We hear this word ‘Beds’ a lot when we hear discussion of mental health services and it can get very confusing because the word is used to mean different things, not all of them literal. It happened earlier today during Prime Minister’s Question time in the House of Commons so I thought I’d again stress the detail of certain distinctions that become confused and conflated when we hear discussions of various kinds of ‘beds’ that are not the same thing!
- Version One of what we mean by ‘bed’ is a place in hospital for someone who is admitted as an inpatient, either voluntarily or whilst detained under the Mental Health Act 1983 – this often will involve an actual bed! … with pillows and sheets where you can get your PJs on and hopefully get a good night’s sleep. In this sense, it’s like a bed on a medical or surgical ward, although in modern mental health units, patients often have their own room.
- Version Two is where we hear the word ‘bed’ used after a person has been detained by the police under either s135 or s136 of the Mental Health Act and removed to a Place of Safety. If the NHS cannot make a Place of Safety available for that person’s assessment under these provisions we sometimes hear that “the NHS have no beds”. This is completely different to Version One where someone might have been arrested for an offence, taken to police custody and then assessed as needing admission to hospital.
Strictly speaking, the Place of Safety Version Two thing is usually nothing to do with beds in any literal sense – it is more probably appropriate to talk about ‘capacity’ or ‘space’ affecting the ability of the NHS to accommodate someone until their assessment can occur. I’ve seen many such services and most of them have no sleeping facility at all because the vast majority of people are dealt with in under 6hrs. (This is an average – please don’t write in: I am aware that some areas take much longer and individual circumstances can go way beyond 6hrs!) One or two PoS services which do have a room which doubles as a seclusion style area for those exhibiting challenging behaviours and a mattress can be brought in if people really do need to sleep overnight. Otherwise it chairs or sofas in the assessment room(s) if someone wants to sleep until assessment things happen. It’s not about beds: it’s about the ability to undertake an assessment during which someone is unlikely to need to sleep or lie down for any length of time.
PRIME MINISTER’S QUESTIONS
So today, the Leader of the Opposition asked a question about beds (version one) following which the Prime Minister answered by saying something about beds (version two):
From Hansard 19/10/16 –
JC: “I received a letter from Colin, who has a family member with a chronic mental health condition. Many others, like him, have relatives going through a mental health crisis. He says that the “NHS is so dramatically underfunded” that too often it is left to the underfunded police forces to deal with the consequences of this crisis. Indeed, the chief constable of Devon and Cornwall has this month threatened legal action against the NHS because he is forced to hold people with mental conditions in police cells because there are not enough NHS beds. I simply ask the Prime Minister this: if the Government are truly committed to parity of esteem, why is this trust and so many others facing an acute financial crisis at the present time?
TM: “May I first of all say to Colin that I think all of us in this House recognise the difficulties people have when coping with mental health problems? I commend those in this House who have been prepared to stand up and refer to their own mental health problems. I think that has sent a very important signal to people with mental health issues across the country. The right hon. Gentleman raises the whole question of the interaction between the NHS and police forces. I am very proud of the fact that when I was Home Secretary I actually worked with the Department of Health to bring a change to the way in which police forces dealt with people in mental health crisis. That is why we see those triage pilots out on the streets and better NHS support being given to police forces, so that the number of people who have to be taken to a police cell as a place of safety has come down. Overall, I think it has more than halved, and in some areas it has come down by even more than that. This is a result of the action that this Government have taken.
JC: “The reality is that no one with a mental health condition should ever be taken to a police cell. Such people should be supported in the proper way, and I commend the police and crime commissioners who have managed to end the practice in their areas. The reality is, however, that it is not just Devon and Cornwall that are suffering cuts; the Norfolk and Suffolk mental health trust has been cut in every one of the last three years.”
Why does this matter? – well, I’m not offering particular criticism of our political leaders on this, because it’s commonly misunderstood and other politicians very active on mental health matters have made this mistake. Frontline officers often talk about ‘beds’ when they mean capacity in a PoS for an assessment; I’ve heard NHS Commissioning Managers make the same mistake recently. If we think that reducing the use of police stations as a Place of Safety is going to have an impact on the kinds of problems that were recently highlighted by the Chief Constable of Devon and Cornwall, to which the Leader of the Opposition referred, then we are mistaken.
It has always been the case, despite our focus on the police use of their powers under the Mental Health Act, that we arrest far, far more people for alleged offences who are then assessed in police custody under the Act. On Twitter today, the Leader of the Opposition followed up his PMQ with a tweet that said “No-one with a mental health problem should ever be taken to a police cell”. I presume he also means “whilst in crisis and detained only under the MHA” because if his tweet is taken literally, then we need to think urgently about those hundreds of thousands of arrests every year of people who have mental health problems and are accused of breaking the law – it’s going to require a whole new solution and a pile of legislation.
Nothing at all prevents the arrest and detention in police custody of someone who is seriously mentally ill, especially if they are accused of stabbing, raping or killing someone. Rare though this is, it happens enough to mean we need to acknowledge that if we are to effectively investigate offences and make appropriate decisions about whether people are prosecuted, they may need to spend at least some time in custody where forensic evidence can be recovered, where assessments can occur and where decisions can be taken about how best to proceed.
We don’t have great statistics on this point, but when I looked at it some years ago, the ‘arrested and then assessed MHA’ figure was five times bigger than the use of s136, although that was in a force which had relatively low use of s136. Another force mental health lead looked at this in a higher-use-per-capita force and found that they had three times as many MHA assessments for people under arrest in custody as they had uses of s136 MHA. So focus on beds version two is missing most of the problem.
UNDERSTANDING THE PROBLEM
Sort out further reductions in the use of police custody by all means – who wouldn’t welcome that?! … but don’t imagine for a moment that it will address the problem that appears to be getting greater all the time – the protracted detention in police custody of someone who is due to be diverted from justice under the MHA but where a timely admission to hospital cannot be achieved because of the want of an acute admissions beds somewhere within mental health services, and preferably within 25miles of wherever that person calls home.
If cops, NHS managers and staff don’t understand the difference: it’s no wonder Prime Ministers and Leaders of the Opposition don’t either – and that’s why we heard someone today asking about apples and hearing about pears.
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