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College of Policing – Newsletters

We are in the process of setting up some College of Policing webpages on mental health and will be putting various items on there in due course.  This BLOG post is just a temporary way of uploading some materials, like the College’s newsletters, so they can be publicly accessed and very easily circulated via social media and email.

They will be placed on the College website as soon as I can get the pages created –

NEWSLETTERS

The individual newsletters are uploaded as PDF files and can be access by clicking the links on the relevant date –

  • March 2015 – outlined of the College’s work-plan for 2015/16 on Approved Professional Practice and police training.  An update on various activities the College has undertaken on behalf of or in support of police forces in England and Wales.
  • April 2015 – noteworthy cases and reports from 2015, including the new Code of Practice to the Mental Health Act 1983, Court of Appeal judgments and the inquiries of relevance from the Equality and Human Rights Commission.

This page will be updated and re-circulated from time to time.

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The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs

ccawards2013 was highlighted by the Independent Commission on Policing & Mental Health
– was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.

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Another Dozen Little Details

Again, your indulgence is craved on what is essentially a repeat-publication post.  I’ve argued that there are a dozen or so little nuggets of legal knowledge in the Code of Practice to the Mental Health Act that police officers really need to know in order to be effective but the introduction of a new Code of Practice (2015) on 01st April means that all the numbering and references have changed.  All of it is still there, but renumbered just to ensure that the police get confused all over again!  Not really – but it does have that effect!  So it’s back to the text books for us all and as the new Code is almost five hundred pages long, divided into almost forty chapters, it’s an awful lot to take in.  I’ve now managed to actually read it straight-through, having done similar with the old Code some years ago and having vowed never , ever to do so again!  But I haven’t been able to avoid it, since it’s actually now my job to know this stuff.

But if you’re not at the stage where you are prepared to give up a few days of your life that you’ll never get back – and why should you?! – here are those dozen details, under the new referencing system.  Whether you commit them to memory, or just focus on remembering the summary of what they’re about, it should improve your ability to police effectively in this area —–

  • Paragraph 14.17Don’t threaten patients with being “sectioned” to induce them to agree to voluntary admission
  • The threat of being “sectioned” should never be used to persuade a patient to enter hospital. How voluntary is it anyway, if it only occurred after being threatened with legal detention?
  • Paragraph 14.48Explain why the police are still needed at a MHA assessment if it’s conducted without a s135(1) warrant
  • Where a Mental Health Act assessment is going to take place in a dwelling but where no s135(1) warrant is in force, the AMHP coordinating the assessment should explain why police involvement remains necessary if it is sought.
  • Paragraph 14.56MHA assessment does not always have to be delayed until the effects of drugs or alcohol have worn off –
  • It is often said that “You can’t assess someone under the MHA whilst they’re under the influence of substances. This is the paragraph that shows this is not correct. The paragraph certainly advises delay where possible, but it may not always be possible.
  • Paragraph 14.89 Applications for admission under the MHA must be made to a specific hospital
  • It is not sufficient to specify the mental health trust to which the patient will be admitted.  But this is the paragraph that is often cited to show that you can’t make an application to a hospital that is full.  Begs the question how the CQC ever find 120% occupancy on wards, doesn’t it?!
  • Paragraph 16.11You can make applications for s135(1) warrants without previous attempts to gain entry
  • It is often said that you can’t obtain a warrant without previous attempts to gain entry having been made. This is the paragraph that shows this to be incorrect. It stipulates that if applications are made without previous efforts, AMHPs need to set out the reasons for the Magistrate. This is in order to draw their attention to the fact that they can and to the reasons as to why in this particular case.
  • Paragraph 16.38 The police station should not be the automatic first or second choice as a place of safety
  • This is the paragraph that custody officers and detaining officers should bear in mind when considering the use of the police station as a place of safety. What else did you consider or try, before resorting to it? If you can’t answer that question, you’ve got more thinking to do before seeing the custody sergeant. If you’re the custody sergeant, I’d ask the question!
  • Paragraph 17.7 Sedated patients should be accompanied during conveyance by a suitable professional who is trained in the care of such patients
  • This will normally not be a paramedic because they are not licensed to administer drugs to sedated patients. It will normally be a nurse of a doctor and officers asked to assist in the transfer of patients from one place to another, should bear in mind this requirement and ensure such a professional is involved.
  • Paragraph 17.34 Police involvement in the conveyance of patients under the MHA should be based upon them being violent and / or dangerous
  • This is obviously a far higher threshold than patients being resistant to admission or transfer and officers should be certain to ensure that they are acting according to this part of the Code. It may be that local protocols assume all coercion under the MHA should be done by the police: this appears to be outside the intentions of Parliament who gave others the power to do so and this paragraph sets the bar somewhat higher than a patient being merely resistant to admission / transfer.
  • Paragraph 27.38Voluntary patients cannot be required to seek permission to leave hospital
  • But they can be asked to inform staff that they are leaving. This is important in situations where officers are called to mental health wards to reports of offending, involving voluntary patients. The Care Quality Commission repeatedly warn of the dangers of de facto detention whereby patients under no obligation to remain in hospital are ‘denied’ leave for various reasons. Where a voluntary patient chooses to leave hospital, either briefly or completely, they should be allowed to do so unless the nurse of doctor involved applies a holding power under section 5 of the Act.
  • Paragraph 28.14The recovery of AWOL patients whose location is known is a matter for MH services
  • But the police can be asked to assist in the risks involved suggest it is appropriate. So where, for example, a s3 patient who has been granted s17 leave fails to return on time and telephone enquiries by the ward reveal they are at home, it is up to ward staff to co-ordinate re-detention. It is for NHS managers to ensure they have access to resources by which to do so.
  • Paragraph 28.22All unauthorised absences by patients should be reviewed to identify risks and prevent recurrences
  • It is a requirement that all absences be reviewed.  Given the frequent involvement of police resources in searching for patients who are absent, it seems reasonable to for the police to have an input into this process, especially because the police will have a record of that persons absence history which may cut across different hospitals or even different mental health trusts. That could very well assist the management of risks.

