HMIC

Remember when you were at school at your handed in your maths homework, they would check your answers and your methods?  Having been asked to do 11×44, you wrote ‘484’ (probably because you did it with a calculator?!) and then the teacher declined to give the extra marks as you’d not shown your working out?!  I felt like that when I read the latest report from Her Majesty’s Inspectorate of Constabulary on Surrey Police.  HMIC conducted an unannounced visit in January 2015 and have recently published the report which makes various remarks about mental health matters.

The answers intrigued me, so I wanted to see the working out to understand how the inspectorate is looking at things, I thought I’d read through it.  I’ve read various reports they’ve written over the last few years (including their Criminal Use of Cells report (2013) and the Core Business report (2014).  I’ve previously been confused to know how HMIC have approached their work report work on mental health but I know they’ve emplyed mental health professionals like Heather HURFORD as an inspector which was evident in the thought put in to the HMIC report on vulnerability (2015).

For this localised report into Surrey Police, how did they end up at the conclusions they reached? This was not an exercise in elementary mathematics, so the confusion around methods also caused me to wonder about the answers themselves …

SURREY POLICE

The report makes a recommendation in paragraph 3.12 about Chief Officers reviewing s136 Mental Health Act (MHA) policies to make sure that custody is only being used in exceptional circumstances for those detained under s136.  They recommend a reduction in the use of the power and a reduction in the use of cells.  Fair enough – this is what the MHA Code of Practice demands: the least restrictive practice and custody only on an exceptional basis.  The report hints towards why this recommendation was made (in paragraph 6.23) by explaining that 45 out of 573 detainees held under s136 were taken to custody (just under 8%) and that there was scope to reduce the numbers further, although it doesn’t say how or what the particular problem is.   However, the report also says (in paragraph 2.37) that “there is no evidence of police custody being used inappropriately.”

I cannot find anywhere in the report, anything that alludes to who was detained in Surrey cells, why precisely they were detained there, or how that stacks up against various pieces of guidance that are relevant to consider where the appropriate place of safety is for any particular detainee. For example, did they detain 45 people were under constant restraint for hours because of serious attempts to resist detention and injure themselves because the local health service refused to accommodate them; or was it 45 people who were detained because they were perceived to be vulnerable, at risk and without capacity to consent to other pathways at a point where the preferred Place of Safety provision was simply unavailable? There is obviously a difference between the two and a broader view of relevant guidelines (like those from Royal College of Psychiatrists, National Institute for Health and Clinical Excellence) might have something to say about those situations ending up in custody.

Of course, there is no accepted definition of what ‘exceptional’ means, but I remember a discussion with a government official in which they said it usually means between 2-5%, depending on the issue under discussion. Well, running with that definition, 8% is over the top and therefore there would be evidence of over-reliance upon police custody, for reasons we can’t see from the report – factors influencing that may be beyond the direct control of Surrey Police and this isn’t made clear one way or the other. It would also be great to know where and how the numbers could be reduced and whether this is an issue for Surrey Police alone or, far more probably, the wider partnership in which they sit. A final point on the Surrey report, was paragraph 3.8, which surprised me: the authors expressed concern that accident and emergency was listed in the local protocol as ‘an exceptional place of safety’. They don’t explain their concern and it did make me wonder because Accident and Emergency is, infrequently, used as a MHA Place of Safety for those detained under s136.  I will admit it: I don’t understand.

PART PICTURE

Of course, something the report doesn’t examine – because no-one ever does – is the criminal arrests going to custody which lead to a formal Mental Health Act assessment to identify whether there is learning for the arresting officer, reminding them that s136 exists to focus upon early diversion from criminal justice for trivial matters: that is clear from the history of the power and from long-standing Government policy in Home office circular 66/1990. All forces will have a residual number of criminal arrests which lead to detention in custody where officers would have had it available to them to use s136 (or to link to other health services like crisis teams or street triage services.) Unless you know the extent to which forces may be criminalising low-level offences by those in crisis where the mental health and wellbeing of the offender has to take the immediate priority, you’ll never know whether there is scope to reduce use of s136.

