Last week, Professor Sir Simon Wessely published his interim report after being asked in 2017 by the Prime Minister to look at the Mental Health Act 1983. A lot of people have been interested in this since the moment it was announced – a lot of people have a vested interested in this, full stop. It’s important stuff and I don’t think I under-estimate things when I say that the state of our mental health law partly characterises us as a country, because it speaks to how we see ourselves looking after some of the most complex and most vulnerable people, at their most difficult time. By Christmas we’ll have absorbed what Sir Simon is putting forward as his final recommendations.
A review of what we’ve got raises some of the most fundamental questions: when, if ever, should the state take away someone’s autonomy and, potentially their feelings of dignity and self-respect? When, if ever, should we force people to receive treatments against their will – including treatments where even psychiatrists themselves are unable to agree on long versus short-term benefits? Should our law be ‘capacity’ led legislation: that you should be allowed to take any decision as long as you have capacity to do so? – plenty of patients and mental health professionals of various stripes will say some people are subsequently thankful that someone took control of their welfare and wellbeing when they were at their darkest point and that pure ‘capacity’ based legislation will cause some people with certain kinds of mental health conditions to die.
For me, I was just really glad to see that the police were included in this review early. We have remained involved throughout and you’ll notice in the interim review, that the police and policing will be one of several special interest groups in the second half of the review. My boss, Chief Constable Mark Collins is the policing lead for the National Police Chiefs’ Council and he’s submitted various ideas to Sir Simon for consideration, as well as various problems we’d like to see him address in some way, and been an active member of the Advisory Group referred to in the report. So, we’re in there trying to help people understand what an important role the police can play, but how we are probably over-relied upon already.
The report isn’t that long, as these things go – barely 60 pages by the time you strip out the standard guff that all reports have! Policing is covered in section 7.4, page 24, but you’ll have to excuse me copying it all here as I’d like you to read it all –
“The police recognise that helping people with mental health issues is a part of their core business. The police are key partners in the community-based model of mental health care. This is particularly true in cases of immediate responses to people in mental health crisis, where the police have specific powers under the MHA to section people for short periods of time under sections 135 and 136. The use of these powers has remained at a high level over the last decade. This underlines the importance of the police role, but also challenges the NHS to ensure that services are available and ready to take over responsibility at the most appropriate time.
The contribution of police officers to crisis care has been praised by the CQC, but nevertheless should not have to make up for gaps in health care provision. This is especially so because for many people, interactions with the police can be upsetting and stigmatising, and at the very least not therapeutic. This is particularly the case for certain BAME [Black and Minority Ethnic] communities, such as African and Caribbean individuals. There has been a significant reduction of the use of police custody for people held under section 136 but not yet enough to end this practice entirely.
Another emerging issue is that people who are arrested under criminal law stay in police cells for too long after an approved mental health professional (AMHP) has decided that they should be admitted to hospital. It should be a matter of principle that those who are unwell should be treated within the NHS rather than a police cell. This principle should extend to the transportation of service users under the MHA which should under most circumstances be conducted by NHS ambulance services.
We believe that the care of people in cells is as much an issue for health and social care as it is for police. We will consider whether NHS England should take over the commissioning of police custody health care services, or otherwise create a plan so that people in police custody get better care, and faster transfers out to NHS and social care services.
Finally, but crucially, equality issues are of the utmost importance when it comes to all police work, and we will consider how new approaches and innovations from forces have helped to address the experience of people from BAME communities who come to the attention of the police when needing mental health support.
We will consider further:
- How recent legislative changes to sections 135 and 136 are changing service approaches and whether it is right to bring an end to having a police cell designated as a place of safety. If so, what safeguards and resources are needed to do this safely?
- Why people who are arrested under the criminal law are staying in police cells for too long after an approved mental health professional has decided that the person needs to be admitted to hospital, and what can be done to address this.
- Why police vehicles rather than ambulances are still transporting the majority of people under these sections, and what can be done to address this.
- The practicalities and benefits of NHS England taking over the commissioning of health services in police custody, as has been recommended in both the Angiolini and Bradley reports.
- Equality issues, particularly police interactions with people from BAME communities under the MHA.
This covers the main issues that police forces and police officers raise with me, when they are asking questions that come down to the problems with our mental health law. Others might include addressing, in some way, shape or form, the very real problem that the UK currently cannot ensure the right kinds of professionals respond in a timely way to someone in a house when they are in crisis – do we also need to look at how we safeguard people in their own homes when they are at risk?
IF I MAY?
If I were to offer an observation as someone reading the report and trying to think from the outside, as if I hadn’t been to the meetings or discussed this at all, I think I’d wonder aloud, as I am constantly doing at the moment, about whether the problem to be fixed in policing is the issue of NHS support, delays in achieving that support (for beds, for conveyance, for place of safety spaces, etc.) or whether the real problem is the extent to which we appear to over-rely upon the police as a de facto mental health care provider. The fact that the police are praised for their contribution and that patients themselves report the police as displaying a better attitude towards them and their needs whilst they are in crisis, is welcome, but not relevant to me. My decorator is nicer than my plumber, but when the heating goes in my house, I’m not ring the guy with the brushes and roller.
One thing that’s been obvious throughout this review process, including the various comments I’ve seen from those of us with mental health problems on social media, is that many of the things that people ‘want’ are not, directly, issues with legislation. They are issues with resources: ahead of going to one of the first Advisory Group meetings, I asked on social media what people and police officers would like to see. Often, the answers were things like, “Crisis Teams that can actually respond in a timely way when there’s a crisis incident” or “more inpatient beds”, etc.. Of course, you could have both of those now, without changing the Mental Health Act itself – the NHS just needs to take the necessary action to increase staffing on crisis teams and to open up more beds. (Before anyone attacks my use of the word ‘just’, I am aware of the nurse recruitment problems, funding cuts, etc., etc.. – I use the term to distinguish between choices that could already, in theory, be taken and choices which require amendments of primary legislation.)
So I’m fairly happy enough so far, because a special interest topic group in Phase 2 of the review is bound to get in to the detail of these things and for what it’s worth: I know Sir Simon, who took some flak on social media for even being appointed to lead this review, is trying hard to do the impossible. From whatever perspective you want to look at this, it’s a near-impossible job because when I sit and listen to those parts of the discussions and debates that don’t professionally concern me, I can see there are many people passionately arguing their case for things which are equally passionately opposed by others just across the room. It doesn’t matter what he does or what he recommends here, he is going to disappoint plenty of people for daring to even suggest certain things and for not daring to do so. And whoever was chairing this review, they could be accused of vested interests as well. All I can say is this: it looks to me from the parts I am seeing as if this is being done as fairly and openly as possible and that the various conspiracy theories I hear are ill-founded.
Let’s now see what the second phase brings.
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2019
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – http://www.legislation.gov.uk