The Care Quality Commission have today released an interim update on the progress being made in Place of Safety (PoS) provision, shown in map format (see a snapshot, right). This is just a short post to put out some highlights from it as well as some thoughts and observations —
There is a particular emphasis in the update on many PoS services excluding children. The BBC news covered this with the headline, “Under 16s refused access to safe havens.” I can’t be the only police officer in the country who has looked at the empty PoS room in a hospital and asked, “Are you seriously telling me that you WANT this child in the cells when this room is standing empty are the law inclines towards it being used?”
But given the emphasis that has emerged on child access to PoS services, I can tell without doing too much work, that the map is incomplete or incorrect, in this regard. If you zoom in on Birmingham, you will only see one PoS service shown is to the south-west of the city. This is the service for those who are 16yrs of age or older at the Oleaster mental health unit in Edgbaston and it services both Birmingham and Solihull local authority areas. The map does not show you a green flag somewhere east of that which is a specific children’s PoS at Parkview, the regional CAMHS unit in Moseley, Birmingham. So I wonder about the rest of the map. The BBC cited Birmingham’s facility as not accepting u16s, whilst also failing to mention Parkview.
The update also notes that the only “upper tier” local authority not to have access to a health based PoS is the Isles of Scilly. Despite almost 100% coverage in England, the report details how 35% of those restrict access on the basis of age and many of those are in our larger cities where a disproportionately high number of people are detained under this provision. So whilst in theory, our map is now covered, we are still bedeviled by exclusion criteria.
GEOGRAPHICAL AND OTHER EXCLUSIONS
It still raises issues about geographical coverage and boundaries or borders — the only place of safety in my home county of Northumberland is in the south-east of the county. If you are detained in Berwick or Hexham, you can be a good hour’s drive away from the PoS service. The same is true in Cornwall and North Yorkshire. How realistic and practical is it for police or ambulance services to transport people so far? Accepting that the report is not a final analysis, it also doesn’t touch upon exclusion criteria like drugs, alcohol and violence. We know that around 20% of PoS services will exclude children, but how many would exclude someone who has been drinking … and what threshold or method is used to determine whether some alcohol is too much alcohol in those particular circumstances? What about those who are resistant or aggressive? We know that Royal College Standards have something to say about that – is it delivered in reality in some, all or none of these services?
In particular, I’d love the above map to reflect whether or not these services are staffed by mental health professionals. How many of them involve the police letting themselves into an empty room or being allowed in by a nurse who decides whether or not the person can be assessed there before disappearing back to a ward and having no further part to play. How many of these services involve the police providing security, outside the vision of the Royal College Standards, for three hours or more. Sometimes for as much as twelve or fifteen hours at a time?
What does it really mean when we say “police cells only in exceptional circumstances?” And there is another remark that really made me blink and re-read it. This map is overtly described as being something that “would help the police to identify the nearest health-based place of safety – where a suitable one is available – to avoid people being taken to a police station when what they so badly need is to be assessed in a therapeutic environment.” This, at least to me, implies that officers who make a detention are at liberty to choose where to go. Realistically, areas only ever accept those people who have been detained within their local authority boundary. So if the police from Area 1 detain a 15yr old when there is an age restriction on access, they cannot simply go to Area 2 if they don’t operate such exclusion grounds. I remember distinctly a complaint a couple of years ago where the police in Area 1 detained a man who lived in Area 2 within Area 1’s boundary. Access to a health PoS having been denied in Area 1, they took him to the PoS in Area 2 who were happy to receive him. The Area 1 PoS complained about Area 1 police for doing it. The answer to this complaint, incidentally is, “paragraph 10.22 to the Mental Health Act Code of Practice applies.”
There was a short response from the Royal College of Psychiatrists, who oversee the multi-agency group on s136 that sets the Royal College Standards, last updated in 2011.
All of this means we continue to need strong, clear commissioning of services that operate to agreed standards. Until we get that, we’re gambling with equality, safety and human rights issues that we’ve been burned by before. The progress we are seeing is still painfully slow given that this legislation was introduced 55 years ago. I could testify in a court to having sorted this in one area in under six months from start to finish – it isn’t actually that hard and it’s not a matter of resources: it’s a matter of will on the part of commissioners.
I look forward to the full report in the Summer of 2014.
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