This list is NOT exhaustive: there are other paragraphs in the Code of Practice where it may be worth committing the thrust of it to memory but in order to keep this list manageable, I have capped it at a dozen things. I would encourage frontline police officers (in which I include custody and communications staff) to read the full text of these paragraphs and consider them in operational situations. They can make the difference as to whether you say “Yes” or “No” to requests that are made of the police and help with building a rationale or audit trail for why you did whatever it is that you did or didn’t do!

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The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs

ccawards2013 was highlighted by the Independent Commission on Policing & Mental Health
– was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.

 

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Para 16.38 to the Code of Practice

I have to crave your indulgence in this post, because I wrote and published much of it some years ago.  I’ve done a fair bit of cutting and pasting to put out something very similar all over again – let me explain why!

The new Code of Practice to the Mental Health Act (2015) means that all the numberings for various paragraphs have changed.  So when people are searching the blog for advice, this would remain filed away under the old reference number.  I want a substantive post in the system so it can be searched and found by the new numbering system or reference and so this post is about the old paragraph 10.22, now known by the new paragraph reference 16.38, pertaining to how police officers should make decisions about the choice of a place of safety after using powers under ss135/6.  I have just cut and past the whole thing, though – there are some new thoughts, links and a story to follow!

It is becuase this issue remains topical and problematic that I don’t feel too guilty about repeating myself to ensure the importance of this paragraph is understood.  The original version of this post came about after the (then) College of Emergency medicine published a mental health toolkit, to assist acute trusts’ Emergency Departments in understanding the overlaps with mental health and improving liaison psychiatry services for the benefit of us all.  They have since published a report (2014) specific to the use of section 136 MHA after surveying members and fellows of the (now) Royal College of Emergency Medicine (RCEM).  These are comparatively short documents in accessible enough formats and when I opened up the first once and searched for the phrase “place of safety”, I couldn’t find it – because A&E rarely see themselves as being a place of safety, notwithstanding the law of England.  So I searched for the word “police” and it brought me directly to section 11: which also includes a link to Royal College of Psychiatry Standards on s136 (2011):

“All areas in England will have a multi-agency policy for section 136 patients.  There should be an appendix relating to the use of emergency departments.  It is prudent to ensure that this is appropriate for your local service, and that the ED is only used for 136 patients who have an acute healthcare need.  Otherwise mental health services should provide an assessment suite, or where necessary the patient should be taken into police custody.  The policy should also include a strategy to ensure that acceptable time frames for a mental health act (MHA) assessment are established, with provision for police to remain with the patient if they are managed in the ED.  The police should stay until a MHA assessment has been completed.”

In the 2014 survey of members and fellows, the RCEM reported that only 48% of the time had their local police officers complied with local policy.  I was instantly amazed it was that high, quite frankly – most s136 policy documents I read have very real legal problems.  They often prescribe processes that do not closely adhere to the various laws, statutory guidelines and Royal College of Psychiatry standards and I usually end up with a long list of complaints.  Put another way, if I hypothetically detained someone under s136 in every area of England and Wales, it would be highly unlikely I’d comply with 48% of local policies.  Probably more like 5% – a police officer’s first duty is to the law, not to local policy.  If we must insist on writing policies that are different from the law, we shouldn’t be surprised that police officers disregard them.  It is their job to do so, when put in that position.

