New Section 136 Data

Anyone fancy doing a PhD?! – we’re badly in need of some proper research to be done on section 136 data so we stand a chance of knowing what on earth is going on! Friday saw publication by the National Police Chiefs Council of the latest data on the use of this power and we can see various ways of looking at this stuff if we wanted to provide a tabloid-style headline. So depending on whether your glass is half full or half empty –

“Use of police cells as a Place of Safety reduces by over 50%!”

“Police use the Mental Health Act more than ever before!”

In then bears much further scrutiny and begs many more questions –

  1. Why are some police forces of similar size using s136 very differently?
  2. Why are some forces using this power to a very similar extent when they are so obviously different from each?
  3. Why have some forces with street triage schemes reduced their use of s136 and sustained that, whilst others reduced it but it has returned to normal levels?
  4. Why have other forces not reduced it at all, despite street triage?
  5. Why are some forces still relying upon police custody for almost half of their Place of Safety provision, but some haven’t used the cells at all?!
  6. Where s136 has been used in the street, how long does it take to sort out where someone will be removed to and how long are officers sitting in queues for hours until they can even get in to those locations?

Here is the Press Release from the National Police Chief’s Council (containing links to the last two year’s worth of detailed data).  The image below, broken down by force area, is for 2015/16 and at the bottom, in yellow, are the total figures for the last three years.  During reaction to the release of this data, I raised caution about the accuracy of the numbers involved: not only are simple year or year comparisons sometimes unhelpful, but we know there are still problems with this data despite the effort of NPCC to collate it.

Comparing this year with last year, use of s136 is up by almost 5,000 to 28,271. However, we know there was an incomplete data last year! To point out one big example of that, in 2014/15, the Metropolitan Police reported incomplete data (for whatever reason) which put their annual numbers at 829. This year it was 3,693 – up by almost 3,000 and back to where you’d roughly expect it to be (albeit rising). Factoring that in along with other data omissions, we can see the 2014/15 data needs a lot of salt! –

  • 28,271 (15/16) – inc 2,100 to custody.
  • 23,602 (14/15) – inc 4,537 to custody.
  • 26,137 (13/14) – inc 6,667 to custody.

Here is the detailed breakdown, across England and Wales.  The header image of this post, above, is the (inaccurately!) recorded use of s136 going back over a decade.


WHAT’S GOING ON?!

Who knows what’s really happening?!  In reality and based on what we know there are a large number of significant factors influencing all of this and understanding the relevance of them to different areas is fairly important. It is quite beyond me to understand it all without a great deal of work in each area that I don’t have the time to do!  So I would encourage people reading this in various areas to try to ensure the conversation starts and perhaps engage some decent academics to look at it?

I still receive enquiries at the College of Policing about mental health street triage with people asking, “What’s the best model to operate?!” and I always reply, it depends what your problems are and what you’re trying to achieve.  And of course, none of this even begins to discuss the issue of the ‘conversion’ rate, which is a major piece of information used by some professionals to argue the police are over-using this power. Previously, just 17% of people detained under s136 would be admitted to hospital under the MHA but we know two things that put this figure in context –

  1. The threshold for admission is not a constant factor – many MH professionals have been arguing it has risen over time as the number of available inpatient beds has significantly reduced. Is it any wonder that with fewer beds, fewer patients become inpatients?!
  2. How many ‘successful’ outcomes do not involve admission under the MHA – how many patients were admitted informally, referred or re-referred to a community mental health or other health service? If a cop spots a vulnerable person who is subsequently cared for by a community MH team who transforms their life, isn’t that a success?!

I would argue, for a few reasons, there are forces in represented in the above data who are under-using this power and need to think about how to use it more. I argue this because section 136 is just one legal power from a a whole range of legal authorities that can be applied by the police in various situations. To fully understand section 136 usage, you also need to understand how it fits in to those overall options. How many people arrested for criminal offences or to prevent a Breach of the Peace were subsequently and rightly assessed in police custody under the MHA because of concerns for their health? How are interactions between the police and people with potential mental health problems handled and what factors influence an officer’s decision to a) detain; and b) chose the framework for detention?

In other words: are some forces more likely than others to find their officers are using public order laws, drunkenness laws or other provisions where a further moment’s pause and interaction may make it clear that detention under the Mental Health Act is a more appropriate route – and how do forces encourage officers to make decisions where substantive offences are involved like possession of a knife or an assault?  Only this week, we saw concern raised by a judge about a prosecution being dropped where a man was waving a knife around in a public place whilst mentally ill; this comes just a few months after a coroner raised concern that the police arrested someone with mental health problems for possession of a knife and didn’t detain her under the Mental Health Act.

LOOKING FORWARD

This is the last set of data to be published ahead of the law being changed in 2017 and it’s obvious that some areas have far more work to do than others to prepared for the likely implications. If police stations are banned (one amendment to be discussed in the Lords next week will seek a total ban), there are seven police forces who need to be thinking of their contingency plan for over 100 people a year – will that mean unless there is provision, each of them is taken to A&E?!  I fully accept colleagues in A&E may have a view about this but if the law literally bans the use of custody and there is no health-based Place of Safety, what are the other options?!

