Elephants In The Room

I predict that in a decade or more, we will still know Nicola’s Edgington’s name.  I really fear, as with many of these cases, that the public will have forgotten Sally Hodkin’s name and that it will be her family who keep her memory alive, forever consumed with regret that it was their wife, their mother and their grandmother who had to be the one who was attacked – forever wondering whether two massive organs of the state, the police and mental health services, could have prevented it?  I also predict no-one will remember Kerry Clark, who was fortunate not to die during that incident and who will forever live with the impact that event has had upon her and who has had to watch the trial unfold the background of the woman who attacked her.

The hopeless tragedy of this case is beyond measure.  We will be hearing about it for years to come because there will yet be a criminal appeal against conviction and sentence, there may well be an Inquest, there will – eventually – be reports from within the NHS about the treatment and care of Nicola Edgington and Sally Hodkin’s family have stated through their solicitor, that there could be civil action against the NHS and / or the police.

I want to provoke a thought in you to consider as you read this blog about the Metropolitan police response on 10th October 2011:

Do we think that the judgement of the court today reflects a message from the criminal justice system to the mental health system that attempts to say, “You’ve had your chance to handle this case: now we’re ensuring beyond doubt, the public’s ongoing protection.”



I am not going to rehearse all of the ins and outs of the events leading up to and including the 10th October.  If you are not entirely familiar with the case, you should read the report from the IPCC into the matter or the BBC News website.   (It is paragraph 47 on page 12 of the report that is concerned with the substantive events of 10th October).  Alternatively, pick up a more respectable newspaper but I will tell you upfront that none of them – none – have summarised this case correctly and I’ve spent the afternoon and evening reading them all having read the IPCC report cover to cover – twice.

Finally, by way of introduction(!) – there are two things here that I am not commenting about:

  • The validity of the original decision in 2009 to release Nicola Edgington from secure mental health care; OR,
  • The judgement reached by the Crown Court, in terms of whether I think it was right or wrong.  There is now an appeal pending.

On the first issue, we don’t have published reports about how that decision was reached; on the second, there is a criminal appeal pending where the debate about liability for murder versus manslaughter on the grounds of diminished responsibility will be aired, along with an appeal against the sentence imposed which a life sentence with a minimum tariff of 37 years.

I am interested in the policing-related decisions.


The police were called at around 4am to a taxi rank in Greenwich to a report of a female who was asking for help to get “sectioned”.  When officers arrived, they found Nicola in the private area of the taxi firm’s offices.  She was asking for help and willing to receive it, albeit that she did not want to be conveyed by the London Ambulance Service.  She was removed to A&E by the two officers in police car.

  • They arrived there just before 4:30am and having booked her in and her being in a queue for triage, made to leave A&E at 04:31am.
  • Nicola followed them out, indicating she didn’t want to wait on her own.
  • At 04:34am, the officers returned her into the waiting area – she is shown on CCTV to be agitated.
  • At 04:37am, the officers left the department and Nicola followed them again, claiming she just wanted a cigarette and she then re-entered the hospital.
  • Keep reading the IPCC report from paragraph 72 on page 16 if you want more detail after that point – for my purposes on this blog, that is all I want you to focus upon.

The Independent Police Complaints Commission report highlights two particular points of contention for the police.

  • Firstly – that officers did not undertake a PNC check at any stage prior to leaving at 04:37am – it is suggested that had they done so, it would have confirmed Nicola Edgington to have been previously convicted of a homicide offence which may have influenced police decisions (around the second criticism) or medical decisions, in terms of the priority afforded to her as a patient.
  • Secondly – officer missed an opportunity to detain Nicola under s136 MHA at the point where she first attempted to follow them out of the hospital at 04:31am – it is held that if they had detained her, the assessment of her, especially one informed of the homicide conviction from the PNC check that never happened – may have reached a different decision about her risk and therefore may have taken different decisions.

The PNC Check – I’ve worried about this observation whilst acknowledging that PNC checks take just a couple of minutes and can be done by an officer in any location over their radio.  I’ve worried about it not because I would have questioned a check being done – certainly not.  I worry about it because we’re seeing this through the prism of a murder trial, knowing Nicola’s previous history.  The two officers on 10th October went to a taxi rank and met someone who, at that stage, wasn’t committing an offence, or resisting the care pathway the officers were offering her.   She was described in the report as “agitated” but essential capacitous and willing to engage.

So I ask this: are we now expecting a PNC check on every person we meet in a non-arrest situation where we are any part of offering a pathway to care in connection with mental health issue?  And if we’re doing this for people with a mental health presentation are we also doing this for other, potentially risk-related presentations where we are not detaining or arresting people – like drugs and alcohol?

Section 136 – It is beyond doubt that the officers could have detained Nicola at 04:34am under s136.  I have hinted before that for me, this decision rests on how you interpret the word “necessary” in the definition of s136(1) MHA.  Officers may detain “if it is necessary” … if by that you mean, “making sure she is enters a process she is not willing to enter” then you may take the view it was not “necessary”.  If you mean “making sure she remains detained in a process that she is currently engaging with but from which we worry she may withdraw”, then that is a different approach.  We just need to be clear about which approach we’re telling people to take.  Of relevance to the decision is a whole background of principles to the application of mental health law on vulnerable people which talks of “the least restrictive principle” and the “necessity test” for arresting people under any legal provision.

