Care

This post is influenced by a comment on an internet forum for AMHPs that I’ve been allowed into – it’s an excellent way for professionals to use social media to support each other and share opinions on difficult or unusual circumstances:

An AMHP asked the question about how it could be possible to get the police to understand the “care” part of the phrase “in immediate need of care or control” from the definition of s136.  I’m not entirely sure of the circumstances of any incident to prompt the query but must imagine that it included officers not acting to detain someone who was in immediate need of care, but not necessarily in immediate need of control.

It is a really good point to raise and something I covered when I have delivered training on the use of section 136.  UK mental health law allows intervention by the police based upon an officer’s view that they are purely in need to “immediate care OR control”.  Are you imagining the type of thing the distinction gives rise to?!

My preferred example usually focusses upon a real event: my attendance as a sergeant at an incident along with one of my constables where we were dealing with a chronically depressed man expressing suicidal ideas. The man was not hurting himself, had not hurt himself and was sitting alone and lonely in a church yard in Moseley in Birmingham on a cold evening.  He’d had a bit to drink but was way, way short of being able to be described as drunk and after we struck up a rapport, we were able to secure his nominal details and discretely check him out on police systems.  We learned enough about his history to have reliable information that he had a history of mental illness, although just one conviction many years previously for a minor assault.

Five criteria must apply to use section 136:

1. A constable finds, in a place to which the public have access;
2. someone who appears to be suffering from mental disorder;
3. is in immediate need of care OR control;
4. in their own interests or for the protection of others.
5. [the intervention is] necessary.

Did we take his threats to self-harm seriously?  Yes – they were specific, they involved preparation on his part, which was why he’d started drinking, why he’d gone to Moseley and why he had a certain volume of medication on him, which we found later.  Did we believe he was suffering from a mental disorder?  Yes – because of his current presentation, his known history and the reasons for police attendance at his home address in the past.  He was found in a place to which the public have access and therefore three out of four criteria for detention under s136 were met.

The only remaining question to satisfy the legal criteria was, “Is he in immediate need of [either] care OR control, in his own interests or for the protection of others?”  Yes – he was not in immediate need of control, because the application of his plan was a few hours away yet, but the need for him to receive care was immediate to prevent things getting to a point where the alcohol had taken a real hold and he then took a potentially incapacitous decision to ingest medication and overdose.  No-one else was at risk here but to walk away would have been unconscionable and it never crossed our minds so it was certainly “necessary.”

So detention under s136 Mental Health Act it was – removal to a place of safety, which in the days before my PoS work was police cells, and we arranged for him to be assessed by a Doctor and an AMHP.  I can remember that he was assessed as being in need of hospital admission and agreed to go voluntarily.  He was kind enough to write to our Chief Superintendent a couple of months later, expressing gratitude not only for what we did but also how we did it.  It was extremely gratifying to read the letter, as he was quite obviously grateful for our intervention and in a position to regret that things got that far for him.  (It was a matter of regret to me then and still is now, that we had to put this guy in a cell block – that could never be the right place for an Armed Services veteran, struggling to come to terms with his experiences in the Gulf War and Kosovo and his personal life having broken up since leaving the Army.  I almost wish we could have just called the AMHP and DR to the churchyard, if I’m honest …

Section 136 of the Mental Health Act is not just about controlling dangerous people – far, far from it although it can be used in such situations, of course.  I worry about perceptions that this may be what it may is for and that this may affect our more general view of people suffering from mental ill-health.  Far more frequently, in my experience, s136 is about being able to intervene to ensure care for vulnerable people: those who are at risk by virtue of their condition but posing no threat to anyone but themselves.

This is why, despite some of my reservations about the way s136 MHA is drafted, I think British mental health law for emergency intervention by the police, is in many respects much better than other jurisdictions.  It could also be argued to be less criminalising, allowing lower level, more pro-active interventions than would be the case if the police were scanning for “danger signs” or similar.

Worth getting your head around this if you are a police officer – it opens up the use of this power to various vulnerable groups, including rough sleepers, street-drinkers and other vulnerable groups who often attract the attention of the police.

If you are an Armed Forces Veteran in need of support following your service, please click the “Combat Stress” picture on this blog to take you to their website.  There are loads of resources and contact numbers on there – and NEVER forget how grateful the people of the UK are to you for your service.

The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs

ccawards2013 was highlighted by the Independent Commission on Policing & Mental Health
– was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.


4 thoughts on “In Immediate Need of Care

  1. This is a very moving blog. Thanks ever so much for sharing this situation. I always enjoy reading your blogs and consider they have helped me see Mental Health Act assessments from the police perspective.

  2. I would say this should be made much clearer to the public as well – that if they come across someone threatening to self harm although not immediately that the police have the power to help, properly help. I had a relative who suffered mental illness and so am very aware of its day to day reality and have in the past come across someone (a total stranger) who was “gearing up” for a suicide attempt. At the time I had no idea who I could contact for help and ended up looking up the phone number for MIND – who got me to phone the police . Having read this blog I feel far more comfortable with phoning the police if (god forbid) I come across the situation again.

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