Tour of the new Patchway Police Centre. Inside a custody cell.
Photo by Dan Regan
Reporter - Rachel Gardner
Copyright - Local World


Working as a police officer has forced me to be a part of some of the most unbelievable indignities I’ve ever seen and I wasn’t a willing participant in many of them – and unfortunately the worst of them have been mental health related incidents. After almost eighteen years of experience, I’ve seen and done some things I’d really rather not and it’s influenced my thinking about what I believe we should be trying to achieve here.

I wanted to share just some of them with you —

  • I don’t want to see a complete, unequivocal end to the use of police custody as a Place of Safety under the Mental Health Act because it saves the custody officer some grief – it’s absolutely degrading to see someone in distress in custody where they have done nothing wrong. In many cases it is also legally degrading and no-one should pretend that cases like MS v UK aren’t being repeated in the United Kingdom notwithstanding the court’s ruling. I’ve seen several such cases since that judgment and I’ve flagged every single one of them: the answers that always come back are answers which are never legally acceptable … “not enough money”, “not enough beds”.
  • I don’t want to have to criminalise someone in order for them to be able to access a service which meets their needs and which would otherwise be unavailable – some mental health services are not open to people purely on the basis of clinical need, but require legal conditions to be imposed that only the justice system can determine. This tendency to criminalise people for the sake of accessing clinical services is something I cannot get used to and to have your future DBS record marked by a prosecution is especially degrading when the real issue was you needed empathy, compassion and support. We would never stand for it in any other kind of healthcare and I really don’t see why we insist upon it in mental health.
  • I don’t want to be forced to determine whether or not a vulnerable person in need of care and a safe space should be illegally detained or illegally neglected – I’m actually quite happy to take decisions in legally ambiguous circumstances; it’s not the decision-making I object to. I actually resent be obliged to manage a position where someone suffers such indignity because we cannot plan services to ensure basic human rights. I’m referring here to the rights not to be detained other than in circumstances the law has taken trouble to specify; not to be degraded whilst detained and not to be held in an environment that is irrelevant to my particular needs when I’m unwell.
  • I will admit that I don’t want to be connected to forcing medication on patients because it is utterly degrading to see an adult woman being restrained by mixed sex nurses who are pulling her trousers down in order to force medication upon her by injection to the backside – I’ll be honest: it’s not what I joined the police for! There would be no question in other legal contexts that forcing someone into a situation where their clothing is removed would be done by same-sex professionals. I’ve got huge ethical objections to it, never mind the question of whether it’s even lawful for the police to be involved in such things. If you’re interested in doing that to other people, you should plan and prepare adequately so you can do it yourself, as envisaged by the Act itself and required by Health & Safety law.

Today is World Mental Health Day – the theme is dignity. To begin with, I struggled to think what could be said in short post. It was only when I reversed the proposition to think of indignity that I was over-run with examples, ideas and frustrations from my experience. It has always been at the heart of my concerns in policing and mental health that we need to do much more about very obvious indignities and degradations our broader system of mental health and crisis care inflicts on people and in particular, we need a far deeper understanding of how policing, coercion and a lack of compassion can unwittingly contribute to some of the the greatest indignities we’ll ever see. I suspect some of the things I worry about are easily dismissed by many but having now been actively working in this area of policing for well over a decade I would conclude this:

I blog for World Mental Health DayMental health care seems to works best when it is designed and delivered in such a way as to maximise the engagement of those of us who use services and is built around their needs, not those of organisations or professionals; it minimises power imbalances with those professionals and involves coercion, criminalisation and custody only to the extent that is utterly unavoidable.

I fear we still have a long way to go; indeed I worry that we’re actually going backwards.