Whatever position you take on the issues in this case, one thing is beyond doubt:  Nicola Edgington remained at that hospital until after she was assessed by mental health services who offered her admission to hospital and walked her over to the mental health ward with a security guard.  By this time, because of access those mental health staff would have had to their own medical records, her previous history would have been established and the IPCC note that mental health staff did not legally detain her either.  If the police had detained her under s136 MHA and even if they had then remained involved in the assessment process to ensure she continued to be detained, the officers would have disengaged as soon as Nicola was safely escorted onto the ward.  This is standard procedure across the UK for the police because from that point, hosptial staff are responsible and have their own legal powers to detain, if the need arises.

She was taken from A&E at 06:25am on the 10 minute walk.  She left the mental health ward at 07:19am.  The police would almost certainly have been gone by then anyway.


In my experience, mental health staff don’t take patients into the wards unless they are being admitted – so whilst the IPCC report doesn’t specify that she was formally admitted as an inpatient, I will infer this was the case from the circumstances until I’m told otherwise.  So she was a voluntary inpatient from around 06:40am and she left at 07:19am – at a time when doctors or nurses may have applied their holding powers to her under s5(2) MHA or 5(4) MHA, respectively, to keep her detained.  << This is the first elephant in the room, for me.

When the NHS report into her treatment and care is eventually commissioned and published, I want to know whether my inference about admission is correct and, if so, why holding powers were not applied to stop her leaving or why the physical security of the ward does not prevent this.  There is just as much ground to question this as to question the non-use of s136.  Of course, the IPCC don’t question this, because their remit is not the health staff decisions – we’re yet to publicly learn those because the NHS investigation isn’t public.

Either way, had the police exercised a detention under s136 at around 04:34am, it is my speculation that when she was moved to the ward for admission, there is no way they would have remained there for half an hour or more.  They would have left and the “absconding situation” would very probably have been the same as it was in this case – in my view.

It is worth bearing in mind – that by the time Nicola Edgington absconded, the Trust would have known her previous history because mental health staff have access to their trusts records on which her status as a s42 conditionally discharged restricted patient would have been recorded.  It is also worth noting – that two nurses involved in this case have been sacked.


And why is no-one taking about conditional discharge?! << This is the second elephant in the room for me, along with her status as a MAPPA eligible offender.

Nicola was previously a patient detained after the manslaughter conviction under s37/41 of the Mental Health Act.  This means that if discharge from hospital is considered appropriate, it’s not a wholesale relaxation of all laws governing her treatment or care.  Nicola was “conditionally discharged” under s42 of the Mental Health Act and this ensures that whilst she is in receipt of community care, in Greenwich, there is a named psychiatrist in a multi-agency team including social workers and psychiatric nurses who are responsible for ensuring her care.

We know that Nicola had conditions to her release:  drug / alcohol testing, residence, exclusion from a defined geographical area and compliance with certain outpatient health regimes.

If those professionals develop concerns on any level that a conditionally discharged patient is relapsing and beginning to pose a risk to themselves or others – or merely if they are not abiding by the imposed conditions – then they may ask the Ministry of Justice to issue a warrant for her recall to hospital.  The MoJ can be contacted 24hrs a day to do this, if need be.

We know from the trial that Nicola had stopped taking medication and was making crisis calls to the police – albeit a police service who did not know she was MAPPA eligible because, in breach of legal requirements on others, they hadn’t been told.  I want to read something in an NHS document in the next few years that talks about the 72hrs prior to 10th October and which gives a general impression of how conditionally discharged community care was working – or not.

And what we know about MAPPA offenders, is that where the police are told of them being in their area, the local MAPPA meeting may well have devised a “trigger-plan” – a list of what to do, in the event of a relapse situation involving the patient.  This may well have involved contacting the psychiatrist on-call and / or the MoJ and / or any number of other things depending on the nature of the event that triggered.  Not done of course, because Greenwich MAPPA were not told of Nicola’s release, thus breaching various laws.


We saw the media launch into the blame game, both feet first earlier today.  I was utterly amazed by the media reaction to police failures: many of them reporting the issues incorrectly.

The truth of this case is you could point to about seven or eight different things done or not done by the professionals involved and put an argument that this alone caused the outcome.  The reality is, that it was a mixture of all of those things and more besides that conspired to create the conditions in which it occured.  The prevention of that conspiracy is precisely why we have complex offender management arrangements in the form of MAPPA.  This is the vehicle through which all risks and intelligence should have been brigaded, shared and understood in order to prevent all of the professional groups involved in this case from attempting to distance themselves from the events.  It is human nature to point to the other features of “failure”.

It is perfectly valid for mental health services to point out how comparatively rare mental health related homicide is, especially stranger attacks like this one; they also tend to emphasise “you can’t keep all people detained forever” and that discharge, conditional or otherwise, is a normal part of rehabilitation and recovery that has to be attempted at some stage for most patients in these legal cirumstances.  << This is not the same as saying that this particular decision was appropriate.

