Section 6 Mental Health Act

Where an AMHP has made an application for the admission of a patient under the Mental Health Act to hospital, they will often seek police support to safely achieve admission where patients indicate they will resist admission and detention.  Where do police officers get the authority to detain and convey patients and perhaps crucially, to use proportionate force in achieving this?

There are a couple of barriers to easily understanding this frequent question and I’ve had it posed a many, many times including twice this week alone and I’ve only just realised I hadn’t written a specific blog on it so this one is dedicated to west / central Birmingham, where I began my career and learned exactly how little I knew about policing and mental health!

The barriers to a clear understanding arise because –

  • Nowhere does the Mental Health Act specify police officer’s responsibilities in the scenario of a resisted application for a patient who is not yet admitted.
  • Nowhere does the Mental Health Act talk about the use of “reasonable force” in a way that is as clear, for example, as s117 of the Police and Criminal Evidence Act 1984.

LEGAL CUSTODY

Where an AMHP or Nearest Relative (NR) has made an application for the admission of a patient under either section 2, 3 or 4, the effect of this application is described in Section 6 of the Mental Health Act –

  • “An application for the admission of a patient to a hospital, shall be sufficient authority for the applicant, or any person authorized by the applicant, to take the patient and convey him to the hospital.”

The bold in the above is my emphasis: this is where police officers derive an authority to detain / convey, if they are requested to do so by an Approved Mental Health Professional.

A condition of legal custody emerges after the application, by virtue of s137 MHA, which states:

  • “Any person required to be conveyed to any place shall, while being so conveyed, detained or kept, be deemed to be in legal custody.”
  • “A constable or any other person required or authorized to take any person into custody, or to convey or detain any person shall, have all the powers, authorities, protection and privileges which a constable has within the area for which he acts.”

So the question arises about when AMHPs or applicants should ensure the detention and conveyance and when the police or paramedics become involved in supporting that process.

DELEGATED AUTHORITIES

There are a few points worth making about section 6 and the “delegated authority” to detain and convey.

Firstly, I would argue such authority should always be given in writing – this is alluded to in the Code of Practice to the Mental Health Act, which talks in para 11.17, about AMHPs “providing provide the people who are to convey the patient (including any ambulance staff or police officers involved) with authority to convey the patient. It is that authorisation which confers on them the legal power to transport the patient against their will, using reasonable force if necessary, and to prevent them absconding en route.

This is important: without a properly delegated authority, police officers and others have no legal authority to detain / convey.  The Code of Practice is statutory guidance that should be followed unless there are “cogent reasons for departure”. << This is a phrase from the House of Lords case which ruled on the significance of a Code of Practice.

Secondly, the applicant for admission – whether it’s the AMHP or the patient’s Nearest Relative – cannot compel another professional to accept their delegated authority.  So no-one can force the police or paramedics to detain / convey.  And this is where “local protocols” come into it and it all starts to get potentially very difficult!

Your local area should have a conveyance agreement, between the NHS, the Police and local authority about how conveyance gets done in all the predictable scenarios.  This will include compliant patients, passively resistant patients and aggressive or violent patients.  It is the responsibility of Clinical Commissioning Groups to ensure that transportation arrangements for their populations are properly commissioned, usually through the NHS Ambulance Services, but they could include private providers for some specialist kinds of conveyance.

The protocol should lay this all out and should cater for how the admission of resistant or aggressive patients is achieved, where they have been legally detained and I have written before that the management of resistance and aggression is not just a role for the police.  The first reaction to any level of resistance should not be the police or threats of the police.  If de-escalation is the watchword of mental health care, we can just proceed straight to the final tactic!

PASSIVELY RESISTANCE PATIENTS

Passive resistance is a phrase used in police training to describe people who are resisting a course of action, by doing nothing – sitting still, refusing to stand, verbally resisting, etc., etc..  I’m sure other professions may have different terms for this kind of resistance.  Where such a situation applies to a patient for whom admission is sought and to whom section 6 applies, how do we navigate those waters?

