AWOL from Scotland

It seems that it’s been the week for Scottish mental health patients to journey to England, in a variety of legal situations that have subsequently confused the life out of police and mental health professionals alike.  So we had the incident the other day about a Compulsory Treatment Order patient who turned up in the Midlands and today I’ve had a call about a Short-Term Detention patient who turned up on the south coast.  The first confused the life out of the local police; the second confused the life out of the A&E department.  These things being as they are: I’m expecting the third incident any time now to complete the set and I’ll just bet it has a twist or angle that I’m not about to cover here!

OK … two incidents is not that many, but it’s not the first time I’ve had a batch of ‘Scottish AWOL’ queries so I thought I’d best cover the topic in one post.  First things first: abbrevations to make this easier to both write and read! —

  1. MHA(S) = The Mental Health (Treatment and Care) (Scotland) Act 2003.
  2. MHA(E) = The Mental Health Act 1983 in England / Wales.

Your legislative resources —

  1. The Mental Health (Treatment and Care) (Scotland) Act 2003.
  2. The MH (T&C)(S) Act 2003 Consequential Provisions Order 2005.


Here is a list of the three main detention ‘civil’ provisions under the MHA(S) —

  • Emergency detention certificate, under s36 MHA(S) – this provision allows one DR, preferably with involvement of a Mental Health officer (MHO) – a professional who is roughly the equivalent of an Approved Mental Health Professional – to detain someone in hospital for up to 3 days.  The DR may act alone, if they cannot reasonably consult an MHO. Broadly, this is the equivalent of s4 MHA(E).
  • Short-term detention certificate, under s44 MHA(S) – this provision allows a DR, where supported by a MHO, to authorise detention in hospital of someone for up to 28 days. Broadly equivalent to s2 MHA(E).
  • Compulsory Treatment Order, under ss64/5 MHA(S) – this provision allows an MHO to make an application for a CTO where two DRs submit reports for consideration. This can involve admission to hospital, for up to 6 months, broadly equivalent to s3 MHA. However, it may also allow for the imposition of restrictions upon patients who live in the community, including a residence requierement and / or an attendance requirement (to attend somewhere for treatment). When considering an application for CTO, the Tribunal may decide to grant the application but only on an interim basis, allow for detention or restriction for a 28 day period.


Firstly, AWOL is the English and Welsh term, under the MHA(E) – in Scotland they refer in law to ‘absconders’.  Sections 301-303 cover the powers to re-detain Scottish mental health patients who have absconded from the above provisions and are still in Scotland.

  • Section 301 – covers those patients who have absconded from a Compulsory Treatment Order. As you’ll recall, above: there are two kinds of CTO – the sort where you are detained in hospital, the sort where you are subjects restriction in the community. If a patient has absconded from any hospital in which they are detained by CTO or if they have breached a residence requirement of any ‘community’ CTO, then s303 MHA(S) applies to them.
  • Section 302 – covers ‘other patients’, including emergency detention certificates, short-term detention certificates and CTOs, but also includes those detained under a nurse’s holding power under s299 MHA(S) and those who are subject to certain particular provisions of the MHA(S) that I’ll let you research for yourself, should you need to! If someone subject to any of these frameworks absconds OR if a Reponsible Medical Officer (RMO) issues a certificate under s114 or s115 MHA(S), then s303 applies to them.  (Sections 114 and 115 relate to breaches of CTOs which don’t automatically qualify as ‘absconded’ but which require the RMO to authorise their qualification as ‘absconded’. Those who were paying close attention to a BLOG earlier inthe week about Scotland will remember that even if an RMO has authorised detention under s113(4) MHA(S) for a breach of other, general conditions of a ‘community’ CTO, this does not qualify as ‘absconded’ … as Nottingham city centre police now know!)
  • Section 303 – covers the ability of various professionals to take anyone to whom sections 301/302 applies and return them to the relevant hospital. This includes, a Scottish police officer, a Mental Health Officer or anyone on the staff of a relevant hospital or authorised by the patient’s RMO.

Still following?! … not long to go now!! – once you’ve confirmed that the person has absconded from one of those provisions (ss36, 44, 64 or 65), or that an RMO has authorised detention of a CTO patient under ss114 or s115, then s303 would apply if they’d been encountered in Scotland so any police officer in England, Wales or Northern Ireland may take that person in to custody and return them to Scotland. This is made clear in Article 8 of the MHA(S) Consequential Provisions Order 2005. Such patients may also be taken in to custody by an AMHP in England / Wales or an ASW in Northern Ireland. To conclude this all with a little known fact: it is expressly into s135(2) of the MHA(E) and in to a129(2) MHO(NI) that a warrant may be granted by a Magistrate in connection with the need to exercise detention under Article 8 for a Scottish patient who has absconded to any other part of the UK. If you ever have that situation in the real world, I advise you to take a written copy of the MHA(E) / MHO(NI) to place under the nose of the court clerk or Justice of the Peace becasue I’m guessing they might say, “Eh?!” or simply not believe it’s a thing!

There you go! – all done.  How’s your headache?!