Sally Hodkin died and Kerry Clark was extremely lucky not to.  We owe it to both of them to reflect as individuals on our professional practice and our multi-agency procedures but we also owe it to the professionals involved not to get our analysis wrong.  Everything is connected to everything else and we do confuse cause with effect and vice versa on occasions.  Whatever you think of the content of this post, it is only PART of the debate because we don’t know enough about the role of the mental health trust and that’s why we need to know the outcome of an NHS inquiry into the health service decision-making: argubaly we need this all brought together with the IPCC report and I personally would like to see this all explored at the Inquest.


For what they are worth – media coverage from the main broadsheets.  Should be read in conjunction with the IPCC report and the Metropolitan Police press release.

Update on 01st April 2015 – since writing this article, a new Code of Practice has come into effect in England.  It doesn’t substantially alter the post but certain reference numbers have changed.  My summary post about the new Code of Practice (2015) is here, the new Reference Guide is here and the full document is here.  The Code of Practice (Wales) remains unchanged.

Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award


All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2013

I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current.  Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.

Government legislation website – www.legislation.gov.uk

44 thoughts on “Elephants In The Room

  1. Thanks, a real clear voice. Of course if she had been detained under s136 this would depend on the police surgeon admitting her into care. Too many times in my police service (police support control room staff) did I see cases where admission was refused, patient released, only to be arrested under s136 within a matter of hours.

    I also find some staff do not understand the MHA including medical staff. More than once I had to quote NHS policy to nurses at hospitals and secure units because they did’nt know it.

  2. I must admit I read it and presumed that she had come looking for informal admission and that she had been taken to a ward. As such I would have expected them to use 5.2.

    Even if she had been placed on 136 this would have only prompted a MHA Act assessment and if she had told them she wanted to be admitted that would have ended up in an informal admission more likely than not. Though given her history they may have detained her. But I’m not sure 136 was likely to change anything.

  3. You are right about Sally Hodkin’s name being forgotten very quickly, it is sad but unfortunate fact….even now if someone mentioned Nicola Edgington’s name i would know exactly what was being referred to, yet as for the 2 victims….it takes a while longer for the lightbulb to switch on :-/

    Sadly in my opinion the number of mistakes made in the whole case is appalling, and again it gives bad light to all us “Mentally Unwell” people, that we are a dangerous type of species. Oh well another reason to keep on fighting the stigma. Let’s hope many valuable lessons will be learnt from this case and hopefully not be repeated again anytime soon, if at all!

  4. I had already read Nanthan Constables blog entry before seeing news reports yesterday (well worth a read as is yours of course). However, the media yet again played the mad person – violent card and in turn sought to blame mainly it seemed the police. I heard no mention of the fact that police were restricted as s136 does not apply in private places etc just of failings

    This media take on the story is worrying and whilst yes there were failings in the system it presents them in a manner that is determential to all.

    1. The police- they can only act lawfully within the powers given to them. however,will the outcry lead to imporper use of s136 and the further crimilisation of MH patients.
    2. The MHS – a service cut to the bone already labouring under the MH patient is evil, needs to be restrained tag. Again they can only act within the law, funding and resources restraints and balancing treating the MH sufferer with possible risk to the public etc. So will there be patients being detained unnecessarily in future as the MHS are worried as a result. of this and similar cases. Will very limited resources be directed to systems complaince and away from front line care.
    3. The MH sufferer- as Lottie says the press responces demonises them, people already coping with debilitating illness suffering from stigma and struggling to get appropriate treatment form a crumbling NHS. With ATOS etc breathing down their neck. WIll they believe the hype and suffer. How long before somebody takes their life as a reasult.
    4. The public – they hear the rhetoric increase of stigma, they avoid MH sufferers etc Which can in turn lead to increased risks to and from MH sufferers.
    5. Government- an excuse to pass the blame & move on. Rather than look again at issues surrounding s136 etc funding a service of MH treatment fit for purpose for example.

  5. There was absolutely no requirement for the police to use s136 MHA, it was NOT necessary! At the stage the police were involved Nicola was a voluntary patient who co-operated with the agencies involved and the care pathway. Arresting under s136 may have even aggravated the situation. Many thanks for a balanced view, this is such a tragic case for ALL involved, let’s hope there is a balanced enquiry and the outcomes of that enquiry MAY prevent this type of incident happening again.

  6. Clearly, in this case a PNC check would have resulted in very different care and (hopefully) outcomes. But hindsight is a great thing – should we demand police carry out routine PNC checks on every mentally ill person they meet? The great majority of mentally ill people are not offenders.

    I think it’s very important to note it was the NHS who were supposed to be caring for this women following her previous offence. s37/41 and conditional discharge give strong powers to supervise. The staffing for such patients is very generous in both numbers and skill mix comparative other services.

    The police took this woman to hospital and she was in the care of an NHS mental health service when she was allowed to walk out and commit this second offence. Just to repeat – she was in the care of an NHS inpatient unit, not the police.

    Unfortunately, I don’t think this is some sort of tipping point. Although we hear talk of ‘stigma’ and hopes it will never happen again, in reality it happens circa 100 times every year. Last big tipping point was Christopher Clunis in 1992 and it took 15 years to achieve the changes in law his family campaigned for (CTOs) – in the face of massive resistance from the mental health industry.

    One issue I would like to see in front of the courts is a test of the Osman rationale with regards art.2 right to life – does the NHS have an obligation to take ‘all reasonable measures’ to preserve the life of victims?