I have argued that assessment of RAVE risks are key – this is my mnemonic for attempting to determine what is instinctively a “police job” and what is not (yet) a police job.  It means –

  • R – resistance
  • A – aggression
  • V – violence
  • E – escape

RA should be considered first for de-escalation and this may be better done by non-police professionals – I know that many may contest this and say that the mere presence of police officers in uniform is “motivating” in the sense of presenting an implied consequence to ongoing non-cooperation, but I say two things.  Firstly, I don’t mean here that it may not be necessary to have the police hovering in the background in case things escalate.  That may be perfectly sensible depending on the situation or the patient.  Secondly, it is at least arguable that the introduction of uniformed officers could be aggravating – certainly the Alzheimer’s Society caution against this in some situations because it present extra stressors and unfamiliarity to patients who may be acutely unwell.  All cases on their individual merits.

VE are very obviously police tasks – the management of violence creates that statutory imperative to prevent crime, including against NHS professionals and active attempts to escape do likewise.  When things have reached this stage the proportionality of involving uniformed officers changes because the dynamics of the incident have changed.  Very obviously, RA can escalate to VW and that is something that should be carefully considered when thinking about whether to introduce the police to a scenario.  All cases on their individual merits.

GETTING PRACTICAL

So what is there to say about NHS or social care staff navigating the RA-type scenarios?  Well, I’ve heard interesting debates about whether AMHPs or paramedics could / should / would put their arm around a patient or apply a flat palm to a patient’s back and provide a very limited amount of force to attempt to move a patient by way of “active encouragement” whilst providing verbal instruction AND reassurance.

An AMHP told me earlier in the year that they would be reluctant to even touch a detained patient in case an assault was alleged and that this was not the case when they began their careers twenty years previously.  I replied, “Even though the law that the police would use to move a patient with low level of physical encouragement is the very same law that you would use?  What you’re really saying is you would just prefer the police to take the assault allegation against the officer than against you?”

What about “proactive blanketing” by paramedics?  Incidents involving elderly patients who may have additional physical frailties and who are passively resisting are not, I would suggest, situations where we immediately want to see force being used by paramilitary looking police officers.  There surely could or should be something before this?  I have seen some practically minded AMHPs and paramedics getting hands on, professionally and responsibly managing patients into chairs and pro-actively blanketing them.  Is this not a more dignified way of managing vulnerable people when they are ill?  We were hovering nearby in case things escalated.

SECTION 6

So there will be difficulties in discharging section 6 scenarios – not least when resource issues enter the debate!  But we have seen and we continue to see, situations where absolutely no amount of physical force being used is contemplated by AMHPs or paramedics and let me be clear about what I mean:  no-one is arguing for actively resistant patients who are lashing out to be managed by social workers.  No-one is saying people should risk being assaulted where those risks is heightened beyond the risk that any of us could be assaulted at any time.

I am arguing that NHS commissioning managers should think about the implications of all coercive force being a perceived monopoly of the police, in disregard to the will of Parliament who did not make it a police responsibility and unlike the Irish Dáil which legislated in such a way as to mean that the British police cannot be legally compelled to coerce.

As such, some things are very clear:

  • The police can use force to compel the admission of patients – section 6 MHA.
  • The police cannot be compelled to compel the admission of patients – section 6 MHA.
  • So that means whether they do so, is about properly negotiated agreements which take account of patient dignity, welfare and the particular roles that agencies can bring to coercive care – Chapter 11 of the Code of Practice to the Mental Health Act.

And if you haven’t got properly negotiated arrangements for detention and conveyance, you’ll find that the shades of grey in this legislation cause difficulties.  This is why it’s a matter for commissioning and provider managers in the NHS as well as senior operational police officers to get round a table and get it sorted.


IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


 

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28 thoughts on “Section 6 Mental Health Act

  1. Community health and social care staff are routinely not trained in anything other than breakaway skills, to go into a situation where we would assess that a patient to might use violence or escape (using your RAVE assessment) without having someone who is appropriately trained would therefore seem to be negligent.

