Three Months … and Counting!

Update: since writing this post, the Bill has become and Act and it is still thought commencement will occur in May 2017. I have written an in-depth series of posts on these matters, for more in depth thoughts about what this will all mean.


This year, the Mental Health Act 1983 will change. It will be amended (during April, we think) by the Policing and Crime Act 2017* and by the time we sit here early next year, we will know far more about how we’ve coped with it all, but there are plenty of indicators around that we are not at all prepared for or sighted on these changes. So with three months to go ’til this all kicks in, it seems timely to loudly re-bang the drum lest we risk seeing police forces and mental health services having some really difficult conversations at 0337hrs on some Tuesday morning in early May. I’m nervous about all of this, quite frankly. Some areas are struggling under current laws and these amendments only make things far harder for the organisations involved. However, they should make things much better for the public and that, of course, is exactly the point – we’re talking about the liberty of vulnerable people here!

For the avoidance of doubt, the amendments to the Mental Health Act are almost exactly as they were originally introduced to the House of Commons in 2016 – little has changed during the Parliamentary process so it’s fair to point out that we’ve all had a year already to start preparing for this. I have emailed forces with considerably more detail than I am going to put in this post around three months ago, to point out we were six months out and needed to start partnership discussions if we hadn’t already. I know some forces have done exactly this and have written plans they are working towards completing in adequate time. I know others are nowhere on this – sometimes because they’ve tried to raise the point, but haven’t been heard.

Some forces are still detaining hundreds of people a year in police custody as a Place of Safety, so are struggling under the current legal frameworks to achieve what is needed – often because of problems way beyond their control.  If this stuff isn’t going to fall flat on its face, it’s about senior managers in health, local authorities and police forces who need to be sighted on things. I would urgently recommend some senior managers in A&E get interested in making the points I’m making in this post, because I strongly suspect that if adequate preparation for the changes are not made, they will be asked more frequently than ever before to support vulnerable people in the care of the police. And we all know what a quiet time A&E are having at the moment!

READY, STEADY, GO!

So set your timers for three months and start counting –

  • In three months time, it will be completely unlawful for police officers to take any child to a police station if they are detained under s136 MHA – yet only this week, I know for a fact that the police have had to email chief executives in mental health and acute trusts they work alongside, reminding them of the law and rebutting suggestions that they should just bang kids up in concrete rooms because that’s how the NHS would prefer it.
  • In three months time, AMHPs will have just 24hrs in which to coordinate an assessment at a Place of Safety – if they decide it is necessary to make an application for that person’s admission, they will not be able to extend the 24hrs up to 36hrs where that extension is only necessary to identify a hospital with an available bed. Commissioners need to think about bed capacity and their ability to admit over 3,000 people a year within this timescale.
  • In three months time, the police will have to ring a mental health professional, where practicable, before deciding to remove someone to a Place of Safety.  So we need to know fairly soon, which phone number do the police ring in order to comply with this requirement. It needs to be available 24hrs a day, 7 days a week so even where areas have street triage schemes or liaison and diversion schemes, how will it work when they are not operating?
  • In three months time, adults will only be able to be taken to police cells in ‘exceptional circumstances’ – although this is not yet fully defined, the original idea behind this was around the detention of vulnerable people exhibiting ‘behaviours so extreme it cannot otherwise be safely managed’. We need to see whether that remains the definition, but then understand what it means and how we should interpret that in light of existing medical guidelines.

There is more to the impending amendments, but those are the main things that will require planning and partnership discussions.  If we haven’t started thinking about this stuff already, we need to be ringing people next week to start talking about it, because in April 2017, this will be the law of the country and failure to comply with it will amount to serious problems we won’t be able to defend.

Wider questions: the Code of Practice to the Mental Health Act was updated in England in 2015 and in Wales in 2016 (it has been in operation only for three months!).  We don’t yet know whether those Codes will be updated in 2017 to take account of these changes, so the statutory guidance about how s135/6 operates (chapters 16 of each Code) may become less relevant and less able to be relied upon to hold each other to account. I think it’s vital an updated Code is issued, or at least some transitional equivalent document until such time as the next full revision occurs – they normally occur about every 9yrs or so … next one due around 2024/5-ish!

Oh, and the power itself will be able to be used in private places (except private dwellings) so all other things being equal use of this power will still be destined to rise.  You’re welcome.

That’s probably enough to be getting on with! – we’ve got three months and we really can’t say we didn’t know what was coming.

* The Policing and Crime Bill 2016 is yet to receive Royal Assent and become and Act of Parliament; it is anticipated the Queen will give her Assent to the Bill in late January and that the MHA amendments will take effect approximately three months later. These are estimates, subject to confirmation by the Government!


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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11 thoughts on “Three Months … and Counting!

  1. Well I see some “conflicts” coming, despite your efforts. Will do what I can in my area to ensure local force & partners are as prepared as they can be. And we are one of the better ones, but still expect some resistance from some areas. Wonder who will be collecting data about this change & compliance??