    1. If the police had carried out a PNC check and confirmed Nicola’s previous convictions what do you think would have been done differently by the police and what different care do you think Nicola would have received? It should have made no difference, she should have been cared for and treated on the merits of the case as it stood. As with PACE 1 stop & search powers, you cannot use previous convictions to use as your grounds for searching someone. The mental health team obviously decided Nicola was fit to be released would they/could they have made a different decision based on her previous history?

      1. Hi.

        I’m not saying the POLICE would have behaved differently. I’m quite clear, the police did what they should have done – took her to a health care facility. My issue is how the health care personnel would have dealt with her.

        I’m not convinced the MH ward made a decision to let her go. It sounds like she just walked out. We’ll need to see the health service ‘article two independent report’ to know the detailed facts on NHS staff conduct. I will also be interested to see what information they had from health sources at the point they made any decisions. The IPCC report suggests that the doctor reporting her missing stated she had a past conviction for manslaughter and might be a danger to the public, so presumably they knew by then.

        In answer to your question – yes they certainly can take her previous convictions into account. In terms of risk assessment past behaviour is one of the biggest predictors of future behaviour (under similar circumstances). Most mentally ill people do not engage in serious violence, to be aware that someone has a prior history of violence, even carrying weapons – let alone killing someone – is relevant in assessing their risk. If you look at the figures from the ‘national confidential inquiry’ into homicides by MH patients it’s pretty clear that past convictions for violence are very significant.

        Nurses, doctors or social workers, I would expect any professional to rate the situation as more serious if aware of a previous conviction for manslaughter. I will be interested to find out at what point they became aware of this.

  7. Sectioned someone a few weeks ago… demanding help or he would kill himself or commit a crime to be arrested… in a fraction of a second he picked up the smallest piece of glass and cut one of his wrists… Five hours later he is eventually passed into the care of local MH services….

    24 hours later, over the radio I hear his name mentioned again and he’s demanding the same help, clearly he didn’t receive much treatment 24 hours earlier… apparently he does it all the time but how long will it be before we have another “Nicola” case. It really concerns me.

    Desperately sad for the victims and families affected in this case…

  8. Perhaps someone ought to put people as in the case of this individual out of there misery, rather than wasting precious resources looking after individuals who cost the tax payers millions and lead to nothing but trouble for innocent members of the public or even death as in this case. The victims family have lost out to a bizarre system that looks after useless and dangerous individuals, and try’s to justify reasons for actions at tax payers cost when it all goes wrong as in this case. Time for a change, why protect & pay for something useless that wrecks a families life?

    1. Many years ago I looked after a guy who was convicted of the most horrible rape/murder of a little girl. If anyone deserved hanging it was him and I’m sure that if hanging had still been on the statute book he would have been sentenced to that and no home secretary would have reprieved him.

      Problem was, he hadn’t done it.

      The semen of the killer was on the little girls body. It could not have been this blokes semen because he had a rare condition which meant he had no sperm – a quick look under a microscope would have proved it. Later on another bloke was arrested for something entirely unconnected. His routine DNA sample matched that of the killer, he was living locally at the time of the killing, and he was convicted of the murder.

      The bloke I was looking after did sixteen years in high security prisons and secure mental health facilities. He was cleared and released.

      I used to be in favour of the death penalty for these type of crimes but this chap sort of put me off.

      Until we have a criminal justice system which guarantees zero error then I would tend to stay with that view.

      Whole life tariff (life means life), LWOP, detention without limit of time – yes, sometimes that is justified by the most serious offences – but at least errors can be rectified.

    2. I definitely believe that we should remember, and honour, the victims of crimes like these – I do not believe that either murdering those who have killed people whilst struggling with mental distress, or those those are seen as potentially dangerous is the answer. Instead, I think we need something more radical. We need a mental health system that is fit for purpose, that supports people (rather than puts barriers in the way of this support) and helps them take ownership of their lives and experiences (whether these are voices, visions or extremes of mood). At the moment, we have a system that can all to easily step in and smother people with support when in a crisis, yet turn them away the second time when they believe they need help. This can trigger some major rejection issues and cause a lot of instability, and some people react to that in extreme ways.

      People who hear voices that tell them to kill can, and do, find ways of understanding these experiences and making their own decisions whether or not to follow the voice’s commands. For me (I’m a voice hearer as well as a worker) I know that my voices are related to my childhood trauma and some of them are very angry because of what happened to me – that I am angry because of what happened to me. Knowing that means I can choose to do something different – I can deal with my history and find a way of living with it. I’m not a risk to myself or others, no longer need medication and now work with other who hear very distressing voices. The worrying thing is that it wasn’t the nhs that helped me develop this awareness – it was the Hearing Voices Network and the voluntary sector. Maybe the NHS could learn from these approaches.

      I now work in prisons (amongst other places) with people who hear voices. We run peer support groups in partnership with prison staff, and provide spaces for people to make sense of their experience and gain some sense of control. It worries me that, for these people, prison is often first time they have heard of this approach (even though there are over 180 Hearing Voices Groups in the country). Lets not give up on people and react with even stronger laws, PNC checks and more sectioning – the laws were there in this case, they still didn’t help. Instead, lets invest in helping people before things get this bad and preventing as many tragedies as possible. Lets create a health system that has staff who are empowered to help people help themselves.