    In requiring the police to be in attendance in the use of s135(1) and s135(2) and then referring to the police in conveyance, the MHA, and those that drafted it, and indeed the subsequent CoP, clearly intended the police to have an active role in the process of accessing or moving a person.

    CoP 11.17: “If the patient is likely to be unwilling to be moved, the applicant should provide the people who are to convey the patient (including any ambulance staff or police officers involved) with authority to convey the patient. It is that authorisation which confers on them the legal power to transport the patient against their will, using reasonable force if necessary, and to prevent them absconding en route.”
    Note two things, there is a clear expectation that the applicant, the AMHP, is not conveying the person and there is specific reference to both ambulance staff and the police. I think it’s fair to say that when the CoP was written it’s authors simply hadn’t considered that the police would even be considering withdrawing their support for these processes, the above clearly indicates that police involvement would be as routine as ambulance staff not just where there is violence but also where there is passive resistance.

    1. Again, it seems that in the bun fight that results from massive cuts agencies, rather than speaking with a united voice to fight the cuts, engage in squabble and trying to shift responsibilities in a way that negatively effects the vulnerable people we are supposed to be protecting in order to protect the resources of the respective agencies we work for……

    2. It says ‘including” so there’s nothing stopping MH teams being suitably trained. Besides there are private ambulances where staff will restrain and convey. Just because police and ambulance staff are the obvious ones to include it certainly doesn’t exclude MH staff from doing it.

  2. I’m a paramedic and I frequently transport patients who are being sectioned. It’s very rare (136 apart) that I have/need police assistance for this. Sometimes it takes me a long time to get these patients out but I give that time to form a bond and then generally they will move to the ambulance of their own volition. They have lost so much control already I find it really helps to give them a little bit back. (What do they want to bring with them/ do they want to have a cigarette before we go out to the vehicle/ which shoes/coat/bag are the bringing. ). I just don’t have difficulties with this.

    1. Thanks for saying so – feedback to this post suggests it is an area of ongoing discussion … or dispute? I’ve seen stunning patience by Ambulance crews leading to non-coercive outcomes where coercion was explicitly sought and it does make me think we all still got some shared understanding to generate. 🙂

  3. The trouble is that when it comes to MHA assessments there is no MH Team after the Pinks have been signed. The AMHP is left on their own at times for hours while waiting for an ambulance.
    I would have no problem calling trained MH nurses to assist in conveying a resistant patient rather than the police but that resource doesn’t exist. Mental Health Trusts have no duty to provide this and more and more now if a service is not funded by PbR its not going to happen. The omnishambles which has been created by abolishing SHAs and PCTs has left us with CCGs who have no idea of their responsibilities so unfortunately i can’t see the situation improving in the near future.

    1. why nurses? surely trained social workers are just as capable of getting their hands dirty……..in reality when not enough beds exist and patients routinely sleep on sofas and mattresses on the floor I’m wary of ANY more work for MH staff without nuclear injection of dosh (not going to happen)

      1. Nurses, because they already get control and restraint training – it’s only the restriction of such training to ward staff that prevents this being possible.

        We’re all wary – I’m wary of the situation where seven police officers, including me and one of my sergeants, are stood for hours in a residential unit because some bureaucrat with less clinical training than me (first-aid certificate) took a non-assessed decision at 4pm to inappropriately place an LD patient in nursing accommodation with almost immediate effect and then waltzed off to drink Pinot Grigio and eat pringles whilst the police were called to her smashing the place up with a level of predictability that compares with the potential that the sun will rise in the morning.

        I’m not arguing for yet more work: I’m arguing that the 59% rise in MH funding over the last decade gets properly spent on care so that NHS organisations can absorb the nature and variety of demand that hits it. It is currently nowhere near.