  2. Really helpful also enlightening
    Working as a senior practitioner Mental health A&E Liaison Former chief Inspector Merseyside I get to see the frustration on both sides
    Thank you for your information

  3. ….and meanwhile I’ve been invited to a meeting this month to discuss “bed occupancy.” Code for ‘more beds are being closed this year and how the hell will we cope ‘. This, in the context of people already being admitted Far Away and all the background chaos and human misery this causes. Oh well, at least our PM is making a speech tomorrow

  4. Personal worry that in our are health based places of safety are not intrinsically safe enough, and are not staffed safely/well enough to keep people as safe as they would be in custody, if that makes sense. Search protocols also need to be agreed to make sure people can’t self harm while in a pos. Also always worry that to save issue with a bed then decison may be made just not to detain…..

  5. I have worked as a psychiatrist in the UK and Australia, back and forth over the past 30 years, and am so sad to see what has happened and is still happening in the UK. The whole approach to mental health care of vulnerable individuals is based on risk aversion and custodial, and is not conducive to recovery. The focus is on minutiae, what can be done to change the attitude of policy makers?

  6. “they should just bang kids up in concrete rooms because that’s how the NHS would prefer it.”
    Really?
    I’m an ED consultant working with both adults and young people and I’m sure that none of my colleagues want kids banged up.
    This was unnecessarily vitriolic and possibly false. Before you start pointing fingers, you may wish to reach out to your many colleagues across the UK in the police force that seem to have no understanding of the mental capacity act, who haven’t performed a capacity assessment and bring (mainly adults) to the ED as “he hasn’t got capacity doc”. He may not, but if you haven’t documented a valid capacity assessment then you are on very shaky ground.
    Shame about this as the rest of the blog is good stuff.

    1. Well some of them do in the sense that the partial quote you’ve selected above related to a real incident, in a real A&E I could name, on a date I can name where a child I could name was subject to A&E staff wanting them detained in police custody. You’ll have to excuse me if this example sounded vitriolic, but we are now 37years beyond the enactment of the MHA and the NHS still, in just some areas, does not know where they would like a vulnerable child removed to under the Act and parents contact me, not infrequently, in utter despair at how CAMHS patients are disadvantaged.

      And if you can tell me where, precisely, there is a legal requirement to document a capacity assessment, I’ll happily buy you a pint. The Code of Practice goes so far as to point out that this is not required and that the quality, depth and kind of capacity assessment that can be accepted will be something that should be judged on its own merits in its own context. Elsewhere on this BLOG you will see that I also criticise the police, including for misapplying the Mental Capacity Act – you happen to be reading a post where the implications of what needs to happen broadly sit with the NHS to sort. On other topics, you’ll see criticism directly squarely at the police. You’ll also find that I could probably lay claim, at my own cost, to having done more than any other police officer in the country to get this situation squared away but you fall in to a logical fallacy if you think I’m not allowed to point out the implications of laws that are just about to smack us all in the face because of how under-prepared we are, before I personally sort out every other problem in British policing connected to mental health.

      I’ll presume that you took responsibility for the incidents you were concerned about by escalating your (partially misfouneded) observations about the officers’ decisions to their sergeants and / or inspectors, taking time out of your professional and personal time, as I have, to ensure that the required learning is take on board? The interface of policing and emergency mental health is a mess, not of my making: given the whole narrative about the interface is one of poor, unfortunately untrained, relatively uneducated police officers stuffing things up, it seems remarkable than little has improved in those 37yrs doesn’t it? – it’s almost as if our health service doesn’t understand the country’s health laws, but I’m sure that’s just because as a police officer, I’m not bright enough to understand it all.

  7. Hi Michael

    This is great & very helpful. In the Ready, Steady Go section, in bullet point 2, when does the clock stop on that 24hours?
    Is it when the application is made, when the bed is identified, after the patient leaves the ward to go to the In-Patient Unit?
    Can you clarify that point?

    Thanks

  8. This is setting an unrealistic expectation on the mental health services – which are already struggling. It seems to be that the service offered by the police is the only one considered here. Unless they open more beds and employ more staff these changes will be impossible to bring in, as mental health staff are working as quickly as possible in the safest way for each patient. If they rush to discharge somebody from a bed to accept a new patient, that first patient could then end up being detained under a section 136 that same night.

    Proper thought needs to be put into this before anybody will be able to implement these changes.

    1. I don’t disagree with you at all, not for a moment. You’re far from being the only healthcare professional to voice those views and I can assure you: the police involved in this stuff having been making these noises on your behalf, making these exact representations both formally and informally. As it happens, your comment came through just as I’m sitting down in a meeting with six police officers and the guy from the Home Office leading on all this stuff and we’ve made your voice heard (I read out your comment, in full).

  9. Some very salient realistic concerns raised above, but unless realistic funding and some clear significant structure is established quickly it is the individual who is CFC who will suffer. In some areas of the country the waiting list for counselling is 8 months irrespective of level of mh condition. This is totally innappropriate … if people can get help and support quickly then

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