    3. The issue is not about the death penalty for the crime, MHC is talking about preventative measures to protect people from becoming victims. The police, offender management and the mental health specialists (as well as doctors and even teachers and perhaps family), will have enough information between them to assess or make a calculated call on their behaviour patterns. It is usually a recidivist criminal that “progresses” up to murdering someone. The same case is relevant to the conviction last week for the murder of Catherine Gowling, the way in which she was murdered or treated is beyond rational thought. The murder was 47 but had been in and out of prison since he was 16. The aim now should be to test this individual to find out the causes of his actions, while he is in prison, to then look at preventing future crime and then look to tackle the causes. Everyone has an issue and there is nothing to say it could be someone you know that this may happen to. Mental health is still vastly unexplored.

  9. I’ve just found this site for the first time as a result of being intrigued by this particular case and wanting more background as I found the judge’s comments odd and the length of sentence excessive.

    I agree wholeheartedly with MentalHealthCop’s comments about the real issues not being talked about properly in the media. I had assumed that Nicola would have been subject to a 37/41 and, as such, she would have been subject to some pretty stringent restrictions/monitoring on her release in 2009; so one question for me is what happened to these?As someone who has represented a social services department on a MAPP previously it is my experience that once you’ve been “MAPPED” it is very difficult to ever get off and the monitoring is taken very seriously – certainly at a policy level.

    An even bigger question for me is whether or not NHS staff knew about her offending history at the time she walked out. My assumption here is that, if they did, they would have almost certainly used their holding poweres under S5. The fact that they didn’t may appear to suggest they were not aware.

    As I understand it there is to be an appeal against conviction and sentence which, in my opinion, this is the least Nicola deserves and it needs to highlight a third issue that psychiatry has failed to resolve and the media has ignored: mainly whether “personality disorder” is treatable or not.

  10. There are a lot of if and buts and maybe’s contained within the review. We are all aware that there are deficiency in Mental Health training for Police and that of the professionals who are at the front line. Throw in competing factors like bed space and funding and you have a recipe for disaster.

    Hindsight does indeed come with 20/20 vision and whilst lessons can be learnt it is very difficult to view decisions in the cold light of day when all the pieces of the puzzle are present.

    Would a PNC have saved a life and prevented this review? We will never know, but, then surely we start to move into the should pre cons affect the decision there and then. Hindsight says yes but at the time when the situation is live!!!

    I am confused as to why the great play on the mental capacity act when that is not the all empowering legislation that people seem to think – it is not generic and therefore you need a qualifier; lacks mental capacity in financial matters etc. Surely the Human rights act would have played a greater part in the decision making process and yes the PNC could have revealed information that would have triggered a recall or certainly a conversation about it – I accept that when detained and placed on a ward that information could have come to light; it did not.

    For lessons to be learnt and some good to come from a loss of life, I accept that this will never replace the loss, then a fully open and public investigation of the health departments needs to take place.

  11. Great post. I put a similar reply on NC’s blog.
    First of all – how many operators pass previous convictions from PNC? I can honestly say I would be looking for warnings or missing markers.
    Secondly – If I remember the definition correctly, it says ‘in need of immediate care or control’ I have lost count of the times we have been asked by MH teams to ‘136’ someone for them which on its own is unacceptable.

    From both your blogs , the overriding issue to me is the dependence on the police by the NHS and mental health patients.
    Kate (in reply) makes most of the points I would. I was very disappointed to see that DM headline but was not surprised.

  12. I feel mental health services are lettin patients down as my daughter was discharged from them last year and I fought tooth and nail to get her back in. She has 10 overdoes last year and tried 3 time to jump of road bridges she been on that many s136 if she went on another she be arrested for wasting police time which never happen thank fully but I fear that will make her worse if it did. She fears police now and worries when she a copper, she gets no help when sectioned and even let her home to take od 3 hours later that would of fallen on police heads as they knew when they took her home but mental health said to. Mental health needs to wake up and help these people its not the police or ambulances job but theirs, they won’t help if she rings either it falls down to pcso in area who even won’t go and see her. I fear I will go round to her house and find her dead and I can’t see her daily more like weekly now and no welfare checks she could lay for days!!! I fear more will fall at police and blame will be put there when they only do their job!

  13. BANANAMAN, when I was in comms and I saw offences on PNC that I thought relevant or serious I would tell the officer the basic summary. If minor then more often not as air time could be busy. Certainly in this case yas I would said something. Sometimes the officers may ask for more info and in that case of course I would go the the relevant page and pass the details.

    1. I would imagine in the circumstances a VI marker is probably going to be on her record with an apporopriate explanation on the front screen but playing devils advocate how many times have I checked, seen a VI/SU/DR marker with no corresponding text explanation and simply passed the marker? Hundreds of times. Unless asked I do not have the time to go into the warning signals page or trawl through previous to find out why. The PNC is a completely un user friendly system with at times some horribly out of date or plain incorrect information. Radio time being what it is now (an expensive commodity) leaves even less time to pass relevant information.

      1. It a year since I left the role but from memory the info I used was on the AS page. ie
        2 Theft and kindred (2002-2011)
        1 Public disorder (2012)

        Your right about the lack of info. Rather like the comment “area of curfew as outlined on the map” and of course no map can be seen on PNC.

