Getting It Badly Wrong

First, I need to give you some examples of police officers getting things badly wrong and then I want to make certain points – again – that arise from them. These examples are all real, incidentally.

NUMBER ONE

Officers are directed to man outside a pub who seems confused and vulnerable.  They talk to him and he’s very uncertain of his whereabouts and identity, they agree with the original caller that he seems vulnerable and they have no way of identifying who he is or where he lives.  Feeling they have little other option and being of a genuine view that this man may be mentally unwell, they detain him under s136 of the Mental Health Act, believing it to be in his own interests that he receives care immediately.  They call an ambulance to ensure they don’t overly stigmatise him by putting him in the back of a marked police car and they are astonished to see that when the paramedic is doing some basic checks, he collapses.  All of sudden the urgency increases and he is rushed to A&E.  It emerges that the man suffers from diabetes and was quite unwell with very irregular blood sugar levels and the urgent treatment he received has ensured that he did not suffer the serious consequences that would have otherwise occurred.

Appalling use of s136 wasn’t it – no-one was sectioned or even admitted to a mental health unit?  In fact, he wasn’t even mentally ill at all, was he?!

NUMBER TWO

The police are called to a situation where a young woman is self-harming in the park and when they arrive, her friends say that they’re not sure what has happened to cause this, she’s never done anything like this before but they know that her grandfather recently died and she’s failed an exam at school this week.  The police officers can tell that she’s had a few drinks and are unable to persuade her to stop hurting herself.  In the circumstances they detain under s136 and remove the blades from her.  They take her to the local mental health unit and although there is a four hour delay to allow the effects of alcohol to wear off, she is assessed there with her father present.  The conclusion reached is that she does not have a mental disorder but the AMHP is able to offer her some signposting to support organisations for bereavement and ensures that the school are made fully aware of the ongoing family and personal difficulties so that they can support more appropriately, including with any re-take or mitigation in her exams.

Dreadful isn’t it? – no mental disorder at all.  What were the officers thinking?!

NUMBER THREE

Before I move on to make my various points, here is just one last story of inappropriate decision-making for you –

The police detained a man making threats to kill himself after he climbed the bridge barrier over-hanging a major motorway which the police had to close for 2hrs whilst they talked him down.  At no stage could they establish his identity or background and he was taken to police custody as a place of safety, because the local unit would not accept him whilst under the temporary influence of alcohol.  After 10hrs of sobering up, a psychiatrist, a force medical examiner and an AMHP assess him and detain him for hospital admission under s2 of the Mental Health Act.  He spends two nights in the local mental health unit and on the third morning suddenly appears very lucid and coherent in a way he didn’t upon admission and he enquires of a nurse where he now is and how he got there.  To learn that he’d been ‘sectioned’ was a huge shock as he had no history of mental health problems.  It emerged that he’d omitted to read the instructions on his over-the-counter medication to help him stop smoking and then drunk a lot of alcohol, against advice. Presumably this means that the psychiatrist, the FME and the AMHP should be criticised as well and the success or appropriateness of their actions subject to this particular kind of 20/20 hindsight?!

9 O’CLOCK JURY

You can see what I’m getting at here, right? – it’s not too subtle a point, I’m making?!

We saw last week, again, reference made to the ‘conversion rate’ of police uses of section 136. As I’ve mentioned before – indeed several times, now! – the numbers quoted in the conversion rate are the proportion of people detained by the police under s136 who are subseequently detained under the MHA by mental health professionals after a statutory assessment. So what it won’t count is the number of people who are voluntarily admitted to hospital without being legally detained and it won’t include the number of people who are referred to other mental health services after assessment – things like community mental health teams, Home Treatment Teams and so on.

Do you think that the first two people and their families in my above examples think that the police use of that legal power was a success or a failure? The officers safeguarded someone who undoubtedly needed it in circumstances where it was perfectly plausible to wonder whether that person had an underlying mental disorder. In one case, it took the person into contact with the health system in circumstances where, when things became more serious, paramedics could act quickly to avert potentially disastrous consequences from undiagnosed disease. In the second, it stopped someone self-harming whilst intoxicated and who knows where that may have ended without police intervention? That both of those people walked away from a Place of Safety without ongoing referral to secondary care mental health services is no more the point than the observe that the man in our third incident also walked after we all realised we’d got it ‘wrong’.

