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.
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?!
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?!
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!
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