  14. ‘Do we think that the judgement of the court today reflects a message from the criminal justice system to the mental health system that attempts to say, “You’ve had your chance to handle this case: now we’re ensuring beyond doubt, the public’s ongoing protection.”’

    In a nutshell yes! I think that the courts have sent a strong mesage to the mental health system by giving her a prison sentence rather than a hospital order, you have to ask what has changed when she was previously given a hospital order for killing her mother – is her diagnosis in question or are the courts saying we gave mental health services a chance last time and within a decade she killed again whilst under the care of services. I am of MH background and for me the glaring oversight is the lack of referral to MAPPA – although I believe from my own practice view that this is not an isolated incident. The lack of any warning system or the failure of the nursing staff on the acute ward she was admitted to in checking her forensic history also plays an important role in this sad saga.

    1. My reading of the judgement is that the courts found her criminally responsible for what she did. That is they did not feel her actions were a result of some kind of mental illness over which she did not have control. I have not come across any hint anywhere of the criminal justice system saying “we are taking over” to the mental health system, rather the opposite in the moves to shift mentally disordered offenders from prisons to hospitals.

  15. It echoes the Hannah Bonser case. Why won’t mental health services listen when service users repeatedly tell them they are seriously thinking of killing someone??? It doesnt make sense because there are times when I have been having a totally innocent late night walk and been picked up by the police on a section 136, the police stayed with me for the whole 10 hours until I was assessed and then free to go home.

  16. There are several issues here:
    1 the scare mongering of the press and the subsequent rise of fear and hatred of those with mental health diagnosis
    2 the abilities of MH services to reduce the risk of the small number of people who have previously offended to offend again
    3 the general treatment of those who are seriously distressed by MH services.

    My experience is that MH services are using more and more restrictive practices in order to try and avoid being found negligent when violent or suicidal incidents occur.. So more CTO’s with more unwanted, forced druggging is occuring. There is evidence, such as a Chocrane Collaboration review, that non of this has resulted in better outcomes for patients or less violent outbursts by those who are prone to them.

    These drugs are dangerous and often not helpful. They are likley to provoke violence when they provoke akathesia (an internal agitation that is unbearable for sufferers) and also when abrutly withdrawn when a withdrawal psychosis often results. Services either deny or minimise these problems. Outcomes were better before modern so called anti-psychotics were develeoped (see Robert Whittaker’s book Mad in America for more details).

    There is increasing evidence that anti-depressents are likely to lead to an increased level of violent outbursts. Most of the school shooters in the USA were on them.

    At the same time the basic theraputic skills of offering understanding and encouragement are not something I see evidenced in most MH workers I meet, especially those involved in working in the community, yet these are the skills that are most likley to reduce the risk of violent outbursts, as they are with any problematic behaviour. Instead they seem to see there role as monitoring the patient and if the person is seen as getting worse they are encouraged to see a psychiatrist for more medication which as detailed above has it’s own problems.

    Whatever the solutions are to reducing the risk from the small number of MH patients who do present a risk to the public they are not being debated at the moment. There programmes that are likely to help such as the Finnish Open Dialogue system or therpuetic communities and they all rely on intensive social support, and in the case of people whose previous behaviour has been violent, appropriate monitoring until the person has shown a basic change in the way they deal with there problems (something which I think is possible as I have seen it happen) but non of this seems to be debated much in relation to this current case.

  17. I am curious as to why it is assumed in this blog that NHS staff would have had access to the full details of her past history and convictions?
    Certainly there is nothing in our locality which would provide the information as quickly as the two minute radio call that the PNC check would have taken.
    In office hours a phone call to her care team might have provided that information promptly, assuming she had given details of that team, but out of hours it is possible that even ward staff admitting her didn’t know – i certainly wouldn’t expect A+E staff to know. Liaison Psychiatry staff might be able to access some form of basic information in my trust such as a CPA review but it’s worth remembering that A+E staff will work for a completely different organisation. It’s akin to suggesting that a police officer would be able to easily access a probation workers notes (although maybe this is possible).
    For a client previously treated within the trust it can be extremely difficult to obtain appropriate information out of hours, for a client outside of the trust, or who receives specialist care from another trust or team it can be near impossible.

    1. It’s assumed because we know from public record and from the IPCC report that by the time she absented herself from the MH ward that the staff knew about her background.

      Secondly, and I’m sure you’ll correct me if I’m wrong, but when assessment was undertaken in A&E, would in not be normal practice for the assessing staff to make those enquiries with staff who can access her medical records. Certainly in all of the MH trusts I’m familiar with, there is one IT system which records basically all patient information and therefore MHAA assessing staff can find out whether the patient is known to the trust – currently, or previously – and access that immediate risk information.

      If this is not the case everywhere, then things I worse than I feared.

      1. That’s my point. A+E staff cannot access Mental Health Records routinely, and there are Data Protection Reasons why they can’t, in the same way as I cannot access records from phyiscial health without long winded requests.