For all anyone knows, Surrey could be over-using it the sense that they are relying upon the power to connect vulnerable with mental health services because there is often no other way of doing it, but simultaneously under-using section 136 and need to increase its use, to avoid criminalising people by arrests for low-level offences. If we could click fingers and put that all in place, I don’t know whether use of section 136 would go up or down … but obviously the more available Surrey and Borders Partnership Trust can make themselves to work in real-time with Surrey officers, the greater likelihood that they could reduce the use of all legal powers of detention for those in crisis.  This is true of every police force in the country, it just happens to be the publication of the Surrey report that grabbed my attention when a headline that appeared in my Twitter timeline said they should ‘Reduce the Number of Mental Health Act arrests’.

If I’ve understood it correctly, having fully read the report, HMIC appears to be saying, “You’re not using custody inappropriately, but you need to reduce the use of custody and the use of the power even though we don’t really know whether you’re using the power enough to start with because we haven’t examined everything that is truly pertinent to an assessment of that.”

I’m not sure how helpful I find that, if I’m honest.

USE OF SECTION 136 MHA

We hear so much about s136 usage and it’s potential to be reduced.  Before we go much further with that idea, I could do with someone explaining to us all what the correct level of use is? If Chief Constable Lynne OWENS CBE issued a direction that MHA powers will not be used where any other legal option exists, you would see it fall substantially, almost overnight – she could fill up the cells with hundreds of vulnerable a year who would be criminalised to an even greater degree (and probably for a greater period of time) and there would be a massive tick in the box for having sorted the recommendation in paragraph 3.12.

I’m sure that nothing will be further from her mind, but it emphasises the point about arbitrary notions of what is the right level of use – it’s not quite a target, but if some s136 use is too much, then it suggests that less is right and that there is almost a target to hit.  So if Surrey put themselves to work on all of this and got things down to 30 people going to custody out of 500 detained under the MHA for 2015, would that be OK or not enough? – who knows?!

Hello to my friends in Surrey – I didn’t mean to single you out in particular! … it just happened to be your HMIC report that caught my attention on publication.  I know you’re all working on very hard on all this, from the top to bottom of the organisation and doing it sensibly and with great care. Keep cracking on!


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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5 thoughts on “HMIC

  1. I suspect for all sorts of reasons – Sec 136 is under used, overused, misused & used appropriately everyday. I think in my part of the word I have seen an inprovement in its overall use because of a certain initiative (ST) But I am not convinced that over all that has led to less demand for AMHPs & MHA Assessments. However there are still plenty of other officers & BTP filling their boots when faced with the unknown/distressed/unwell/unclean/odd/pissed/substance misusing/none compliant individual & definitely people who are unwell.

    I also agree that the police really need to look at demand for MHA assessments from custody. I have little confidence that private (for profit) FME services are getting it right often enough & no one appears to care or be monitoring that. While they are at it they might also want to look at the provision of Appropriate Adults.

  2. Great post. Like your last thought, (not!!) have a friend who could have been arrested for an offence every time pretty much, but police thankfully used s136.Arresting for an offence would certainly have decreased the force’s use of s136 but at enormous cost to the individual!!!!!!

  3. Of course the other way they could reduce the use of s136 is not to respond to calls for vulnerable missing people etc. It sometimes feels like that is Mental Health Services preferred option (I’m sure it’s not), I hope it doesn’t become the police’s.

  4. Thanks for reading/your interest in the report. We’re working with HMIP to review the methodology for these inspections, and this is very useful feedback for this work. I understand you will be meeting with Zoe soon but any more thoughts, please let do get in touch (contact@hmic.gsi.gov.uk).

  5. Thanks Michael for this blog. It helps to clear up the deepening fog that is being caused by certain agencies. HMIC say they don’t regulate or set targets yet the evidence I have seen shows otherwise. I know from your blogs that you are fighting for the right treatment for those with MH issues but when Inspectorates make recommendations you expect them to be helpful in how to deal with it. This is not the case and seems to be making things worse.

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