So based upon that, I want to re-highlight what is now numbered as paragraphs 16.36 to 16.38 of the new Code of Practice (2015) to the Mental Health Act.

  • Para 16.36 – The locally agreed policy should contain a list of identified places of safety.  The process for identifying the most appropriate place of safety to which a particular person is to be removed should be clearly outlined in the local policy.  this should be a hospital or other health-based place of safety where mental health services are provided.  health-based places of safety should ensure that they have arrangements in place to cope with the periods of peak demand, for example using other suitable parts of a hospital, neighbouring health-based places of safety, or alternative places of safety.
  • Para 16.37 – Other options which might be appropriate to the individual’s needs should be considered, for example a residential care home or the home of a relative or friend of the person who is willing to accept them temporarily.  There is nothing precludes other areas of a psychiatric hospital (such as a ward) being used as a temporary place of safety, provided that it is a suitable place and it is appropriate use that place in the individual case.
  • Para 16.38 – A police station should not be used as a place of safety except in exceptional circumstances, for example it may be necessary to do so because the person’s behaviour would pose an unmanageably high risk to other patients, staff or other users if the person were to be detained in a healthcare setting.  A police station should not be used as the automatic second choice if there is no local health-based place of safety immediately available.  (My emphasis.)

THE BROADER PICTURE

Let’s not revisit the nonsense that A&E is not a place of safetyOf course it is: whenever they agree to temporarily receive a patient and by virtue of them being hospitals.  And we understand that A&E can be a distressing environment that can exacerbate symptoms but I’m not sure what we think happens in police custody when the masturbating drunks are singing songs and we’re dragging in offenders who are screaming obscenities at the custody officer, wishing cancer upon their families?  Not a great place to be if you’re mentally unwell.  Has anyone asked patients where they would rather be if it came to a choice – it often does: the RCEM document does talk about service-user engagement, after all.

Of course the problem really is about how local services are commissioned and to smaller extent how and where they are provided.  One of this week’s phone-a-friend queries was from a police force who had been asked to execute a warrant under section 135 of the Mental Health Act.  They were told in advance of attending that after gaining entry, the person concerned would be subject of an initial assessment by the AMHP and DR but would probably need to be removed to a police station until a second doctor could arrive because they anticipated that the man would need to be admitted under the Act and they would need two medical recommendations and a bed that hadn’t yet been identified because it didn’t appear to exist.

So there we had it: on day one of the new Code of Practice to the Act, the AMHP actively wanted the Code breached and was asking police officers to do so.  No clear record of why the health-based PoS was unavailable or inappropriate; no record of why alternatives were unavailable or inappropriate; no identification of those decision-makers, as required by the new Code (para 16.62).  Of course, once the warrant had been executed and the person detained for removal to a Place of Safety, the officers should have followed standard procedures –

  • Call an ambulance – to assist in complying with the new chapter 17 of the Code
  • Try to access the identified health-based Place of Safety for that area – which was about forty-five miles away, in the circumstances.
  • Take the name of the decision maker if access is refused – a new requirement from the new Code of Practice.
  • Consider the alternatives to that health-based PoS if it was unavailable – what was considered and why was it ruled out?
  • Use a police station only as a last resort – in exceptional circumstances only.
  • Limit the use of police custody to 24hrs maximum – so if the bed doesn’t exist, to which PoS will the person be transferred during that initial 24hrs period.

The new Code very much assists the police in ‘pushing back’ against assumptions that the police will keep plugging gaps in crisis care systems, but we need operational supervisors and custody sergeants in particular, to know of these provisions.  If you haven’t read the new Code of Practice, I did a brief summary of it to save you reading all 462 pages!  If you ever have time, focus on chapters 16 and 17, as well as 27 and 28 and if you’re really keen, chapters 14 and 15.

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The Mental Health Cop blog

Badgewon the ConnectedCOPS ‘Top Cop’ Award for leveraging social media in policing.
won the Digital Media Award from the UK’s leading mental health charity, Mind
– won a World of Mentalists #TWIMAward for the best in mental health blogs

ccawards2013 was highlighted by the Independent Commission on Policing & Mental Health
– was referenced in the UK Parliamentary debate on Policing & Mental Health
was commended by the Home Affairs Select Committee of the UK Parliament.