        I can only speak for my location. Here, out of hours, the A+E staff may/should have contacted the Psychiatric Assessment Team as there is no mental health professional employed in the dept. Because the client wasn’t detained under a 136 she may not have been deemed a priority by the PAT. The PAT should have had some access to basics, ie a CPA care plan and any records of previous contacts they (the PAT) had with the lady, but if the she was under a forensic service those details would be held by the forensic service – in your area that is managed by the same trust, it’s not in mine. The PAT team might have redirected A+E staff to contact the forensic mental health service. In an busy A+E dept this provides many opportunities for process failure.

        All in all there are many ‘mights’ but I don’t think it’s safe to assume that knowledge was effectively shared. Did the mental health ward know her background because a member of staff remembered the patient’s history from previous contact or because they had full access to the records?

        Worth noting that the massive IT project to centralise all health records so that any professional could access them anywhere, anytime was cancelled by the Government due to the costs.

        All in all I don’t think this discussion fits in with a ‘no-blame’ culture that allows us to learn from mistakes, instead we are all being a bit defensive, even when we don’t know details.

      2. There are Data Protection reasons why one part of the health service who are required to provide health services can’t access health records? I don’t believe this for one minute and it’s certainly not what the Data Protection Act says. There may be logistical or IT barriers to this, but they are of NHS making, just as they are of police making that West Midlands Police cannot directly access Metropolitan Police intelligence records. But if WMP contacted the Met and said, “This is what we want to know and why” then the information can shared. Moreover, the information MUST be shared because those requesting access have a lawful reason for accessing it.

        The facts remains: by the time Nicola Edgington absconded from mental health care on 10th October, the NHS knew what they were dealing because some kind of liaison function was involved with her and they didn’t get this information from the police. We don’t more than that at this moment, because no-one in the NHS will publish a report on the matter despite the events having occured eighteen months ago and despite it being known that something somewhere went wrong because two nurses who used to have jobs now don’t have jobs. Everything else is a degree of assumption or speculation but it remains true that we do know for a fact that the NHS knew her background information – because they relayed it to the police when she absconded – and they didn’t get this from the police originally.

      3. I should have read the IPCC report first. Now that I have I can see that there was later contact with a liasion nurse and then a doctor. Key will be what information they had, not just about her conviction and previous sec 37/41 but more importantly her warning signs profile and her ‘normal’ presentation.

  18. Michael, I’m interested in your view on paragraph 146 of the IPCC report which states “Where the conditions for use of Section 136 are fulfilled the person MUST always be detained under Section 136”

    If this is IPCC advice, then it appears to be at odds with S136(1) which states that a constable “MAY, if he thinks it necessary” remove to a place of safety, not MUST.
    It also appears to be at odds with the MHA Codes of Practice with it’s overarching principles of Least Restriction, Respect,and Participation.

    I really think that paragraph of the IPCC reports needs to be challenged as it seems to fly in the face of necessity, proprtionality and the exisying legislation and guidance and smacks of the IPCC trying to find fault with the actions of the Constables on the scene when in fact, having read the report, they appear to have done very little wrong.

    1. Well said Steve, I completely agree. To me, although not having read the IPCC report, from what’s been said on this forum there does seem to have been some almost naive statements made by the committee.

    2. I agree, as a service user this really scared me. So I can’t ask the police for help without being arrested and getting a criminal record? And where I live there is no ‘136 suite’, so EVERYONE goes to the cells.
      This does not seem right at all, there should be room for negotiation and flexibility.

  19. The IPCC report says that because of cuts, Met police officers are only given computer training on Section 136, which the report describes as a ‘tick box exercise’.
    That seems very very wrong to me. I know you don’t like calls for more ‘awareness’, but you can’t get any awareness of how to deal with someone who is hearing voices or actively suicidal from just a computer, surely?!

  20. Re being detained on a 136 and then having a criminal record this is because it is exercised under PACE and therefore is often (although bizarrely not always) recorded on the PNC. If you request your records under the Data Protection Act you get to see if it has ben recorded. This has much wider implications that further interactions with the police. It also appears on the CRB check (now called something different) when you apply for jobs or volunteer posts – however as a criminal offence. Plus of course when you apply for visa to US and other countries and a ‘criminal’ check is done. So as someone with a mental distress history but with no offending or violence history I am criminalised.

    With regard to this case a PNC check may have informed the police who in turn could notify A&E staff but my understanding is that she had repeatedly told police and MH authorities of her offending history so it was already out there. It was why she was asking for help. The reason MH services ignored her is because they had given the diagnosis of personality disorder and that conditioned their response ( or lack of it). In their eyes she would have been seen as manipulative and attention seeking and admitting her would probably have been considered as reinforcing her behaviours. Just my opinion for what it’s worth but let’s see what the NHS report reveals. More likely we will hear fuller details from any Employment Tribunal hearings for the 2 sacked nurses in this case. And while MH services boot the blame football about maybe they should be reminded someone died as a result of their inaction. The sooner a duty of candour in the NHS happens the better….except of course MH will be excepted from that

      1. I understand that S136 is not a criminal record. However for employers who believe they are essentially checking criminal history ( and now barring history) this is the context it is seen in. How would they know differently? It is rarely relevant to employment but unless a personal approach has been made to the police authority who detained to use discretionary powers not to disclose then it often will be. Therefore you are presented with 2 potential problems as a job applicant ot volunteer: Firstly you may well be refused emplyment/ volunteering and secondly if you choose to explain then you are forced to disclose your MH history when you wouldn’t have otherwise .

