Yesterday in Parliament the Care Bill 2013 reached its report stage in the House of Commons. I learned via social media that certain MPs, including former care minister Paul BURSTOW and former GP and police surgeon Dr Sarah WOLLASTON, have tabled an amendment to the Bill, additionally suggesting that the words “police station” be removed from s135(6) MHA. This would have the effect of preventing police stations from being used as a Place of Safety under the Mental Health Act and would bring the UK into line with various other international mental health acts: including the Republic of Ireland and South Africa, as well as the states of both Canada and Australia.
What’s not to like?! – I have to admit, I was actually quite excited at the prospect of it! Well, Twitter was not entirely convinced … the concerns were broadly of three types —–
- There is no point removing the words “police station” until we know what the contingency arrangements are within the NHS;
- There will always be at least some situations where use of police cells is necessary;
- The police have always been responsive and caring to enough that individuals who have valued the humanity they have experienced were less concerned by the location.
DEFENDING THE INDEFENSIBLE?
I want to explain why these three reasons are not significant —– firstly, even with the current legal framework, the extent to which we use police stations gives rise to illegalities of various kinds, all of which touch upon the three objections to even greater change. We know that MS v UK saw human rights violations being inflicted in police custody; we know that police officers have been prosecuted in the criminal courts for relying upon police cells where they had little other choice but in the sorts of circumstances that are usually given to justify the second claim, above.
We know that the current statutory framework demands that police stations be used only on an exceptional basis. Whether we regard ‘exceptional’ as being 1 instance in 10, 1 in 20 or 1 in 25 will probably vary amongst us, but we know that the national figures currently indicate that we are using police stations for 33% (or 1 in 3) of all s136 place of safety detentions. So after five long hard years of effort since the IPCC reported that 66% (2 in 3) of those of us detained were being taken to custody, we only managed to dent the problem by half, which is hardly ‘exceptional‘! A long way still to go!
- Contingency plans – even if the amendment were successful, it would still be a matter for the Secretary of State to determine an implementation date. Nothing requires that to occur before the NHS is ready. Having watched a large number of health areas have to put their PoS arrangements in order, I know it can easily be done in 6 months – so let’s give everyone a 12, or even an 18 month, deadline. Of course, that is exactly what the proposed amendment does: it would require no use of cells for under 18s by April 2015 and no use for adults by April 2017. This stuff can be sorted in under six months – I’ve seen and made it happen – so it’s perfectly do-able.
- Some situations – we know that when some people list the situations in which police cells would always be helpful, they will say certain predictable things that have seen disasters previously. Resistant or aggressive detainees, especially those who are affected by substance (mis)use should be taken to the cells. We know that this raises the risks of contact deaths and has been the very point of criticism that such attitudes prevent proper identification of medical risks connected to these presentations. The Royal College of Psychiatrists “Standards on section 136” don’t agree.
- Positive experience – I’m always really touched by feedback that people have found the police officers they have met have treated them with dignity and courtesy and nothing would prevent officers displaying a positive, supportive attitude when accessing more appropriate locations. But I admit to thinking, that however heart-warming this is, it’s not sufficient justification for ensuring that one-third of people affected by s136 should be locked up in custody.
THE REAL REASONS
All of that having been said, I’ve suspected for years that there are other reasons behind the continued support for the use of police cells. Some of these other justifications are often entirely unspoken.
- We haven’t yet properly ensured appropriate use of section 136 by police officers – in too many discussions we still see the expression of attitudes by at all levels that supports the use of 136 in indefensible circumstances. So for example, we still see uncertainty about substantive criminal offending and about how to handle incidents involving the obvious consumption of alcohol. In some areas, we still hear frequently of section 136 MHA being “used” in private places and of frustrations between agencies about all of the above.
- We don’t know how to ensure that place of safety services survive contact with the realities – we know, to put it very bluntly indeed, that a sufficient proportion of professionals working in health and social care, simply disagree with the move towards greater use of health settings for those detained under s136. Perhaps because a good proportion of those detained subsequently emerge from the assessment process without the need for inpatient admission, possibly because of understandable nervousness about the security implications for health – we know that in some areas, the NHS won’t want this because they won’t know how to make it work.
- We don’t have adequate trust and confidence between our police and mental health services – largely because we don’t actually see proper debate about the inherent tensions that exist between the objectives of our health and justice systems. There are plenty of notable people from each background who are prepared to publicly demonstrate not only that they haven’t absorbed the learning from the section 136 disasters that have befallen us but also that they don’t get the day-to-day problems that we see each agency causing for the other or a real sense of how we can manage our way around those problems.
- We have an abundance of guidance that not everyone agrees with and is perceived by many as unrealistic – it’s all very well the Mental Health Act, the Code of Practice and even the Royal College of Psychiatry Standards saying certain things about the section 136 process: the first thing that has to be said about the totality of those frameworks is that plenty of people of importance just don’t agree. The notion that officers could or should deliver a detained person to the NHS and leave them in the care of health professionals within 30 minutes “even if they are quite disturbed” is just laughable, to many.
And sitting there at the heart of it all, is the difficulty for section 136 that troubles everybody – even some of the better examples of section 136 provision in the UK at the moment still don’t fully comply with the Royal College Standards and there are genuine obstacles to overcome in terms of commissioning, even where the will exists to do it properly. Many areas of the UK have genuine geographical challenges because of the large areas that they cover and the relatively low use of section 136. Herefordshire, for example, sees section 136 MHA as a once-a-week thing. Northumberland is over 100 miles from south-west to north-east with a population concentration that is not in the middle. So how do you structure 24/7 health services in such a way as to mean that neither of those counties struggle when there is no contingency fallback of police cells?
In reaching answers, we can predict the need to go over old ground: how do we provide an environment that is safe both in terms of clinical and security risks for those who are detained; to what extent will ongoing police support in health-settings be required for those detained whilst resistant, aggressive or intoxicated? I personally massively welcomed the idea that police cells could be excluded from section 135(6) but it draws into sharp focus the work that will be needed despite a three-year lead in. This sounds like a long-time doesn’t it? I mentioned above that this can be done in under six months where the will exists – in some cases it takes years to build the will but I suspect primary legislation amending the Act itself would be the necessary lever to make progress – because we’d have to!
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