The Royal College of Psychiatrists chairs a multi-agency Mental Health Act group which produces guidance, standards and documents around “Section 136 of the Mental Health Act 1983 and the operation of ‘Places of Safety’.” Over the last five or six years, I have probably quoted their guidance several thousands of times when trying to push for services to improve or alter the way they operate, or in some cases to push them to exist at all.
The other organisations involved in that multi-agency group include: the Association of Chief Police Officers – representing the police; the College of Social Work – representing AMHPs; the College of Emergency Medicine and the NHS Ambulance Chief Executive Group, amongst others. It is also supported by the Independent Police Complaints Commission and the Care Quality Commission, along with equivalent organisations in Wales.
In other words, you’d imagine it to be the final word on what s136 and Place of Safety services should look like – and you couldn’t be more wrong!
Although the position on these issues has improved considerably in the last ten years, there is still a long way to go. Some counties within England still have absolutely NO place of safety provision for those detained – none whatsoever. Everyone is taken to the cells, unless they go via Accident & Emergency because of physical injury / illness. Many more still operate ‘exclusion criteria’ of various kinds which prevent some people being able to access those services, amidst ongoing presumptions that cells can be used. As you’ve read on this blog before: this should not be presumed because to do so would not always be possible, by virtue of not being safe and legal.
2013 GUIDANCE TO COMMISSIONERS
The recent publication of the April 2013 ‘position statement’ from the Royal College attracted my attention. I was keen to see what it involved and what it added to the 2011 Guidelines. Not much, although I welcome the publication because it is a useful document which presents relevant issues even more plainly than the guidelines.
In particular, I like the fact that this document is pitched at NHS Commissioners. Of course, April 2013 saw Primary Care Trusts (PCTs) in England ceasing to exist as GP-led Clinical Commissioning Groups (CCGs) take over responsibility for healthcare:
- Pages 11/12 – summary of the main problems with s136 pathways and what should be a feature.
- Pages 13/14 – a succession of questions which should prompt review of how effective PoS services are in terms of delivery.
There are various statements worth highlighting and I’d like everyone to fully absorb how unambiguous this is. The challenge for us all is therefore not to keep debating, obfuscating and resisting this, but focussing upon how it can be realised –
Nearly all individuals detained under Section 136 should be taken to a place of safety in a mental health unit – the main exceptions are those requiring urgent medical assessment and treatment and those too disturbed to be safely managed in a hospital setting.
- There must be adequate provision for the anticipated demand – this should include suitable provision to meet the needs of specific groups; in particular, those under 18 years, the elderly and people with intellectual disabilities.
- Individuals who are intoxicated should not be excluded from the MH PoS – unless they need acute medical intervention or are too behaviourally disturbed to be safely managed.
- The MH PoS must have staff on hand to receive the individual from the police without delay – there should be sufficient staff to cope with all but the most challenging behaviour, without recourse to ongoing police support.
This can actually happen – most of this happens, most of the time in the West Midlands. I’m not pretending it’s perfect, all of the time – but I am saying that in a police force where around 1,000 people are year are being detained by officers, we have in two years had just 23 + 43 people in police cells, detained under the MHA. That is 96.5% of detainees directly accessing healthcare and a more appropriate environment.
You’re not going to convince me that within that number there were no resistant or intoxicated detainees; no children – this can be done, and it does most appropriately sit with NHS Commissioners to ensure it gets delivered. As my previous experience with Commissioners in PCTs revealed people who had varying levels of knowledge and interest around mental health and its interface with the police, this document is very welcome because it effectively summarises the guidelines and makes the important parts both blunt and obvious.
The only remaining question is whether we’re going to do this, or not?
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.
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