        I speak from personal experience and as an Adviser. MIND have campaigned on this and the All Parliamentary Group on Mental Health have discussed it as a problem. The current case going through the courts regarding disclosure of spent offences/ offences in youth may give further legal guidance on this. We will see.

        The DBS appeal system does not prevent s136 dislosures. It’s remit is about informed recruitment decision and not human rights issues or the fact that the mechanics of s136 means it is under PACE and recorded as such. You can only appeal AFTER you know there is a problem and when this has been addressed with them they acknowledge that there is little understanding of the issues. My working and volunteering background is health and social care and I will always require a high level of check . And rightly so. What I object to is essentially criminalising me because I am vulnerable at time to mental distress when I have absolutely no forensic or criminal history.

      2. It is my view that the DRB appeal system should not prevent s136 disclosures – they will be irrelevant to employment a lot of the time, but not always. Don’t forget that s136 is often used in circumstances where criminal offences have in fact been committed, but for reasons of humanity, expedience and public interest that is not regarded as the priority.

  21. The problem with 136’s is that they turn up randomly regardless of whether you have been completely passive and compliant or whether you are aggressive and threatening to others. By lumping the first group in with the second you simply reinforce all the stereotypes that those with mental distress are violent and have potential to injure and threaten others. Police forces should apply guidelines to decide but it is totally arbitory and they don’t have the time, resources or even information needed to make fair and just decisions.

    In my case a formal complaint about misuse of s136 ( including unlawful detention) was upheld by the force involved with apologies but still appeared on a CRB check. Other s136’s with the same force ( lawfully exercised) have not appeared. If I commit a criminal offence and am deemed responsible for my actions then this should be differentiated from me being in a state of mental distress and confusion. Rethink has a useful factsheet on how the police should make decisions and how to challenge a disclosure.

    However the ONLY practical way to pre-empt an inclusion is to challenge a s136 as having been inappropriately exercised – by raising a formal complaint against the police . Then the full details needed to decide on future disclosure are recorded. There is no other way of there being the detail needed for the police to make an informed disclosure for a future DBS check. This is onerous and triggering for the person with mental distress and extremely expensive for the police. However in my area it was what the police advised me to do – and believe me I tried to have informal discussions to manage the situation but there was no mechanism for this.

    So until the guidelines change and s136 are not automatically considered for inclusion I will have to continue to challenge in this way simply to get the facts in record.

    1. Since CRB checks became DBS checks after legislation ammended the vetting processes last year, the is a strengthening of the procedure from a patient’s point of view. The threshold for inclusion of information is now higher AND the person has a right to know about and appeal the information before it is disclosed to the prospective employer. Still not ideal, in my view: but a step in the right direction.

  22. Agree entirely with Susannah. I was shocked to be honest to find out that detainment under a section 136 (and indeed other sections e.g. section 2) can be revealed. Given the stigma around mental health problems it is entirely understandable that people don’t want their history being revealed to a prospective employer. Doesn’t matter how long ago it was, in this job market, you seriously think any employer isn’t going to run a mile when they have 100 other qualified applicants?!
    This is why I can’t get the voluntary work and employment which would, ironically, help me rebuild my life and recover from years of mental health problems.
    On Nicola Edgington, I maintain that police should have done a PNC check and should have remained in A&E. They would have discovered her history i.e. that she had killed before and this might have influenced whether they stayed at A&E. Surely someone who is stating they will kill *and has done it before* is a high risk? OK she went willingly with the police at the time…so I agree, no need for a section 136 – but I know from personal experience that willingness to co-operate can change in minutes. I have taken myself to A&E, only to walk out and attempt suicide…I have been taken by police to A&E ‘willingly’ only to try to abscond and be sectioned. Asking for help didn’t work. Even being picked up by police and co-operating in going with them often didn’t actually get me any help. I would go from recognising I needed help and being willing to make a last-ditch attempt to get it to deciding to give up and commit suicide.
    I will grant that the NHS also failed Nicola Edgington and importantly her victims, more so than police. The nurses involved in allowing her to abscond entirely deserved sacking. This is probably, as someone pointed out, due to the nonsensical ‘personality disorder’ label (read: bad person who doesn’t deserve help).
    A similar point can be made from this case (apologies, Daily Mail link): http://www.dailymail.co.uk/news/article-2338439/Cumbria-double-murder-Son-suspected-killing-mother-sister-begged-stay-locked-mental-hospital.html?ITO=1490&ns_mchannel=rss&ns_campaign=1490&utm_source=twitterfeed&utm_medium=twitter

  23. thanks a very interesting and informative article. From a position of very little knowledge (i.e. press coverage) I had picked up that the police hadn’t used S136 but I was unaware that she had actually walked out of a psychiatric unit (the press reported she had walked out of A+E thus leading me to conclude that the police were at fault for not using S136) so on the whole I agree that S5(2)/5(4) could have been used and this is probably the key failing.

    Having said this guidance recommends that police should be more ready to use S136 in these situations. If they believe that someone needs to be taken to a place of safety they should use S136 rather than taking the person informally as this makes management of the situation easier for everyone. It may also have been the case that it would have triggered a more thorough assessment of her situation earlier in the process by the mental health professionals.

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