IMG_0053IMG_0052Winner of the President’s Medal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


Forcing Entry for Welfare Checks

Another BLOG to reinforce points that have been made by the police for some years now: we have no legal  powers whatsoever in private premises under the Mental Health Act and we cannot force entry to someone’s private premises in order to check on their welfare, unless there are reasonable grounds to suspect that their life is very literally at risk. This is the express statement of the Courts – in SYED v DPP [2010] and D’SOUZA v DPP [1992] – and it is the express position of your elected Government who have specifically reviewed the matter during the introduction of the Care Act 2014 and in forthcoming amendments fo the Mental Health Act 1983.

This stark reminder comes against a very tragic backdrop: an inquest in Staffordshire into the death of an unwell, vulnerable man who took his own life by stabbing himself repeatedly whilst the police twice decided not to respond to requests from other agencies to check on his welfare. A Coroner’s court heard how the man failed to attend an outpatient appointment and failed to respond to mental health services when they attended his home address. He was seen moving within the premises by staff who then left the area and rang the police who twice pointed out they have no more powers to act in that situation than whoever had knocked the front door and been ignored.

You will note in this particular article that the Coroner is not quoted in any way criticising the position that the police took in connection with the requests received – in previous coverage the  Coroner was told by an officer from Professional Standards that officers had to make a judgement call and the Coroner wondered “the wrong judgement call had been made.” We can l wonder, but we have to assume a Court would take a view about whether officers did or did not have grounds to force entry.

It is the second Inquest in Staffordshire where police powers to address mental vulnerability in private premises have been relevant – the police have no powers in private premises to take action or to force entry and should not be the lead agency in addressing the needs of vulnerable people unless there are literally life-threatening risks. (I’ll add a link to this paragraph as soon as I can dig it out.)


The police service receives, quite literally, thousands of requests every day to check on the welfare of various people. In London alone, the numbers are in excess of ten thousand requests a month: that’s around 322 requests every single day and only a small minority of them (4-5%) relate to urgent or imminent risks to someone or relate to a situation where a crime has occured or is in progress. Many of them relate to individuals who are also owed a duty of care by a range of other helath and / or social care organisations. There is a very legitimate question of whether the police add anything to a situation: anyone can knock on someone’s from door, telephone them or write them a letter – the police bring powers of coercion to force entry, but they are tightly controlled in light of the law and the above-mentioned legal rulings and they don’t apply to the vast majority of situations to which welfare requests relate. I do accept that people may be differently inclined to answer their door to a uniformed police officer, but not always that they are more inclined – the reverse could be true because of what that person anticipates the police may then do. We should not assume the police are always a welcomed aspect of responding to someone who is unwell and we should treat each person as an individual.

So in this particularly tragic case, we should note that those who attended didn’t keep the house under any form of observation whilst urgently seeking a warrant under the Mental Health Act to allow action to be taken. We can infer it’s therefore questionable how concerned they were that immediate action was needed – they were concerned enough to ring an agency with no powers to do anything else they hadn’t already done; but not concerned enough to remain in place whilst escalating the problem to mental health professionals who could have brought something else to bear. For the record: I’m not questioning the correctness of that decision – not for one moment. I obviously don’t have enough information to know whether or not they had enough justification to do anything else but I point this out because it allows us to infer that concerens cannot have been at the upper end of the scale, because no urgent action was deemed necessary. So why would the police take urgent action? – and what urgent action could they lawfully take?!


Beginning a news article with “paranoid schizophrenic” set me off on the wrong foot for a start – as if this was the most important descriptor of a vulnerable man and his life? Within the first paragraph we then have suggestion that the police “twice failed to respond” and this assumes that a) they had a duty to respond and that b) they had relevant legal powers to respond. Neither of these claims is true on the facts given in the article. No-one told the police that his life was immediately at risk, officers did take the time to check on his background and had no reason to think he was self-harming or would do so; they concluded that they had no legal powers to force entry to the premises and mental health services had already visited and seen him moving within the premises. On the facts as reported to them, the headline could have been “Police refuse to unlawfully invade a vulnerable man’s home” or similar.

