The Code of Practice to the Mental Health Act 1983 is almost four hundred pages long, divided into thirty-odd chapters and it is an awful lot to take in. I did read it right through many years ago and vowed I would never do so again! I will probably have to do so at the end of the year, because they’re currently updating the 2008 version and we will apparently see a 2014 update. I’ve been mentioning the importance of the document on this blog since the very beginning and, if anything, I have become more convinced of its importance over time.
I have contrasted the weight placed upon it in some situations by with that placed upon the Police and Criminal Evidence Act Codes of Practice; I have highlighted one particular paragraph of the Code – paragraph 10.22 – because of its importance the extent to which it is often ignored; and I have written about the stated case of Munjaz in which the highest Court in the United Kingdom reminds us that this is not a document dispensing advice that we can take or leave depending upon whether it suits us – this is statutory guidance with which we must comply unless there are “cogent reasons for departure.”
So this stuff is the law to be followed in the vast majority of situations.
IMPROVING WORKING KNOWLEDGE
This morning, I sent out one tweet with a link to the Codes of Practice which listed the main paragraphs that I think a police officer needs to know about, in order to police effectively. Knowledge of these paragraphs is key to knowing whether to say “Yes” or “No” to certain questions that operational officers will encounter and they cover the main issues: places of safety, MHA assessments on premises along with the recovery of AWOL patients and the conveyance of patients in all circumstances. I have often seen the wrong answer given because of a lack of this knowledge.
So, if you’re not quite at the stage where you are prepared to give over a few days of your life that you’ll never get back, here are a dozen little details to focus on. Whether you commit them to memory, or just focus on remembering the summary of what they’re about, it should improve your ability to police effectively in this area —–
4.12 – Don’t threaten patients with being “sectioned” to induce them to agree to voluntary admission – The threat of being “sectioned” should never be used to persuade a patient to enter hospital. How voluntary is it anyway, if it only occurred after being threatened with legal detention?
4.47 – Explain why police are still needed at a MHA assessment without a warrant – Where a Mental Health Act assessment is going to take place in a dwelling but where no s135(1) warrant is in force, the AMHP co-ordinating the assessment should explain why police involvement remains necessary if it is sought.
4.55 – MHA assessment does not always have to be delayed until the effects of drugs or alcohol have worn off – It is often said that “You can’t assess someone under the MHA whilst they’re under the influence of substances. This is the paragraph that shows this is not correct. The paragraph certainly advises delay where possible, but it may not always be possible.
4.90 – Applications for admission under the MHA must be made to a specific hospital – it is not sufficient to specify the mental health trust to which the patient will be admitted.
10.10 – You can make applications for s135(1) warrants without previous attempts to gain entry – It is often said that you can’t obtain a warrant without previous attempts to gain entry having been made. This is the paragraph that shows this to be incorrect. It stipulates that if applications are made without previous efforts, AMHPs need to set out the reasons for the Magistrate. This is in order to draw their attention to the fact that they can and to the reasons as to why in this particular case.
10.22 – The police station should not be the automatic first or second choice as a place of safety – this is the paragraph that custody officers and detaining officers should bear in mind when considering the use of the police station as a place of safety. What else did you consider or try, before resorting to it? If you can’t answer that question, you’ve got more thinking to do before seeing the custody sergeant. If you’re the custody sergeant, I’d ask the question!
11.5 – Sedated patients should be accompanied during conveyance by a suitable professional who is trained in the care of such patients – this will normally not be a paramedic because they are not licensed to adminster drugs to sedated patients. It will normally be a nurse of a doctor and officers asked to assist in the transfer of patients from one place to another, should bear in mind this requirement and ensure such a professional is involved.
11.17 – Police involvement in the conveyance of patients under the MHA should be based upon them being violent and / or dangerous – this is obviously a far higher threshold than patients being resistant to admission or transfer and officers should be certain to ensure that they are acting according to this part of the Code. It may be that local protocols assume all coercion under the MHA should be done by the police: this appears to be outside the intentions of Parliament who gave others the power to do so and this paragraph sets the bar somewhat higher than a patient being merely resistant to admission / transfer.
21.36 – Voluntary patients cannot be required to seek permission to leave hospital – but they can be asked to inform staff that they are leaving. This is important in situations where officers are called to mental health wards to reports of offending, involving voluntary patients. The Care Quality Commission repeatedly warn of the dangers of de facto detention whereby patients under no obligation to remain in hospital are ‘denied’ leave for various reasons. Where a voluntary patient chooses to leave hospital, either briefly or completely, they should be allowed to do so unless the nurse of doctor involved applies a holding power under section 5 of the Act.
22.13 – The recovery of AWOL patients whose location is known is a matter for MH services – but the police can be asked to assist in the risks involved suggest it is appropriate. So where, for example, a s3 patient who has been granted s17 leave fails to return on time and telephone enquiries by the ward reveal they are at home, it is up to ward staff to co-ordinate re-detention. It is for NHS managers to ensure they have access to resources by which to do so.
22.20 – All unauthorised absences by patients should be reviewed to identify risks and prevent recurrences – it is a requirement that all absences be reviewed. Given the frequent involvement of police resources in searching for patients who are absent, it seems reasonable to for the police to have an input into this process, especially because the police will have a record of that persons absence history which may cut across different hospitals or even different mental health trusts. That could very well assist the management of risks.
This list is NOT exhaustive: there are other paragraphs in the Code of Practice where it may be worth committing the thrust of it to memory but in order to keep this list manageable, I have capped it at a dozen things. I would encourage frontline police officers (in which I include custody and communications staff) to read the full text of these paragraphs and consider them in operational situations. They can make the difference as to whether you say “Yes” or “No” to requests that are made of the police.
The Mental Health Cop blog
– won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs
– was highlighted by the Independent Commission on Policing & Mental Health
– was highlighted in the UK Parliamentary debate on Policing & Mental Health