    2. Very aware it doesn’t exist: my point about it is that its non-existance is a decision – albeit an implicit decision or rather an omission – on the part of those who design the service. It’s rather like the Chief Constable looking out of his office at the riot and saying “We don’t deploy officers to that because they’re not public order trained.” Mental health trusts have no duty to provide it, because they’re not commissioned appropriately and that comes back to your above mentioned omnishambles. The point is, this doesn’t create any imperative whatsoever for the police to run along, allowing themselves to be sucked into the vacuum of the commissioning gap.

      So consider this a polemic about what CCGs and NHS England should be looking at!

  4. ‘An AMHP told me earlier in the year that they would be reluctant to even touch a detained patient in case an assault was alleged and that this was not the case when they began their careers twenty years previously. I replied, “Even though the law that the police would use to move a patient with low level of physical encouragement is the very same law that you would use? What you’re really saying is you would just prefer the police to take the assault allegation against the officer than against you?” ‘

    The point i think that the AMHP is making is that the detained patient is unlikely to make an allegation of assault against a police officer to another police officer. If the detained patient makes an allegation against a social worker to a police officer i’m afraid the perception is that a police officer may well take the complaint seriously and arrest/interview the social worker. This may be a totally unfair perception arising from a few blown up scare stories of members of the public being arrested by over zealous police officers but it is a perception that exists. So it isn’t about preferring the police to take the assault allegation but more that if it is a police officer there won’t be an allegation.

    1. Just as pointless to argue that the officers should be wary of what they do in case the force they use is subject to a complaint by the AMHP for being excessive. We all know what we need to do and we should be prepared to act in ways which are justified. Parliament envisaged AMHPs and others that aren’t cops using force: otherwise they wouldn’t have bothered to legislate that way. I’d like to know what those circumstances are because no AMHPs I’ve conversed with seem to think it is their role, even though it is clearly envisaged by law.

  5. #GENOWINS
    ‘…..I’m afraid the perception is that a police officer may well take the complaint seriously and arrest/interview the social worker.’
    It is attitudes like this that foster such distrust between MH workers and those being assessed or detained. Why shouldn’t Social Workers ( and nursing staff) get interviewed when an allegation of assault is made – are they immune from the law? Do they never overstep the mark? Safeguarding not an issue when being detained against your will?You seem to have the belief that because someone has a mental health crisis they should not be afforded rights as a citizen to be protected from assault.

    As posted already some skill and treating people with humanity, dignity and compassion would go a long way . If someone is forcibly having their liberty taken from them because they are unwell they enter a system where they have less rights than someone charged with a criminal offence. Force has to be proportionate and allegations taken seriously. Without this there is no credibility. If patients detained had more trust in MH workers per se than these incidents would be fewer.Dismissing allegations does not foster a culture of trust and may well be well outside the law.

    1. You’re quite right, of course — all complaints should be taken seriously, whether against AMHPs, police officers or anyone else. They should be investigated proportionately and to a professional conclusion. Anything else would be negligent and if you’re in the business of coercing other human beings, you’re accountable for the legal decisions you make including detention and / or the use of force.

    2. SarahR. At no point did i say social workers shouldn’t be interviewed where an allegation of assault is made. The point I am trying to make is that it is because AMHP’s do not want to have an allegation made against them that they don’t lay hands on a detained patient. If they did and an allegation is made of course it should be investigated. I’ve read my initial comment again and can see i wasn’t clear so apologies for that. I agree with paramedic Sam’s comments, regarding a lot of patience from the AMHP and paramedics often overcomes the initial reluctance to step into the ambulance. The majority of community MHA assessments do not require the police to assist and when they do it is rare for even reasonable force to be necessary. Normally the paramedics do a fine job in persuading reluctant detained people into the ambulance and i am also quite happy for family members to convey as long as the risks are managed and assessed. It is all about the individuals dignity and my original comment didn’t reflect that.
      MENTALHEALTHCOP – As you say the law allows for it but there is also a recognition that police assistance is required if the patient is likely to be violent or dangerous. The commonly held AMHP view, i think, is that if a detained person is refusing to move into an ambulance with an AMHP and paramedics present and after considerable verbal encouragement has been made then there is a reasonable chance they will strongly resist even minor force with the real risk of the situation escalating into a violent and dangerous situation. I realise that there is a difference for the police in using pain compliance on an aggressive drunk on a Friday night and a person requiring reasonable force to convey to a Psychiatric hospital but like it or not you guys are seen as the specialists and in those rare occasions the ones who will ensure the most dignified entry to hospital as is possible in the circumstances. I don’t think it has anything to do with your response to the AMHP they they would prefer the police to take the assault allegation.

