Just when you think you’ve got it all sorted out in your head – and just when you’ve been nationally recognised! – there’s a curve ball thrown at you!? Typical.
Incidentally, this has happened to me before … I spent a year writing a proper mental health policy for my force in 2005/6. In doing so, I solicited officers’ views about ANY and ALL questions and queries on mental health so that I could ensure they were addressed in the policy. I carefully listed everything they asked to ensure that what they wanted addressing in operational guidance was included. I considered it a job well done when I published it until a sergeant rang me up to complain that the situation he wanted advice on wasn’t mentioned at all and that my new policy “wasn’t very much use, really”. Thanks, Sarge!
Today, an AMHP presented a situation to me that I’ve never encountered before, albeit I have read about “guardianship”. I read about it partly to try to understand why the police never seem to get requests in connection with it. By definition, guardianship involves patients who remain at liberty and therefore a reduced need for coercion reduces the need for the police. << That’s one of the saddest sentences I’ve typed on this blog, as the police should not be just the coercive arm of the mental health system.
In fairness to the AMHP who I know well, he hadn’t dealt with this kind of situation before either and his need for police support caused me to think I should cover the subject, in case some officers across it.
WHAT IS GUARDIANSHIP?
It may be that some think of the legal status of mental health patients as being either “inpatients” or “outpatients”. Inpatient in a psychiatric hospital, either voluntary or detained under the Mental Health Act; OR “outpatients” under community mental health teams.
Guardianship is something in between, but in my experience, the police service hear of this very rarely indeed – probably because by definition of it, patients are prepared to engage with it and considered able to live in an arrangement where their physical liberty is not totally restricted. It should be noted in particular, that guardianship is totally different to Community Treatment Orders, and should not be confused with it, although both are options for community care which impose restrictions or limitations of various sorts.
Under Section 7 of the Mental Health Act, a person may be placed in to guardianship upon the application an AMHP or the patient’s nearest relative if they have received the medical recommendations from two doctors. A criminal court can also instigate guardianship under section 37 of the Act, if two medical recommendations suggest it is appropriate after a conviction for an offence or a finding of the act being done.
A patient received into guardianship may be required by the guardian to do certain things: “reside at a specified place, attend specified places at times for medical treatment, occupation, education or training; to ensure access for any registered medical practitioner or Approved Mental Health Professional.”
TRANSFERS AND WARRANTS AND AWOLS
Where a patient is received into guardianship in one local authority, it may become necessary to transfer them to a new guardian in a new area, much like inpatients are occasionally transferred between hospitals. All of this is covered in s19 of the Act and if need be, that transfer can be effected by the use of reasonable force.
Where access to a premises is not enabled, a warrant can be sought under section 135(2) to force entry in order to transfer a patient under guardianship. << This is what the AMHP was asking for, in the example which gives rise to this post.
If a warrant is secured for this purpose, then the police will need to be involved because only the police can execute the warrant. Of course, any conveyance which is subsequently necessary, should be done in accordance with the Code of Practice which presumes ambulance transfer.
If a patient absents themselves from the care of the guardian, then they become AWOL for the purposes of the Mental Health Act and may be re-taken by a police officer, an AMHP or anyone authorised in writing by the guardian or the local social services authority. If entry to a premises must be forced, in order to re-take someone received into guardianship, then a warrant under s135(2) is required.
This is no different to the re-detention of an inpatient AWOL from hospital under the MHA. Of course, guardianship being less restrictive on a patient’s liberty, having been re-detained and returned to the guardianship from which they were AWOL, they cannot be then compelled to remain there, unlike an inpatient under a section like 2 or 3.
- Mental Health Act reference guide from the Department of Health
- Code of Practice to the Mental Health Act
- MIND – an outline guide to the Mental Health Act 1983.
The Mental Health Cop blog
– won 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
– 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.