We’ve been playing with the newly amended police powers under the Mental Health Act for over a week now – I say ‘playing’ because it seems there are various kinds of games going on from the early feedback I’ve received! This post aims to just highlight those kinds of problems that have been drawn to my attention, so those of you reading may reflect on them and how things have been working in your area. It’s nothing major and new legislation always takes a while to settle – for example, we’re now more than 58yrs on from a Place of Safety being defined as ‘social services accommodation, a hospital and police station or anywhere temporarily willing to receive the person’ and we’ve still enjoyed a healthy dose of A&E departments insisting that they are NOT a Place of Safety under the Act. Fifty-eight years … are A&E departments not part of hospitals, then?!
The Royal College of Emergency Medicine has published a new guidance document about the changes which came in, to assist staff in EDs to navigate the new requirements. It carefully avoids addressing the ‘Place of Safety’ question head-on, but in fairness to them, it does outline various things that appear to reflect the new Government guidance on the amendments: that hospitals are a place of safety (see paragraph 4.4). RCEM point out that the place of safety ‘clock’ starts from the point where someone first arrives in ED after detention. Why would a Place of Safety ‘clock’ start, unless it was being accepted that the place was being used as a Place of Safety, even if just whilst initial assessment and care of injuries or other illnesses are undertaken? It points out that referral for MHA assessment should occur as soon as possible after the person arrives. << Police officers should always inform the local AMHP as soon as possible – even if the assessment will need to be delayed for a few hours, it puts the need for it on the AMHP’s radar and may allow them to plan more appropriately to be available when they are, in fact, required. It also allows them opportunity to conduct background research, if required.
There are some basics around s136 and Places of Safety which have not changed in the amendments, but which seem to feature in last week’s highlights. For example, if someone is to be transferred from one place of safety to another, it has always been a requirement of the Code of Practice that this transfer be authorised by a doctor or an AMHP and that before moving the patient, it is confirmed that the other location can receive the person on arrival. There’s no point removing someone from an A&E department after treatment for injuries to a mental health unit PoS if it is already fully occupied and unable to physically accommodate the person. Yet that’s what happened in one area last week and we had a poor guy in a police vehicle bouncing around a system that wouldn’t allow him in. This simple shouldn’t have happened – he should not have been removed from ED until we knew the MH PoS was in a position to allow him in!
We’ve been aiming to get the police to ring for an ambulance in connection with s136 for some whilst now – apart from anything else, it is a requirement of chapter 17 of the Code of Practice to the MHA (in England and in Wales) that non-police vehicles be used for conveyance and following use of s136 this is most usually only possible in an NHS ambulance. But we also want our hero colleagues in green to help us out with clinical stuff: remember, what YOU think as an officer may be a mental health problem could be any number of other medical maladies: meningitis, diabetes, encephalitis, brain tumour, serotonin syndrome, Addison’s Disease (you’ll probably have to look that one up!), etc., etc., … you can see my point? I chose each of those conditions because they have happened in the real world after police contact with someone thought to be mentally ill. Paramedics can help with identification of this stuff! But paramedics also now have a statutory role to play, because they are named in the Mental Health Act (Place of Safety) Regulations 2017 as being one of the professionals with whom to have a pre-s136 conversation. Without accessing to MH records, I’m not necessarily what they’ll be able to say to the police, but they are listed as an option so we should be trying to get them involved, for all of these reasons.
The choice about a Place of Safety is broadly similar as it was before:
- First consideration: does this person present with a RED FLAG that means they require urgent removal to ED? – if so, go there.
- If not, can we access a health-based Place of Safety where this person may be assessed? – if so, go there.
- If not, can we improvise a location that is appropriate and suitable (person’s home, that of any family or friends who may be willing to help? – if so, try that but remember the caveats in s135(7) which apply to this.
- Finally, no child may be taken to a police station, EVER; adults may only be taken in exceptional circumstances – ensure this doesn’t occur without an inspectors authority and unless there has been at least some clinical assessment to ensure it would be safe, especially if ongoing restraint is required.
- Nothing in law prevents a police officer asking ED to consider helping, if they genuinely find themselves without other options which exists in the real world.
The pre-detention consultation requirement has proved interesting in some areas! – several officers have attempted to contact a crisis team or triage team only be told it wasn’t clear why they were ringing and any decision to detain was theirs to take! – this caused confusion at both ends of the phone. In fairness to my nurse colleagues in community or crisis teams, no-one specified the purpose or nature of this consultation, so it may be some haven’t had to think through what information may be useful to the officer and what they can or can’t share. In fairness to some police officers, what
One duty inspector contacted me about an incident where it had been drawn to his attention officers were physically detaining and handcuffing a person, pending the outcome of an attempt to consult with healthcare professionals. Again, in all fairness, brief detention and the use of force are not only permitted where officers have arrested someone or detained them under the Act, but the more restrictive that brief intervention, the easier and faster it will start to amount to a deprivation of liberty and how brief can that be before a court would think it unlawful? Is 1 minute OK, if the consultation then gives us a better plan than detention? It 1 is ok, is 2 or 5 … or 10?! In the particular situation the inspector formed the view the officers had no rationale for the detention except that they were waiting on information from the NHS, so he suggested that perhaps the detention decision was already, in fact, taken and it would be better resolved at a Place of Safety.
Finally, there is the whole ‘crime’ thing. What if someone is arrested for a fairly minor crime, even possibly arrested for it in private premises; and the FME in police custody calls for a Mental Health Act assessment because they think someone is fairly poorly and may require admission? Already this week, we’ve had a situation where the police were called to a hospital where a teenage child was on an open paediatric ward voluntarily, because of mental health problems. After some kind of disturbance officers were requested to arrest and remove them because of risks to others. Once in custody it quickly became clear that there was little evidence of offending, limited public interest in criminalising a young person and that they were going to have to be detained under the MHA. Therefore the custody took the decision to release the child under investigation, to allow for MHA processes to occur. The arresting-investigating officers were asked to liaise with the AMHP to arrange the MHA assessment and if the child been at liberty was thought unsafe, to consider the use of s136. That is ultimately what occurred, but the Place of Safety did question the use of s136 in police custody. Remember, s136 no longer requires officers to ‘find’ a person in any particular kind of place, it merely says s136 cannot be used in “house, flat or room where that person, or another person is living”.
These are just a few early thoughts and anecdotes about it all – I’m sure we’ll hear more over the coming weeks!
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Since this blog began, the law of England and Wales, including the Codes of Practice to the Mental Health Act 1983 have been updated, several times. Always check the date of publication, displayed below; and cross-reference to current legislation and guidance when using this material as a reference guide.