      1. You can see me as whatever you like: the acutality is that I am a cop, trained in pain compliance and I think that specially deployed nurses with therepeutically appropriate restraint training are the specliaists – just like they are in hospitals. I am – as all police officers are – generalist “or else” muscle. AMHPs, commonly or otherwise, are welcome to their view. As am I. Of course, where the risk are at the violence or “dangerous” stage, there is a role for the police, supported by medical professionals. But that’s not what my above-mentioned concerns are about, are they?! It is about the low-level management of passively resistant patients. I can only say so many times and as unequivocably that active and assertive resistance is a matter for the police.

        Parliament legislated as they did, deliberately and for a reason. So I ask again: in what circumstances are AMHPs going hands on with patients? If the answer to that is “never”: it either means you’ve failed to prepare and train for your statutory role, or the NHS Commissioning managers have failed to prepared and plan on how others will support you. If this were not the case and if it really were that the police were expected to always be the coercive arm of the UK mental health system then Parliament would have done what the Irish Dail did – obliged the police to do as they’re told when mental health professionals direct them. They didn’t: they ghave powers to AMHPs and enabled them to delegate to non-police professionals. I, along with Parliament, expect to see them used in just some, situations. Not all – not when it’s dangerous, but when it’s appropriate. It’s not appropriate for the police to inflict pain compliance on a 84yr old conused man who is so frail we’d probably break him by doing so. And the Coroner agreed.

        If an AMHP chose to refuse because of internal bureacracy and politics, that’s fine: but I’m not here to do as I’m told when the safety and dignity of vulnerable people is brought into question by decisions that were taken because of expedience. I am entitled – actually, the law has made clear I am obliged – to resist doing that which I know is wrong, until I can evidence it has become the absolute last resort, and that’s it’s proportionate to the risk of not acting, etc., etc.. This means, in situations which are well short of violence and danger and in cases that are just about passive resistance of confused people, that police refusals accompanied by professional resistance and reprepsentations to AMHP managers and on-call managers should be expected. I have (tens of) thousands of words to write for the complaint investigation that may result from any AMHP suggesting I was out of order, based upon what the courts and medical authorities of this country have to say about the situation.

  6. Accountable is a key word here. Too often being accountable is seen as some sort of dirty word rather than explaining justification for actions and decisions that is actually required and professional. It’s an essential part of the thinking process in detention, or at least should be. Think about it – as an AMHP/s12 Dr you are requiring the individual to account for their thoughts, words, actions often in minutiae at a time of great distress and fear while knowing all the time they are likely to be locked up ( no beds now wothout detention) by strangers. It is this resistance. seeing accountability as some sort of threat that will lead eventually to a criminal Duty of Candour being imposed.

    Being accountable, being transparent and if necessary saying sorry is good practice. Applies to us all.I really wish that MH workers would get this concept. Instead the over reliance on threat is used for a multitude of reasons- none of which are acceptable. In this area it is stated Trust policy/protocol to call the police EVERY single time there is a s135 assessment irrespective of RAVE risks identified on this site. Not after assesment, not with a warrant but on first attempt to visit.

    This can only have been the Trust putting their own interests first as it certainly doesnt support the patent and wastes police resources. Yet I have never seen or experienced these same staff making a stand and not depending on police back up which lends heavily to the belief of patients that all sections are pre- determined. Iis the aspect of MHA assessments that is complained about most And therefore the next time ( and there is usaully a next time) is charged with distrust, anger and risk for all increases. If you know police are always called the pressure to act on thoughts, voice commands etc rises exponentially. You know the AMHP has given up on the idea of talking.