IMG_0053IMG_0052Winner of the President’sMedal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award


Authorised Professional Practice

The College of Policing has now completed the production of new guidelines on mental health for the police service in England and Wales and this blog is a part of the College’s efforts to communicate this publication to the public as a whole, as well as the police service and partner organisations. These new guidelines are known as Authorised Professional Practice (APP) and they are supplemented by the first national training products on mental health for policing. These are the College’s main contribution to the 2014 Crisis Care Concordat which aims to improve the country’s response to vulnerable people right across the mental health and criminal justice systems.

APP and training materials have been available to police forces for several months and work has begun to prepare for the impact they should have because mental health issues effect every area of policing and are believed to be connected to a third of all demand: this is core police business and all officers, at all ranks, need to understand how it affects their role and responsibilities. It was being publically launched to coincide with World Mental Health Day on 10th October 2016 – on the theme of psychological first aid. The College of Policing held several events around the country in July 2016 to introduce forces to these materials and to help them understand the preparatory work that they will need to do, to prepare for the implications they have.

Mental health issues inherently demand a partnership approach: the police service cannot do this alone; and forces should use the publication of APP and national training standards to influence and improve their local arrangements. We know that challenges across the country do vary, with different challenges in urban versus rural areas; we know that mental health funding and commissioning varies across the country. That is what forces must address and what operational police officers must assist in identifying and handling.


APP represents the standards which must be met in all areas of the country and in any analysis of local arrangements, forces and officers must bear in mind that any difference between the two means something needs to change in local arrangements – this is what local Crisis Care Condordat actions plans should have already identified and every area has made a commitment to address those things. APP is based on statutory requirements, relevant Codes of Practice to those instruments and case law – as well as on lessons that need to be learned from IPCC inquiries, Coroner’s inquests and from medical and healthcare guidelines.

The aim here is to ensure that vulnerable people access crisis care without being unnecessarily criminalised by the police and that vulnerable victims and suspects are identified as early as possible and supported within the criminal justice system, where appropriate. For example we know that people with mental health problems are three times as likely to be victims of crime as people without; we also know that people with mental health problems are heavily represented within the criminal justice system.

It will be important to the success of this programme that Chief Constables ensure sufficient resources are allocated to understanding what this programme means for their organisation and their local partnerships. There local Crisis Care Concordat forum in each area is the arena in which any particular issues can be raised which are crucial to the success of the programme. It is also important that individual police officers take the time to read the guidance: they will often be far better placed to understand any particular challenges and difficulties in making the APP happen in the real world.


The public can expect to see much closer cooperation between their police service and the relevant partners in the NHS and other public bodies: this should be reflected in better access to crisis care and a greater range of options to resolve situations where the police become involved. Partner organisations from ambulance services, mental health trusts and acute care providers should expect to see their police services reviewing their overall approach as they move towards ensuring the way in which they deliver their service complies with APP. Ultimately, this is the standard against which the Independent Police Complaints Commission will hold police officers and forces to account.

The College doesn’t under-estimate the difficulties in some areas of ensuring that policing / mental health partnerships work in a way that reflects the statutory framework, the Codes of Practice and so on. However, we know that many of the most high-profile and difficult incidents which have often arise against a background of the police service being unable to operate in the way they have been expected. It is vital that the national partnership working envisaged by the Concordat ensures that operational officers have every chance to do the right thing.

APP on all police topics is available publicly on the College of policing website –

This is not the end: merely the end of the beginning – we already know that there will be further changes to come and that many challenges remain: In October 2016 a new Code of Practice for Wales was introduced; by Spring 2017 the Policing and Crime Bill will have received Royal Assent and that will amend the Mental Health Act 1983. We also know that other organisations are continuing their own work to delivery on their obligations under the Concordat and that forces still face important decisions about street triage and / or Liaison and Diversion schemes in their areas. For that reason, the College will continue to support nationally by engaging with other national bodies and supporting police services and their partnerships.

IMG_0053IMG_0052Winner of the President’sMedal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award


Conflating Beds

We hear this word ‘Beds’ a lot when we hear discussion of mental health services and it can get very confusing because the word is used to mean different things, not all of them literal. It happened earlier today during Prime Minister’s Question time in the House of Commons so I thought I’d again stress the detail of certain distinctions that become confused and conflated when we hear discussions of various kinds of ‘beds’ that are not the same thing!

  • Version One of what we mean by ‘bed’ is a place in hospital for someone who is admitted as an inpatient, either voluntarily or whilst detained under the Mental Health Act 1983 – this often will involve an actual bed! … with pillows and sheets where you can get your PJs on and hopefully get a good night’s sleep. In this sense, it’s like a bed on a medical or surgical ward, although in modern mental health units, patients often have their own room.
  • Version Two is where we hear the word ‘bed’ used after a person has been detained by the police under either s135 or s136 of the Mental Health Act and removed to a Place of Safety. If the NHS cannot make a Place of Safety available for that person’s assessment under these provisions we sometimes hear that “the NHS have no beds”. This is completely different to Version One where someone might have been arrested for an offence, taken to police custody and then assessed as needing admission to hospital.