Odd, isn’t it? If we’re judging ‘conversion’ rates, the third story stands out as a truly successful use of section 136 because he was sectioned afterwards – that he was no more mentally ill than the first guy doesn’t alter this, because it was psychiatrists and an AMHP that made that judgement. Experts in their field, aren’t they?

This all just serves to show how ridiculous it is to judge the police by the conversion rate to detained admissions and to forget to remember the other relevant outcomes and issues – it is barely more ridiculous than judging s2 or s4 admissions on whether they become s3 admissions. As Baroness HALE pointed out in her 2010 book “Mental Health Law” (5th edn), we don’t actually know what section 136 is for. You can imagine how hard it must be to determine whether you’re succeeding in what you do, if you’ve no idea what you’re actually trying to achieve. Baroness HALE wondered whether we might, in fact, be under-using section 136? We’re working hard right now on reducing the use of section 136 without a clear, shared vision as to what this legal power is trying to do for us all.

The Health and Social Care Information Centre statistics on the use of s136 are still evolving – they record detained admissions, informal outcomes and no further follow up. We need more detail and we need to understand what section 136 is for. This latter challenge may well be a matter of personal politics and what kind of criminology you subscribe to. But we need to be clear about this and ram it home again and again: the fact that use of section 136 MHA needs to no follow up whatsoever does not mean that the officers’ decision to use the power was flawed at the time the decision was made. The mere process of being detained and safeguarded for a period of some hours, may be sufficient to stop someone who is at that time, in that place, somewhat vulnerable and prevent them from coming to medical or other kinds of harm.

In my view section 136 MHA is to ensure that police can do something when something’s happening that ought not to be happening about which somebody ought to do something now, in circumstances where it isn’t obviously immediately necessary to criminalise them. I’ll let you decide for yourself what your criminological looks like!


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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16 thoughts on “Getting It Badly Wrong

  1. Absolutely! Great article.Your last paragraph summing up says it all…..First at the scene,,,,,’fire-fighting ‘ choices need to be made quickly in the particular case and are hugely difficult often. What responsibility….on the moment judgements / risk assessments made that can and do save lives… But may be not according to protocol and the legal framework of support,……’gut instinct’ acting in emergency without a safety net …..but thank goodness for such brave and resolute actions…..
    .

  2. Here’s a thought …. Why not replace S136 with a ‘Safeguarding’ Power for officers. They could use this whenever they find someone clearly in need of help but the officers don’t have to trouble themselves trying to work out if it’s Mental Ill Health related. With one fell swoop we would do away with conversion rates, bad judgements(sic) and misuse of powers…. simples hey!!!

  3. Psychiatry is v far from an exact science & there are v few, if any experts, who get it right all the time. If psychiatry worked I might not have a job & the use of 136 or any discussion about other MHA sections would be mostly redundant.

    See from my seat that is part of the problem. It’s not quite a conspiracy theory, more a sophisticated con trick. Society has been conditioned & told & believes that psychiatry works & it does sometimes, maybe even often. However the medical profession & miulti national pharmaceutical companies are well rewarded with £s, status & profit to promote the idea of the expert doing to & helping the person & that treatment is always effective & therapeutic. It is simply not the case.

    An actual formal MHA assessment in a police station or PoS can often be a fairly chaotic exercise & that is just from the AMHP perspective. You are presented with a person, who may or may not be distressed or disordered, who may or may not have committed some kind of offence. You probably don’t know them or indeed very little about them, neither do the 2 medics & you might not know them two either. Then you have the police & or manager of the PoS often with great self believe & authority telling you what you should do. Btw very often there is no bed & remember that is usually the outcome others are seekinging, I suspect to both validate their decision making & because they want to help the distressed person & psychiatry & treatment is that help, right?

    Back to the MHA assessment – the person may or may not engage in the process, indeed they might not be able to, or choose not to & I guess some of the skill & expertise is resisting the pressure described above & actually being able to engage with the person on a human level, in those difficult & distressing circumstances. We might be able to get some background info, indeed on reflection,sometimes services might even know them well – a % of those picked up on 136, or now increasingly helped & supported by versions of Street Triage schemes (not using 136) are repeat customers, known to CMHTs, HTTs, AOTs etc.

    Arriving at a decision to detain or just as difficult sometimes not to detain a person is not an exact science. Yes sometimes it is obvious either way & you don’t have to be any kind of expert. However often you need experience & knowledge to make that decision collaboratively, to understand concepts of risk & it really does help to understand the MHA & CoP. I describe it sometimes as an art not a science, because it is not exact & it is not always possible to accurately predict outcomes or indeed the effectiveness of interventions.

