An Alternative Place of Safety

Very First things, first: this phrase needs explaining because it’s been used in at least two circumstances that I am not referring to here and I just want to be überklar! We know what a ‘Place of Safety’ is, defined clearly enough in section 135(6) of the Mental Health Act 1983 but the ‘alternative’ has previously referred to police custody, as the alternative to the preferred NHS assessment suite that should exist as an MHA Place of Safety in each area. Less often, the same term has been used to referred to those NHS services when they have been newly established in areas that have previously relied almost exclusively upon police cells: the NHS representing the ‘alternative’ to that which we all agree is probably the worst of all possible options. Those are the two circumstances in which I’ve previously known the phrase ‘alternative Place of Safety’ and this BLOG is about neither of them!

The alternatives which we are now hearing about and starting to discuss are distinct again from a PoS in a mental health unit, an A&E department or police custody. Earlier this year, an initiative opened up in Sussex, funded by the Home Office, which was aimed at providing further assistance to reduce reliance upon police cells in that county.  Sussex is one of several areas which have struggled to ensure that police officers can avoid relying upon custody after detaining someone under s136. The physical building assessment area is part of a residential care facility owned and run by the Richmond Fellowship, a mental health charity who provide various kinds of support services across the country and it looks to contribute locally to increasing the options available to officers. I’m writing about this because of a Twitter conversation earlier today where a local ‘mental health parliament’ in the Sandwell area (where I was last an operational police officer) raised the question about alternatives in order to help avoid the three traditional options: mental health unit, A&E department or police custody.

EXACERBATING CRISIS

So there are (at least) two things going on here: firstly, the desire to increase options available to police officers so that police cells are less relied upon. Of course this begs the question about why some areas of England continue to struggle to ensure capacity and it will be the traditional mix of two things – overuse of the power and under-commissioning of services. If supply doesn’t match demand, you have to either increase supply or reduce demand – or accept that things will get messy and / or go wrong. Secondly, there seems to be a call for options to be made available which minimise the distress for those who are detained. We can probably all agree that this should be the most important reason of all: to ensure the dignity of vulnerable people detaind in the care of the state, pending decisions about their wellbeing. 

We don’t yet know the outcome of the Sussex pilot as it is still only four months old and I’m keen to learn more, not least because there seems to be a market for safe places which are not the traditional options. As ever, I do have certain questions and to be fair to me, they are the same questions I have of any Place of Safety service and it relates to whether they operate to national guidelines? In 2011, the Royal College of Psychiatrists published a multi-agency document, signed by all of the relevant national agencies. This was supplemented in 2013 by a guidance note to commissioners which further developed a few of those standards. Whatever an alternative to the traditional three may look like, everyone has to be really clear about how it operates and what the rules are.  

Over the years, I’ve formed the view that it is the apparent complexity of process that makes section 136 difficult to operate effectively. Areas have shown tendencies to confuse and conflate law with local policy; to operate their traditional PoS services outstide national agreements – for example, by not staffing the mental health unit place of safety at all, resulting in officers having to remain there for several hours. It’s one of the myths that pervades much of the interface between policing and mental health: that doing things properly via mental health services always saves police time. Obviously, it depends on the specifics and it is often not the case.

NATIONAL STANDARDS

In one area I am familiar with, the use of the local mental health trust place of safety means the relevant police force spending more time and committing more resources to any individual detention, than if they had condemned the person to custody. This is the case because the CCG has never commissioned any staffing for the Place of Safety and because the non-availability of Approved Mental Health Professionals and s12 qualified Doctors to undertake s136 assessments means long delays. The police are just expected to tolerate the fact that after detaining a vulnerable person they could have half of their 24/7 operational response cover off the road pending that assessment occurring at some later point. There are comparisons in this regard to be made with some street triage schemes – some of them are probably saving police time, some of them very probably aren’t.

We need to bear in mind that there are two or three deaths each year following the use of section 136 and that mental health related deaths in custody or following police contact are amongst the most sensitive and damaging of incidents, not least for those vulnerable people and their families directly affected. This particular legal power is instigated when things can be especially complicated: those of us in distress who may also have priority medical problems and who may be agitated and / or under the influence of substances which make identification of need more difficult.  Most obviously, the power commences because a police officer (with a first-aid certificate that included nothing specific on mental health) has made some fairly basic judgements – it is vital that any alternatives considered don’t further complicated the landscape whilst striving to ensure that the very process of detention and assessment does not exacerbate an already serious crisis incident that has become even more distressing now that the police have become involved.

So I want to know more about alternative places of safety that are being pilotted, contemplated or that will be proposed in the future concerning the traditional discussion points for any Place of Safety service, set against the national guidelines: how do these services operate when the following factors are featured in any particular detention? –

  • Children
  • Drugs
  • Alcohol
  • Aggression
  • Learning Disabilities

I increasingly keep coming back to the same points in most of the service initiatives we see at the interface of policing and mental health: why don’t we keep it simple and ensure firstly that we’ve actually understood the demands we face (about which I will BLOG next) and the problems we are actually trying to solve.  Then ensure –

  1. Flexible, accessible mental health services to meet demand
  2. Better training for police officers on mental health

I’m working hard on the second point, as are many other officers and College of Policing staff but all I see at the moment is a lot of activity across the interface of mental health and crimnal justice that is busy without understanding why or what the aims are.  So further alternatives to the traditional, tripartite Place of Safety arrangements will be welcome if they don’t further complicate an already dense process, creating an unnavigable landscape. One might imagine from the Home Secretary’s speech delivered at the opening event for the new service that it has already been declared a success, which is why a proper evaluation will be important. What if we learn that the facility will deny access to people who present with one of the five problematic exclusion criteria, putting it beyond the touch of most people detained under this provision? 


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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3 thoughts on “An Alternative Place of Safety

  1. Ever counted the stats on how many are released from your 136 PoS after finally having been assessed as not in immediate need? After you’ve spent half your shift waiting for the assessment? After the detained person has calmed down considerably from their previous distressed state through the attention of the officers and just the passage of time? I wonder if this is amongst the reasoning for not routinely manning some 136 suites.

    1. The PoS assessment is not trying to confirm / refute the original detention decision about ‘immediate need’ – it is trying to establish whether it is necessary to make any further arrangements for that person’s treatment or care. Figures vary by region so in some areas it’s fewer than 10% who need no further referral or follow-up at all; in other areas it can be up to 40%. In the latter cases, it’s my view that the power is overused in situations where it should be more thoroughly questioned whether the person does have a mental disorder within the meaning of the Act.

  2. Two unrelated points. 1) In my limited experience if the ‘diagnosis’ is emotionally unstable personality disorder’ then you will never be admitted to hospital however severe the need appears to a lay person. If you are already involved with services and say that you can keep yourself safe for the next 49 hours, then you will never be admitted as the assumption is that it should be a decision made by your existing team.
    2) Re Places of Safety, if assessments were carried out within guidelines then my (second hand) experience is that the only requirement is that they should be able to keep people safe until the assessment is completed. Then it really doesn’t matter how nice it is as you will only be there for a few hours . Safety has to be the priority.
    3) If assessments were completed within a maximum of 6 hours it is possible that more people would be admitted as they wouldn’t have had time to compose themselves etc. That would then allow s2 to do what it’s meant to do – observe people in hospital to decide what they actually need. Cynically I’m not sure if that is what Mental Health services actually want……..

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