Strictly speaking, the Place of Safety Version Two thing is usually nothing to do with beds in any literal sense – it is more probably appropriate to talk about ‘capacity’ or ‘space’ affecting the ability of the NHS to accommodate someone until their assessment can occur. I’ve seen many such services and most of them have no sleeping facility at all because the vast majority of people are dealt with in under 6hrs. (This is an average – please don’t write in: I am aware that some areas take much longer and individual circumstances can go way beyond 6hrs!) One or two PoS services which do have a room which doubles as a seclusion style area for those exhibiting challenging behaviours and a mattress can be brought in if people really do need to sleep overnight. Otherwise it chairs or sofas in the assessment room(s) if someone wants to sleep until assessment things happen. It’s not about beds: it’s about the ability to undertake an assessment during which someone is unlikely to need to sleep or lie down for any length of time.


So today, the Leader of the Opposition asked a question about beds (version one) following which the Prime Minister answered by saying something about beds (version two):

From Hansard 19/10/16 –

JC: “I received a letter from Colin, who has a family member with a chronic mental health condition. Many others, like him, have relatives going through a mental health crisis. He says that the “NHS is so dramatically underfunded” that too often it is left to the underfunded police forces to deal with the consequences of this crisis. Indeed, the chief constable of Devon and Cornwall has this month threatened legal action against the NHS because he is forced to hold people with mental conditions in police cells because there are not enough NHS beds. I simply ask the Prime Minister this: if the Government are truly committed to parity of esteem, why is this trust and so many others facing an acute financial crisis at the present time?

TM: “May I first of all say to Colin that I think all of us in this House recognise the difficulties people have when coping with mental health problems? I commend those in this House who have been prepared to stand up and refer to their own mental health problems. I think that has sent a very important signal to people with mental health issues across the country. The right hon. Gentleman raises the whole question of the interaction between the NHS and police forces. I am very proud of the fact that when I was Home Secretary I actually worked with the Department of Health to bring a change to the way in which police forces dealt with people in mental health crisis. That is why we see those triage pilots out on the streets and better NHS support being given to police forces, so that the number of people who have to be taken to a police cell as a place of safety has come down. Overall, I think it has more than halved, and in some areas it has come down by even more than that. This is a result of the action that this Government have taken.

JC: “The reality is that no one with a mental health condition should ever be taken to a police cell. Such people should be supported in the proper way, and I commend the police and crime commissioners who have managed to end the practice in their areas. The reality is, however, that it is not just Devon and Cornwall that are suffering cuts; the Norfolk and Suffolk mental health trust has been cut in every one of the last three years.”


Why does this matter? – well, I’m not offering particular criticism of our political leaders on this, because it’s commonly misunderstood and other politicians very active on mental health matters have made this mistake. Frontline officers often talk about ‘beds’ when they mean capacity in a PoS for an assessment; I’ve heard NHS Commissioning Managers make the same mistake recently. If we think that reducing the use of police stations as a Place of Safety is going to have an impact on the kinds of problems that were recently highlighted by the Chief Constable of Devon and Cornwall, to which the Leader of the Opposition referred, then we are mistaken.

It has always been the case, despite our focus on the police use of their powers under the Mental Health Act, that we arrest far, far more people for alleged offences who are then assessed in police custody under the Act. On Twitter today, the Leader of the Opposition followed up his PMQ with a tweet that said “No-one with a mental health problem should ever be taken to a police cell”. I presume he also means “whilst in crisis and detained only under the MHA” because if his tweet is taken literally, then we need to think urgently about those hundreds of thousands of arrests every year of people who have mental health problems and are accused of breaking the law – it’s going to require a whole new solution and a pile of legislation.

Nothing at all prevents the arrest and detention in police custody of someone who is seriously mentally ill, especially if they are accused of stabbing, raping or killing someone. Rare though this is, it happens enough to mean we need to acknowledge that if we are to effectively investigate offences and make appropriate decisions about whether people are prosecuted, they may to spend at least some time in custody where forensic evidence can be recovered, where assessments can occur and where decisions can be taken about how best to proceed.

We don’t have great statistics on this point, but when I looked at it some years ago, the ‘arrested and then assessed MHA’ figure was five times bigger than the use of s136, although that was in a force which had relatively low use of s136. Another force mental health lead looked at this in a higher-use-per-capita force and found that they had three times as many MHA assessments for people under arrest in custody as they had uses of s136 MHA. So focus on beds version two is missing most of the problem.


Sort out further reductions in the use of police custody by all means – who wouldn’t welcome that?! … but don’t imagine for a moment that it will address the problem that appears to be getting greater all the time – the protracted detention in police custody of someone who is due to be diverted from justice under the MHA but where a timely admission to hospital cannot be achieved because of the want of an acute admissions beds somewhere within mental health services, and preferably within 25miles of wherever that person calls home.

If cops, NHS managers and staff don’t understand the difference: it’s no wonder Prime Ministers and Leaders of the Opposition don’t either – and that’s why we heard someone today asking about apples and hearing about pears.

IMG_0053IMG_0052Winner of the President’sMedal from the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award