Political Developments

Theresa MAY will address the Police Federation Conference later this morning in her first speech since being re-appointed Home Secretary after the 2015 General Election.  In the pre-speech media coverage, it is anticipated that mental health issues will feature as headlines in her address:  principally £15m for further investment in health-based Places of Safety and new legislation to improve the experience of those who are detained by the police under the Mental Health Act.  I’ll let you decide whether to read Guardian or Telegraph coverage of this, to suit your taste / politics!  Taking the media coverage at face value and whilst anticipating the speech, a few thoughts occur to me —

  • £15m for new PoS facilities – you may remember that a previous Government gave money for PoS facilities in every area.  This was back in 2005/6 and it took until 2014 before every city and county had coverage.  It was in the same year that the CQC report A Safe Place to Be highlighted that the provision was inadequate to ensure police cells could be almost eliminated.  And now there is even more money to do what previous money failed to ensure – having seen the work that was necessary to commission NHS based Places of Safety, I’m not convinced it takes much money, but it does take will and knowledge.  That’s what I’ve always thought was lacking.
  • Exceptional circumstances – the Government Review of the operation of s135/6 which was published in December 2014 suggested that the ‘exceptional circumstances’ in which police cells could be used should be clarified and it proposed legislating to rule out the use of custody for children (under 18s) and that adults could only be held if “the person’s behaviour is so extreme they cannot otherwise be safely managed”.
  • What does this mean?!  – it is absolutely crucial … and I don’t often use colour in the blog to emphasise particular words!  It could have been said of Sean RIGG, Michael POWELL and many, many others and it was the decision to use custody in the first place, potentially in disregard of the fact that acutely disturbed behaviour can be symptomatic of underlying conditions and in itself be a medical emergency.  We need to be very, Very, VERY careful that we don’t encourage the kinds of response by police officers that have massively criticised, including in the courts, after previous untoward events.
  • Reducing the detention timescales – it has been suggested that the 72hr timescale for detention under ss135/6 be reduced, probably to 24hrs.  It’s intuitively attractive, isn’t it? … we can’t detain a criminal beyond 24hrs beyond some exceptional circumstances that have very intrusive safeguards and yet we could detain an unwell person for three days, potentially in a cell block as occured in MS v UK [2012].
  • Children – it’s amazing that in 2015 you are more likely to be held in custody if you are a child than if you are an adult because some NHS have PoS provision but exclude from it those who are under 18yrs of age.  I know that work is already ongoing to prepare the NHS for a world in which the law prevents the use of cells as a PoS.  But let’s not get too carried away that it means children will never end up in custody.  The example from November 2014 in Devon is often used as the outrageous example in this area, but we seem to have forgotten that the young woman concerned was not detained under s136 MHA, Devon and Cornwall Police said in their press release that she had been arrested to prevent a breach of the peace – and such detainees normally go to custody!  The new Code of Practice MHA now makes it clear to nursing and medical staff that if such an event happened today, they would be expected to use s5 MHA and arrange an MHA assessment and / or hospital transfer, as appropriate.

The difficulty with reducing this timescale is the small matter of bed access.  I don’t doubt that most areas could ensure an AMHP-led assessment involving a s12 DR within a day – whether they could also identify a bed which patients requiring admission can access is quite another matter and many AMHPs have already commented this could be unworkable unless attention is given to bed provision.  I merely remind everyone that they should be reading and giving effect to the implications of s140 MHA – my favourite piece of ignored legislation.

Finally, I wouldn’t be doing what I normally do, if I didn’t point out that these announcements – whilst welcome with the caveats mentioned – are addressing some of the obvious difficulties we face.  I haven’t seen any media coverage about the less obvious, ongoing difficulties, which are also faced by street triage teams, of ensuring consistent and appropriate responses to mental health crisis incidents in private premises, depending as they currently do on the ability to summon AMHPs, s12 Doctors and warrants, on occasion.

IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


5 thoughts on “Political Developments

  1. All good stuff, however you can go on about S140 forever but this ignores the political context. The elephant in the room is that there aren’t enough beds with no sign of previously closed beds being re-opened or indeed new facilities being built. The “funding increase” is misleading; budget cuts have essentially been devolved to NHS management and Trusts are losing staff in many areas and services, as well as commissioners de-funding or passing things to the private sector.

    1. How does it ignore the political context. The following points are either true or they’re not –

      1. NHS funding increased overall, almost keeping pace with inflation.

      2. NHS managers underspent their budgets by billions during 2010-15.

      3. NHS managers, not ministers, de-prioritised mental health and made cuts in that period, by 8% after a decade in which MH funding rose by 59% during which time we still didn’t address simple issues like PoS provision.

      4. Many beds were cut despite it being predictable and obvious that out of area and private provision would be required to plug gaps and that this would be more expensive than simply commissioning effectively.

      6. There are plenty of new MH facilities being built – I’ve been in several in the last three weeks.

  2. I have to agree with Dan in respect of the points he makes in his post.

    In order to back up his comment there is a current and ongoing situation in my area where an individual under s2 MHA has had to be nursed for more than 48 hrs in a p.o.s suite as there are no intensive care beds available in the country, and indeed, some of the private providers have refused admission due to having staffing issues.

    This isn’t an isolated incident or a one off sadly, it happens all too frequently and this is in 2015!

    I am sure you are right MHA cop and new facilities are being opened across the country, however, opening a few beds here and there is not going to solve the very real issue that exists in the here and now like the above because so many beds have been cut and there is nowhere to place people.

  3. Can I offer this?
    Mental health beds are in short supply. That much is true. However, we need to look more widely at the pressures on services generally. Assertive outreach teams have been disbanded in some areas. They were able to prevent people coming into hospital and worked to prevent ‘revolving door’. Dedicated crisis and home treatment teams have been cut leaving this skilled area of work to be managed by workers in mental health teams who already carry a case list and cannot replicate a crisis care model. Social housing is extremely limited, with many years wait for those that need it. Therefore, supported housing projects cannot ‘move on’ people who are ready for independent living into social housing. In turn, those people on wards who need supported housing are also ‘stuck’ because there is no availability for the supported accommodation that they need. Private rental can be impossible to achieve when you are in receipt of housing benefit and have support needs.
    Just my observations…..

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