We are obviously still waiting to learn what ‘exceptional circumstances‘ will mean if that Lords amendment is defeated and the original proposal in the Bill is enacted.  A further problem that is not reflected in these figures is the ability to access a bed for those who are to be admitted to hospital following the police’s use of s136 MHA.  Only this week, I was called at 9:30pm by a triage car from one force who told me their duty inspector was putting pressure on them to sort a situation where someone had been in detention in a health-based PoS for around 30hrs and the MH trust were having a right old job finding a bed in either the public or private mental health sector. In eight months time, that situation will either be unlawful and a violation of European Convention Rights; or just a couple of hours away from becoming so.

Section 136 MHA and everything that flows from it and is associated with it needs to be better understood. In all fairness, there are PhDs being done as right now on the use of the power, on street triage and other aspects of policing and mental health. However, what access those research students have to some of the data, I don’t know. How many forces or MH trusts will be free with data that supports the notion that they are breaching the law or Codes of Practice to the Act because of the overall pressure on our mental health system. How much of this research will reflect operational practice where police officers are sometimes required to become involved in or responsible for highly un-desirable situations that should never have occured in the first place?

We have a lot still to do – and first of all: what is section 136 actually for?! 


IMG_0053IMG_0052Winner of the President’sMedal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award


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13 thoughts on “New Section 136 Data

  1. Yup. I’m interested in research, as I mentioned a while back. If you are serious about it, I’m pretty keen. Maybe email me if you want to pursue? Bill

  2. Hi Mike,
    3 years into a five year part time PhD at the University of Kent.
    I know of others in Sussex and Yorkshire.
    I should have my first publication early next year but in summary so far is that risk averse behaviour by officers frightened by the prospect of a death in police contact, has completely changed the pattern of peoples’ behaviour leading to detention. In effect the police have potentially created a new patient pathway giving priority access to assessment if not treatment.
    There is an interesting interplay between the various triage schemes and officers’ behaviour. I can only comment on a couple of forces so far.
    Best wishes,
    Allyn Thomas (ex Kent and Hampshire police officer)

    1. Very aware of your PhD, of course – it was more of a rhetorical device than anything else! Do you mind if I ask now you’re further in to it – what is your research question, specifically?

      Looking forward to reading what comes out if it all. Let me know if I can support in any way. 👍🏼

  3. Yes, I’m a acute clinician and suspect that part of the issue is the different ways that people with non psychotic illnesses are dealt with by MH services. Working in London (very high levels of psychosis) I have colleagues who have worked in other parts of the country, particularly rural, who are amazed at the way this group of people are admitted to wards, given care coordinators etc. I suspect this approach leads to medicalisation of human distress and subsequent repeat presentations and escalation of dysfunctional behaviours of which s136 arrests will feature prominently. Despite much talk of this anectodally among professionals, I am not aware of research into this. In other words, looking into police response will only be part of the picture

    1. Totally agree: apart from anything g else, history infers that areas with high use of either s136 itself or police custody are areas with less developed relationships between services OR, of course crucially, lower funding per capita from the CCG for MH.

    2. So are psychotic illnesses the only ones that merit an admission? People with mood disorders and personality disorders are just left to carry on with their ‘dysfunctional behaviours’ until they see the error of their ways, or die, whichever comes sooner. Apologies if that is a massive over reaction, I have close relationships with people with both types of disorder (psychotic and mood)

  4. what would be helpful if somebody really brainy could crunch the numbers and give a rate of 136s per 100,000 population, then we might be able to see some interesting contrasts, anybody out there can do that?

  5. i am sure you right kelly, the contrast between rural and inner city is stark, last week the majority of the rural ward i worked on had a personality disorder, despite no evidence that being on ward is beneficial indeed it often has a detrimental effect,

    1. So what treatment is available in your area for personality disorders. It also seems to be over diagnosed , so young women will be diagnosed as PD instead of psychosis or mood disorders, Seems to take longer hospital admissions before a diagnosis of anything else is arrived at. In the community it seems that PD diagnoses are arrived at without the extensive psycholgical reviews etc recommended then colour the view of every professonal involved.

      1. hi judy
        tends to be outpatient based with group therapy, crisis house, looking at individual components ie anger, assertiveness etc, not a perfect solution and i take your point about women and getting pd diagnosis particularly eupd. wards tend to be destructive places that can over medicalise some behaviors leading to a pattern of dependency

      2. Can’t work out how to reply to a reply. My issue with saying admissions don’t help is that people are left to self harm repeatedly, as if it didn’t matter. Even non suicidal self harm can result in lasting injuries, scars and disability. Self harm left unaddressed will often escalate. A hospital admission of itself isn’t helpful for anyone, it is what happens during the admission, normally assessment and changes in medication which help. The patchwork of provision doesn’t seem enough for people who are struggling with disabling symptoms every day. I wish services would address self harm and suicide attempts as emergencies, rather than them frequently being treated as ‘attention seeking’. If they did the police would be able to dramatically reduce their use of s136. I can’t begin to imagine the frustration it must cause to repeatedly detain people for their own safety. only to see then again a couple of days alter.

  6. In my research, I look at this topic but in terms of trends at the population level (in Canada though). In the event someone takes this project, a few pieces they may want to consider is at the event level (Mick: the rural/urban component should be statistically and clinically important), where the incident has occurred (e.g., the proximity to hospitals/pharmacies), and w.r.t. to the patient, their gender, age, and what their underlying illness might be. Chart 1 certainly tells the story of an inverse relationship but certainly more digging into the data would help highlight which subset of the population has been most impacted by s.136.

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