    The police here have finally taken a stand (enforced cuts) as they cannot and should not attend in many circumstances. Believe me once an AMHP decides on police intervention any trust with the person assessing goes out the window Previous poster who is a paramedic shows us all how to de-escalate and convey with dignity in what is a truly terrifying situation for patients – often the focus is only on what may be difficult for professionals.

    1. Could you clarify what you mean by the police being called every time there is a section 135 assessment. If you mean every time that a section 135 warrant has been granted by the magistrates then the police are required to execute the warrant so they would have to be present. The AMHP should only be granted the warrant if they can show to the magistrates that reasonable efforts have been made to assess the person without the need for the warrant.and that the warrant is justified.
      If you mean that the trust and/or the Local Authority who employ the AMHP insist on police attendance at every community mental health act assessment then that is very wrong. As said in my recent comment the majority of assessments do not require the police to attend or convey so there is no need for there presence.
      I’m also unsure what you mean by you haven’t seen those ‘same staff making a stand and not depending on police back up’. Do you mean AMHP’s or ward staff. Again in my experience the vast majority of community MHA assessments and incidents on the ward do not involve the police. I will qualify that to say that i don’t work on the wards so the evidence i have for that is anecdotal or based on a selection of MDT notes i have read for MHA or Safeguarding purposes.
      I have to disagree with your final comment that the focus is only on what may be difficult for professionals. A lack of resources, whether that be staff, beds, training etc mean that there are going to be compromises that impact on the patient experience (to coin a phrase) but maintaining the dignity of the patient as much as possible should and i would say almost always is the focus of the assessing professionals.

      1. “The AMHP should only be granted the warrant if they can show to the magistrates that reasonable efforts have been made to assess the person without the need for the warrant.and that the warrant is justified.”

        That just couldn’t be more wrong. It’s one of those (many) things that MH services have just made up. Criteria for getting a warrant are five things –

        1 Person with mental disorder believed on the premises.
        2 Is or has been ill-treated
        3 Is or has been neglected
        4 Is or has been kept otherwise than under proper control.
        5 Is living alone and unable to care for themselves.

        Satsify number one and any ONE of the other four – bingo: legal grounds are satsified. This is all subject to one further consideration, which shows that what you argue isn’t true: para 10.10 MHA CoP – “Applicants should provide documented reasons for seeking a warrant if they have not already tried to gain access” which shows that it is possible to get access, despite not having previously tried. I’ll leave you to imagine what they might be but the above claim is simply WRONG.

  7. #GENOWINS
    No I don’t mean s135 assessments with warrants. In this area (in London) the Trust’s and LA joint internal guidance, policy and protocols ALL state that the police should be called to ALL s135 assessments if there is any concerns. They do refer to risk assessments but the reality is that on figures provided by the Trust and cross referenced with the Met and the LA is that police attendance was requested 93% of the time for s135 without warrant. The missing 7% are probably missing stats. Some of the guidance refers to ‘notifying the police’ but the protocol and policy and pre-assessment forms all refer to requesting police attendance

    Now either that means that 93% of people are likely to pose risks of violence/absconsion/whatever or that it is routine. When queried AMHP’s and managers have repeated that this is what they have been instructed to do – even when they admit they cannot actually identify what the risks are. It seems that they adopt an ‘if in doubt call the police to cover us’ approach.I suspect it has arisen out of litigation but as previously stated what it means is there is antagonsim from the start.

    And for potential detainees the presence of the police becomes automatically threatening and means the AMHP is much less likely to be given access and very importantly very unlikely to get a full enough picture of what is going on. For patients – once police have been called to you that remains on all risk assessments and the assumption for all future MHA assesments is that you pose a risk. So it has a domino affect and reinforces the worst practices and a new risk assessment is simply not done the next time.

