So last night’s BBC Panorama was always up against it – all of policing and mental health in less than 30 minutes. We saw very human stories and in keeping with the proportions I see at work, most of them involved people with serious mental health problems who were actually arrested for a criminal offence, not detained under the Mental Health Act.
Tyler’s case highlights everything perfectly – he called 999 from his home after being unable to access the mental health care that he recognised he needed. The police, having no legal authority under the MHA, detained him for the offence of threatening to kill someone and that guaranteed his detention in police custody. Detention in a MHA Place of Safety (PoS) does not occur after arrest for an offence and although there is no reason why it can’t, legally speaking, it’s just not the way they are set up to operate. Those of us working the frontline of policing know that if he’d been taken to A&E, as he would have been with a head injury that lead to equally disturbed behaviour, he would have been quickly checked out “physically” and then declared fit for custody. Why can’t he get checked out “mentally”, demonstrating a parity of esteem?
Dave’s story was also interesting: he was arrested for punching someone in the street, which means officers recognising his mental health issues, could have chosen to prioritise his mental health by detaining him under s136 MHA instead. In Hampshire, this may not have made much difference because he would have been removed to custody anyway, given his resistance and aggression. However, officers in Birmingham could have detained him MHA and accessed the Oleaster Mental Health Unit where they would have stayed with Dave supporting our NHS colleagues in managing his risky behaviour. Dependent upon the outcome of the assessment, which would have happened faster, he could still have been prosecuted for assault, if that had been felt appropriate.
Speaking to Dr Lesley STEVENS, the Clinical Manager for Southern Health NHS Trust who provide mental health services to Southampton – so many of the problems for vulnerable people in the care of the police is the commissioning of services and the funding given to the providers. I’m sure if the cheque book were opened and Place of Safety services fully established in proper accommodation, numbers detained in police custody would shrink – as they have in the West Midlands where around 97% of people detained do not go to police custody. And whilst Panorama hinted at it, I would have loved the point to be shouted far louder, that the number of patients detained for offences dwarves the use of section 136 MHA by a factor of TEN. Which means we need to see far, far better Liaison and Diversion services and I would have liked to hear that far more prominently.
But Panorama made a valient effort to raise awareness of the reality of custody and I agree it showed my working day very well. It seems the objective was awareness raising and I think it did that without telling us anything new. This comes at the inevitable cost of getting into the causes of the issues with some depth and moving beyond “Street Triage” as the solution to everything, because it really isn’t. In a one-hour version of this programme, I would have wanted more from the medical and social care professionals and I wanted to hear the word “Adebowale” and didn’t.
In particular, I would have loved to see an interview with the lead Commissioner for mental health services in Southampton’s CCG. I heard nothing of Approved Mental Health Professionals (many of whom were shouting at their televisions as the programme broadcast) – the role of social workers is always going to be key in a system that rightly looks to operate a least restrictive principle, detaining people in hospital only where other support is not appropriate. I also wanted to hear why ambulance services are often not fully involved in this area of healthcare.
There was a particular distraction to the show, caused by the reporting of a side debate – Chief Superintendent Irene CURTIS, President of the Police Superintendents’ Association was interviewed and – amongst other points made that weren’t used! – called for an end to the use of police cells. Having discussed this with her, I know she means an end to the use of cells as a Place of Safety under the Mental Health Act, calling instead for A&E to be used where mental health units are unable to accept. This would merely put the UK on a similar international footing as countries like Australia, Canada and South Africa who do not allow cells to be used. Dr STEVENS’s on-screen reaction was described as “Shock”, stating that A&E would not be suitable. However, this betrays an attitude the police custody probably is suitable despite it representing an argument for the ongoing breach of Para 10.22 of the Mental Health Act Code of Practice. To deny Ch Supt’s CURTIS view, is to argue for potential breaches of statutory guidelines and to increase the potential for patients to be held away from mental health care. And this debate is a red-herring: arguing about A&E or cells as the best back-up is like trying to decide which car you’d prefer to use if you were sailing to France. You obviously don’t want a car at all, you need a boat – and this means properly established MHA Places of Safety so that 500 people a year in Hampshire are not detained in custody at all.
NB: Having reflected further on this programme, I am going to do a follow up to this post focussing on how the tactical examples given did not serve the more strategic and political points being made.
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