Your Government reviewed police powers under the MHA last year and published a document about it. This document reflected considerable feedback from the public and other interested organisations that police powers in these circumstances should not be extended. Forthcoming legislation to amend the MHA will not amend this part of it – and this is a deliberate decision in light of what the public want. It is therefore incumbent upon other organisations who do have legal powers to act in these situations to take advantage of their powers to do so. It seems arguable from the facts presented here that a warrant under s135(1) may well have been possible to obtain – perhaps we should ask why this wasn’t done as soon as the patient refused entry to the premises instead of berating the police for respecting the rights of people not to have their homes unlawfully violated? After all, one feature of the Government review was repeated anecdotal evidence that the police have done exactly this in the past and that it needs to stop.

This case is too awful for words: poor bloke was seen alive by mental health services at one point and subsequently found dead – accepting that not all risk can be totally eliminated, it does re-emphasize the need for professionals to understand legal frameworks, potentially to communicate more clearly with each other and to work more effectively together. The importance of this cannot be under-estimated. 

IMG_0053IMG_0052Winner of the President’s Medal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


Clinical Commissioning Groups

Clinical Commissioning Groups (CCGs) were introduced by the Health & Social Care Act 2012 – they are now the bodies in England which are responsible for healthcare. They are, in principle, led by GPs in the area they cover and, as the name suggests, they are responsible for ‘commissioning’ the medical care that is provided for their areas, having taken over this legal responsiblity from the Primary Care Trusts which they replaced. During this time, the structures in Wales remained unchanged: they had Local Health Boards (LHBs) in Wales prior to 2012 and they still do – health provision being a constitutionally devolved responsibility in Wales.  Both CCGs and LHBs have certain specific responsibilities under the Mental Health Act 1983 and it these responsibilities I want to touch upon here.

The health professionals reading this should try hard to accommodate my blatant over-simplification in this paragraph, bearing in mind it’s for a police audience, in the main! — the idea behind commissioning is that the CCG can ‘buy’ the required medical services from any competent provider, whether they are an NHS Trust or a private provider like Virgin Care. CCGs are given the budget by NHS England (who in theory hold CCGs to account, but who have also decided to uplift the money given to CCGs for mental health by less than that for physical health) and the GPs are assumed to be competent to take the best decisions for their local areas. Where thought appropriate, CCGs they can combine their efforts to buy care in order to achieve economies of scale: so for example, all the CCGs in Birmingham and Solihull have pooled their money for adult and older-adult mental health care and bought it from Birmingham and Solihull Mental Health Foundation Trust.  Just to give a sense of how complicated it can be, one of those ‘Birmingham’ CCGs is actually the Sandwell and West Birmingham CCG who have given some MH money for their Birmingham residents to the overall MH Trust for Birmingham and pooled their ‘other’ mental health money for their Sandwell residents with Wolverhampton, buying services from the Black Country Partnership NHS Trust.  Having worked in both Sandwell and west Birmingham as an operational cop, there is therefore a road bordering the areas where you have the same CCG but which MH trust supports you is determined by which side of Stanmore Road you live on – and they provide services in a very different way.  Hope that’s nice a clear for you!

This post is about CCG and LHB responsibilities under s140 of the Mental Health Act: this is a section of the Act few people may have heard about, but some of will be familiar with the fact that I bang on about this section with monotonous regularity, ignored as it is by CCGs!


At the end of 2013 I was sat at home one evening, frustrated by yet another story of police officers being asked to illegally detain people in police cells pending a MHA application to hospital by an AMHP. The AMHP was struggling to identify a bed in to which a patient could be admitted and in all fairness, it’s not the AMHP’s legal responsibility to find a bed when it’s required – that duty sits with the lead DR from the patient’s MHA assessment. The DR was struggling because the local trust’s ‘bed management’ system was saying everywhere was full up and they were struggling even to find an ‘out of area’ or private bed in any hospital further afield.