    As far as AMHP’s speaking up about poor practice I expect them to. I am glad that you try and put the person first but it is impossible to see how the practice above can be repeatedly justified. Personally I am glad the Met are finally taking a stand because they are treated as some sort of MH lackey enforcer in this area.

    On a final point I think it is negligent that this happens which is ironic given they probably are acting out of some sort of defensive practice. When you turn up without a warrant with the police and are not given access what do they think will happen? Most people will be avoidant of assessment after that and this is simply unsafe for all. In very real practical terms you have called the police and scared off the distressed and possibly very unwell person and now raised the risk exponentially. This area has the highest suicide rates in the country. The aggressive approach used arguably contributes to this – this is consensus amongst service user groups . I am aware that MH professionals would argue that their requests for police are a response to risk – inc suicide – but really? The trauma, cost and legacy this leaves cannot be underestimated.

    1. There is a fundamental misunderstanding of the law here. An assessment at home without a warrant is not a assessment under s135.

      A s135(1) warrant can only be enforced by a police officer with an AMHP and doctor.
      A s135(2) requires a police officer and a representative of the hospital
      Managers.

      The law was written specifying police involvement and entry into a person’a home cannot happen against their will without the police.
      It is defensible practice not defensive practice.

      1. Yes, very well said – although verbose I tend to refer to “Assessments on private premises” and then breakdown issues arising from “Warrant” or “No Warrant”. However, another misunderstanding is that section 135(2) does requires a representative of the hospital managers – it is actually merely suggested good practice. Such warrants can and sometimes are sworn out and executed by the police alone – I’ve personally done it. For example where the urgency of recovering a restricted patient who has been absent for weeks and whose whereabouts suddenly become known in the middle of the night means there is no ability to secure a healthcare professional’s support and because the CrisisTeam wouldn’t get involved and the hospital concerned was about seventy miles away and wouldn’t send staff (fair enough).

        The law is not quite as you state it on opposed entry: it is perfectly legal to enter a patient’s home against their will, having been given consent to do by someone else entitled to grant access – wife, mother, etc..

    2. MENTALHEALTHCOP. . I was pointing out that when an AMHP lays information on oath to the magistrates in writing they have to justify that the criteria for a 135 (1) warrant are met. In my local authority we do this by completing two forms that are handed to the magistrates along with the warrant. Other local authorities may do something differently, i really don’t know if the forms are standard throughout the country. One of the sections that has to be completed asks for specific information on ‘recent attempts to make contact with the person’. This is the part that i have found magistrates are most likely to question me on and if i cannot justify this section i would be surprised if i left with a warrant. Of course if i can provide documented reasons why i haven’t already tried to get access as per CoP 10.10 then that would go into that section. So i don’t believe my comment was wrong, not clear maybe and i will seek to be clearer given the level of scrutiny comments on this blog are subject to.
      You have taken my lack of detailed reference in my comment to make a snide remark about the (many) things that MH services have made up. I think that was an unnecessary remark from somebody who i thought seeks to encourage respectful MDT working. Would you care to elaborate on how MH professionals make things up ?

      Regarding the separate discussion point made below

      ‘So I ask again: in what circumstances are AMHPs going hands on with patients? If the answer to that is “never”: it either means you’ve failed to prepare and train for your statutory role, or the NHS Commissioning managers have failed to prepared and plan on how others will support you’

      Personally the answer for me would be in a very limited way such as assisting paramedics in moving a elderly person into a wheelchair. So while the answer is not quite never it is ‘hardly ever’. More often I have stood in doorways to prevent a person going back inside their house although i’m not quite sure what i would have done if they had shoved me aside. For many of my colleagues, particularly female ones the answer i expect is never. I wonder if it was made clear to trainee AMHP’s that using some physical force on resistant patients is part of the role whether the numbers putting themselves forward for training would reduce. I would also be interested if ASW’s at the time the 1983 law came into being understood physical force may be part of their role and were more prepared to be pro-active in that way. I have a few i can ask and will try to post their responses, if anybody’s interested of course.
      I had an assessment today of a middle aged man who was purely R according to your mnemonic. However he was very strong and very resistant. The police officers had to handcuff him both to take him to the police station (136 suite full) and then bring him to the hospital once he had been detained. Unfortunate but it does show how each case does indeed have to be taken on it’s merits.