    But to use your analogy the FME is long gone & the psychiatrist is well protected & far away, let’s se who we can blame ? A yes there must be a social worker lurking somewhere looking guilty. But what is an AMHP anyway ? Most people have no idea btw.

    I don’t disagree with your conclusion & as I have said elsewhere, I suspect that Sec 136 is somewhere being over used, under used & misused, sometimes for the right & wrong reasons.

    Complicated this stuff ain’t it!

  4. I really don’t understand why it ends up being talked about as a failure by the police. The police have the legal power to arrest someone under s136 if they are in a public place, in need of care and conrol and they have reason to believe may be suffering from a mental illness. As long as those criteria are met they have done their job. The assessment is just to decide whether in the view of mental health professionals the person can then be released or needs to be detained in hospital.This decision is totally outside the police’s control. So why do the police get slammed for it?
    I am very grateful that the police use s136 where they perceive someone to be in danger and would really not want them to start saying ‘oh will they really go through with it, are they just attention seeking , have they just had one drink too many?’ etc etc

    1. Hi Judy the MHA assessment, if it gets to that (remember a medic can/must discharge someone from Sec 136 if they are clear that there is no mental disorder), is more than simply about a decision to detain or release – there are other option & alternatives. Sometimes the medic won’t make the decision because they want to share the risk of getting it wrong with the AMHP & Sec 12. Or if I a, generous they feel the AMHP is better placed to sign post & refer on, which is part of the AMHP role.

      In terms of being critical of police use of Sec 136. While I don’t doubt that the vast majority of officers use the power invested in them in good faith. They do, like other agents of the state misuse the power given to them. I am reminded of what a judge Munby said yesterday in relation to a child protection case http://www.judiciary.gov.uk/wp-content/uploads/2015/02/re-a-child-2.pdf & the role of the state when it comes to policing (in the wider sense) people’s behviour.

      While I don’t doubt for one minute that the use of Sec 136 can be life saving etc I do suspect it is over used, under used & misused. Which will of course take us back to the matter of police training & MH matters & the role of other agencies etc.

      Inappropriate referrals for MHA assessments from FMEs for people in police custody following arrest for offences & referrals following on from the misuse of Sec 136 tie up vey limited resources that are stretched well beyond the capacity that they are commissioned to deliver. The misuse of 136 can also see people in police custody & PoS when they don’t & should not be there.

      As for those that have had a drink to many & then end up arrested …. Well issues of personal responsibility & the words like grow up & behave yourself & stop wasting my & the police & the ambo etc time spring to mind – to them not you.

      It’s complicted this stuff.

      1. At the risk of further / over complicating it: what is this ‘misuse’? If you mean illegal use (for example in private premises) then I totally agree. One problem with street triage is that we are starting to see use of 136 that became unnecessary because of the involvment or advice of a MH nurse being branded ‘inappropriate’ or ‘misuse’ when it isn’t. Section 136 is the “somebody needs to ‘do something'” power if health and social care services want to structure themselves so that less use of it is needed, then fair enough. But for me, misuse means it was illegal, not merely that it wouldn’t have been necessary if a nurse had been there. It’s like criticising nurses for knowing their possession have been taken but failing to spot those occasions where it wasn’t a theft-related offence.

  5. I do indeed refer to illegal use. But also in a slightly wider sense e.g. When somebody, everyone there thinks somebody should do something, except of course themselves & that somebody should in reality do nothing.

      1. Of course – but that gets us back into the territory of who is defining ‘appropriate’. As these are police powers it is, by definition the police, so we’re back to your point about better training. Or some training! 😃

  6. An interesting statistic would be how often officers use s136 when they don’t think the person is in need of care and control and suffering from a mental disorder………..To arrest for an offence because it is going to save everyone time and effort and the pertson might have had a drink would seem to be about the most stigmatising thing you can do…..

  7. As ever back to the training & as I have volunteered usually the officers r trying to do the right thing. Judy – they simple do not keep that kind of stat & by its v nature every officer using 136 is going to say/record that it was required. Further its not about saving peoples time & effort it is about using the resources we have in the best & most effective way. Where I am the amhps r v hard pressed to meet the demand for MHA assessments. Some of which r not required & if people are finding themselves in this kind of situation solely by having had to much to drink, then I can only refer u to my earlier answer. In my experience officers have discretion when it come to arresting drunk people misbehaving & try v hard not to. But some of these drunk people just don’t listen & argue & behave their way into custody.