So I decided to dash off three dozen requests under the Freedom of Information Act: asking CCGs to provide to me the list of those hospitals they have a duty to specify to Local Authorities who oversee the operation of AMHPs. I’ll let you read up on the specifics of s140 in a previous BLOG if you want more detail.  Suffice to say here that NONE of the thirty-six CCGs could actually answer the question – some of them were even honest enough to admit they did not understand the question! Section 140 obliges CCGs to identify those hospitals within their area or to which they have access that may receive patients in “circumstances of special urgency”.

Where do AMHPs make urgent applications when risks are such that someone needs urgent admission?

Urgent admission is a human rights issue: we saw this in the case of MS v UK [2012] where even ostensibly lawful detention in a police cell under s136 MHA was deemed incompatible with Article 3 of the European Convention because a patient was allowed to get in to an extremely degrading condition when they were in ‘dire need or urgent psychiatric treatment’. So the ability to admit patients quickly is a legal requirement not only to manage any risks to the patient or, less frequently, to others; but it is also necessary to prevent patients who appear lawfully detained suffering extremely degrading conditions when acutely unwell.


When this discussion emerges, it is normally pointed out that s140 doesn’t actually oblige hospitals which find themselves specified from receiving those patients who admission is urgently sought – that if hospitals are full and there are no beds then “there are no beds and that’s the end of it!” said an AMHP to me on one occasion. These kinds of responses miss the point being implied by the section – it’s not so much about creating a duty on already stretched (or over-stretched) hospitals to find capacity to manage another unwell person; more importantly it is about an implied requirement on the CCG to ensure that within their overall commissioning arrangements, they have planned for peaks and troughs of demand and contingency for urgent admissions.

I was caused to think of this again earlier in the week when I read an open letter from the Chief Executive of Help for Heroes, responding to criticism that the charity had done too much, too well, in ensuring provision for injured military personnel. A minister had questioned the provision because beds were empty and Bryn PARRY replied “Recovery is not measured in the number of beds occupied on any particular night; we are not running a Travelodge.” This is the point: an empty bed in a Help for Heroes rehabilitation unit or in a mental health unit is not a disaster: in fact, it’s a necessity if you are dealing with complex service provision and levels of unscheduled demand, you may need available capacity to manage urgent admissions. This is what the court found in MS v UK: that making arguments about a lack of resources in the mental health system was not adequate to explain why someone’s human rights have been violated and it implied the need for contingency. That, to my mind, is all that section 140 is getting at: commissioning.

So back in the world of service delivery decisions by AMHPs and DRs, delaying applications for admission for bed management reasons may well be something advocated by the Code of Practice to the Mental Health Act, but a Code of Practice is legally far less significant than violation of the mental Health Act itself – which makes no mention of ‘beds’ as a threshold for admission – and less significant than violation of the European Convention. But these arguments are about the complexities of service provision: what is ultimately important is that when CCGs are sitting down to make commissioning decisions about mental health care, they anticipate the very obvious reality that from time to time, admissions to hospital are going to be required and that to delay at all will sometimes amount to a violation of Article 3 and / or Article 5. CCGs are public authorities under a proactive duty to prevent those violations in the way they do undertake their work, so they need to be commissioning slack in the system.

Probably best not to get going on supposed financial implications: more than one area of England has already found themselves in the position of having incurred more cost from our of area and private placements to cope with demand than they ever saved by reducing the number of beds in the first place.  Cutting beds to save £1m whilst incurring costs well over £1m to cope with resulting excessive demand?! … it’s just inane! Section 140 is not, ultimately, about tactical decisions by AMHPs or about forcing over-stretched hospitals to accept ever more admissions – it is about CCGs recognising a clear implication to ensure they commission just some hospitals in such a way as to maintain contingency options where AMHPs have to act urgently.  CCGs are currently doing to AMHPs what Stuart LANCASTER is doing to the England Rugby team – making the tactical execution harder than it needs to be by making some poor strategic decisions.

On that note: I’m now off to watch whether England become the first hosts to be kicked out of their own World Cup even before the end of the group stage.

IMG_0053IMG_0052Winner of the President’s Medal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.