      SARAHR- I am surprised that the Met have allowed themselves to be put into that position. In my area the police line is quite clear although flexible depending on the case (or it was when i was regularly on duty). In a nutshell it is the AMHP calls the police to create an incident, providing the necessary details particularly risks, and then call 999 if police are required. Unless of course the AMHP has obtained a sec 135 warrant in which case the police always attend. I agree with you regarding the dangers of overusing the police and i believe that the above system works well although there are AMHP’s and particularly doctors who aren’t so keen where a person has any sort of potential risk (drugs, alcohol etc) whether or not they have actually been violent in the past.

      1. I’m sorry for phrasing that in way that could be viewed as snide – that genuinely wasn’t the intention and you will find other things on this blog where I’ve written about stuff the police have made up. In fact there are whole blogs about the stuff that has been legal legend which just isn’t true (in the police, A&E and in mental health) as well as a blog about how some organisation’s policy (which is not the law) gets put across by staff as the law (when it most certainly isn’t.)

        It certainly was intended to be disrespectful, just factual. So for that, I apologise. But I am also now glad we agree that AMHPs (and others) can and sometimes do and sometimes should, use low-level force. I wasn’t ever thinking of a situation other than the sort of frail elderly, gentle resistant person. Mainly because I have a horror of being asked to hurt such people in persuance of the Mental Health Act.

        Made up things include, “AMHPs have no powers to use force on patients under s6”; I’ve heard MH nurses tell me that “I have no powers to stop a s3 patient leaving a ward.”; I’ve heard a psychiatrist say, “Only the police can return a CTO patient to hospital using force.”; I’ve heard liaison psychiatry professionals say, “A&E is not a place of safety.” and I could go on.

        To counter-balance it, cops often get it wrong too: “You can’t arrest someone who’s detained under the MHA in hospital.”; “We can’t prosecute someone for an offence unless the psychiatrist gives us a written statement saying he has capacity.”; “I can’t enter [the communal area of a residential home] and return an AWOL patient, unless I’ve got a warrant.” Again – the list goes on. Names of mental health professionals (nurses and AMHPs) who are equally exasperated by the lack of precision in the legal training we all get and in the legal views we all express. I’m also far from perfect, but keen to learn.

        Regarding your R gentleman – nothing I’ve written suggests that the police should never be present and a “Leave it with you” type-approach. I’ve made it repeatedly clear, depending on circumstances and background, it may well be necessary to have the police standing by to intervene if things need to escalate and the strength and level of resistance is what our training would call “impact factors”.

        Interesting potential breach of para 10.22 in the PoS decision-making – what else was considered before resorting to the cells? Sounds like you’re describing a s135(1) scenario.

  8. Regarding possible breach of 10.22, There is no contingency plan for when the 136 suite is full (or not staffed). It is a two bed unit which can only ever accept one patient as it only has a maximum of one staff. This wasn’t a 135 (1). Gentleman R had a psychotic episode at home, wouldn’t go to A & E with family who then called an ambulance. The operator at the control room alerted the police who arrived before the ambulance. He was detained on a section 136 when he began to wander into traffic.
    Regarding your ‘made up ‘things. I have heard most of your examples and i suppose i have put them down to ignorance or laziness on the part of the practitioners. As you say they are legends that have been bandied about and accepted without being checked. The Mental Capacity Act has brought a new range of examples. I have heard recently a team manager telling a care home manager she can’t apply a DOL and a Consultant Psychiatrist insisting that a patient can be removed from their CTO and go onto a DOL having agreed 5 minutes earlier the patient has capacity.

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