  8. People are arrested every day by the police either on the belief or suspicion that they have committed an offence given the evidence presented. Some of those arrested are released from police custody having been interviewed and the evidence relating to the case scrutinised and reviewed and found and show that they had no part in the alleged offence. Many are charged with an offence if the level of evidence reaches the desired threshold. Those people then have the opportunity to have their case heard in court where the evidence against them can be tested and judged by those suitably qualified to do so. Even then they may found not to have committed the offence in question.

    To my mind the same applies to a police officer detaining someone under S136 MHA. The arresting officer will weigh up the evidence presented to them and make their assessment as to whether the person before them meets the criteria to be arrested under a MHA power. Again that person will be taken to a place of safety where all the evidence can be assessed further by suitably qualified people. If the evidence once collated and reviewed shows that the person needs to be sectioned then this can be completed. If the person does not require any such MH intervention they can be released from their detention.

    The criminal arrest & MH arrest are more or less the same thing in that both are carried out because of what is presented to the officer at the time. If upon further investigation there is no substantive evidence against that person whether it is for an offence or a MH detention they are released and no further action taken against them.

    Police officers on the street are faced there and then with situations where they have to make a decision based on the evidence before them and will act upon the information gleaned. We do not hear a hue and cry against the police arresting people for criminal offences who are released prior to being charged, after the police have secured all the evidence available and had the opportunity to review it often in tandem with the Crown Prosecution Service, who will after consideration of all the facts make an informed decision.
    This is something that cannot be done easily on the street with a situation unfolding in front of you when the arrest may have been undertaken to prevent injury or risk the disappearance of a potential suspect.. Neither is the parapet of a bridge whilst you pull someone to safety, or the side of a busy road whilst you grapple with them to stop them from running into traffic a place where one can make an informed decision about their mental health. That’s done later, all you can do is make the best judgement you can at the time. Whether S136 is overused or under used I could not say; it just is.

  9. As a police officer its always a bit of an eye opener when you read input from different professions and to a degree other forces around the country. And how a individuals experiences in one location leads them to think thats the state of play across the country with regard to police use of 135 or 136 powers the reason why, how often and how appropriate I would suggest vary greatly the factors are down to a now overly risk averse supervision especially at 1st a 2nd line levels within the police in my force area failing mental health and ambulance service.
    Most of the time those on the front line as it were work well together in trying to provide best outcome for those who need help. But it is becoming increasingly obvious and I stress I base this on working in my force area only that the management in social, mental health and Ambulance services are a lot more adept at passing the buck than the police managers. Then we have the risk averse supervision within the police where now promotion is done on ones merits to avoid any risk to police rather than ability to do the job this is probably most evident within the realms of the mental health act and as a result im pretty sure 136 powers are overused
    two recent examples and they are brief for obvious reasons
    female under care of mental and social services moved from here mothers address to a refuge 50 miles away basically to protect her from her violent ex due to the move her care worker has to cease working with her she has no family of friends and told it will be 6 weeks before her new GP can get her assessed (her comments) gets drunk takes 6 tablets and said she going to kill her self police arrival it is assessed she is clearly drunk all actions like walking into the road are clearly done for effect rather than any attempt to cause injury apart form causing a scene no real issues , ambulance already called by her mother and arrives just after police, paramedics want her to go to hospital as she claims to have taken OD she kicks off so is detained BOP and escorted to hospital after a while calms down and talks openly to hospitals staff and police admitting all she wants is some help it is my intention to leave a now calm and compliant person with medical staff while they do checks around tablets taken no other issues raised by anyone so call in to control and update next thing I get is supervision trying to tell me I have to arrest for S136 in case she leaves and does something else and I have to tell the hospital they have to conduct mental health assessment on the patient needless to say I declined and left only to find night shift sent 2 officers to sit with patient until she was released after blood checks came back all clear

    on another prisoners assessed in custody deemed fit and well interviewed for offences he was arrested and charged 24 hours later MHT call we have reviewed our assessment want to detain him can police assist despite telling MHT they have to provide transport and police will only be there if any risk they turned up with no transport the person they wanted was not at home so it was passed back to police as he apparently posed a significant risk he was found in early hours due to no paperwork and on call MHT staff having no idea of the job he was detained under s136

    until everyone starts working together from a standard framework across the country, management stop trying to pas the buck then misuse will continue and if it continues we will get more of front line staff in effect falling out when that happens we are on a very slippery slope

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