Timing Is Everything

In 2016, the Welsh Assembly Government published a new Code of Practice to the Mental Health Act 1983. This followed on the update England had received the previous year. In many respects, there is now far greater concordance between the policing aspects of these two documents which certainly made it easier than it would have been to write the College of Policing’s guidance during 2015/16. We’re going to have to update that guidance shortly, to take account of the new provisions and I have a question to answer which seems literally impossible to answer, as things stand.

Politically speaking, all health issues are a devolved responsibility in Wales, whereas policing is not. This creates some difficulties when it comes to issues which affect both. The Mental Health Act is an example of this – it’s primarily health legislation but it contains policing and criminal justice provisions, like Part III of the MHA and the powers being amended like ss135/6 and s138. The specific example emerges in the guidance document which has been published ahead of the changes to the MHA introduced by the Policing and Crime Act 2017. Forces and mental health trusts are now in to that frantic period of work before the changes take effect on the 11th December and one of the main pressures that we will face as we move in to next year, is that we will only have 24hrs to get someone ‘sorted’ when they are detained under s135/6. It’s sometimes problematic to do so where we have 72hrs, so every minute of the 24hrs will be crucial.

So when, precisely, does the Place of Safety clock start ticking?!

THE LONG ARGUMENT

The English Code of Practice (2015) states, in paragraph 16.26 – the maximum period a person’s may be detained under s136 is 72hrs. In practice, detentions should not need to be this long. The imposition of consecutive periods of detention under s136 is unlawful. The maximum 72-hour period begins at the time of arrival at the first place of safety (including if the person needs to be transferred between places of safety).

The Welsh Code of Practice (2016) states, in paragraph 16.46 – If, in exceptional circumstances, a police officer needs to take a person to an emergency department after detaining that person under section 136, for the emergency medical assessment or treatment of their physical health this should not be treated as an admission to a place of safety. Detention under section 136 will begin when the person is taken to the appropriate place of safety for the assessment of their mental health.

Make of that lot what you will! It begs certain subordinate questions before you can get properly in to it. Before the 2017 guidance document emerged – more on that, below! – people would argue that “A&E is not a place of safety!” and simply hope that ended the argument about a) whether the obligations which kick in upon arrival at such a place began on arrival at ED; and b) whether that meant more officers would be turning up with anyone and everyone, arguing, “because you are a Place of Safety, you have to accept this person!”

In reality, it was only ever about the first aspect, but I do accept the history of this stuff means ED also feel, a bit like the police, that some vulnerable people are somewhat treated like a can to be kicked further down the road and that their (busy and often chaotic environment) wasn’t ideally suited for those of us in distress because of a mental health crisis. I don’t think anyone massively disagrees with that – I’m only making the point that in any area of each country, some people detained under s136 will also urgently require the kind of medical care that can only be provided in an ED. And that if you’re detained under s136, we need to know what to do upon arrival at ED – do we start the clock, must we contact the AMHP, etc., etc.?

ENGLAND v WALES

Since nothing in the 2015 English code specifically stated whether 16.26 applied to arrival at ED (for whatever reason you went there) or whether it just meant arrival the s0-called ‘designated Place of Safety’, we weren’t entirely certain what to make of it. I say ‘so-called’ because neither the Act nor the Codes talked about a ‘designated Place of Safety’ – this is a phrase in common usage and which is given a certain rarified, quasi-legal status, but which isn’t actually found in a legal document of any standing. I think it just means a place of safety that has been agreed or specified in the local protocol about the operation of s136 MHA. Whilst it is, of course, important to outline what the most commonly used locations may be, nothing agreed locally prevents any improvisation because the Act has always said that anywhere can be a Place of Safety under the Act – including my mother’s house, if the need arose.

My favourite point on ED was always , “A&E is part of a hospital and hospitals are a place of safety, according to s135(6). If they are also agreeing the person detained needs to be in their department for assessment and treatment that only they can offer, then how are they NOT acting as a Place of Safety for the purposes of the Mental Health Act when a) they are a hospital; and b) they have agreed to receive the person. The distinction between being ‘injured or ill’ and requiring assessment for ‘mental health’ may not be possible and for various legal reasons, these issues may need to be considered together. And at the risk of making the most obvious point of all: this argument is usually breaking out when the only person who has yet put their professional name to the pathway the person is experiencing is a police officer with a first-aid certificate – and they may be wrong!

The publication of the current Welsh Code complicated things unnecessarily, in my view. Firstly, it started from that premise: that ‘treatment of illness or injury’ is separate to ‘mental health’. So many cases over the years show that some people – not all! – who go to EDs often stay there for urgent MHA assessment and then for admission to the acute hospital for treatment without consent. It is not always known at the point where someone enters ED whether they will be able to leave again – like the lady detained under s136 who was ‘bounced’ to ED by the Place of Safety nurse and found to have meningitis – didn’t leave ED, MHA things considered and concluded in the acute hospital.

ADVICE

So, when does the clock start ticking?! – well, we do know that the English and Welsh Codes can’t both be right! And if you’re a British Transport Police officer and you operate both sides of the border, you might wonder which rules you should be following – does time spent in A&E ‘count’ or does it ‘not count’?! Bearing in mind this disagreement is a disagreement in the Codes of Practice, which is not the law, but statutory guidance, I specifically asked the Home Office to ensure this question was addressed as they produced their guidance.  This is what they came up with —

The recent guidance document states, in paragraph 4.4 – if a person detained under s135 or 136 is taken first to the Emergency Department of a hospital, for treatment of an illness or injury (before being removed to another place of safety) the detention period begins at the point the person arrived at the Emergency Department (hospitals being a place of safety).

For me, whilst accepting this isn’t a court ruling so we do not definitely know, this more-or-less settles the matter. The document has been produced but the Department of Health and the Home Office, in full consultation with the Welsh Assembly Government and the Police Liaison Office of the Welsh Assembly. It specifically points out that each country has its own Code of Practice but that compliance with it may have to change, where substantive laws have changed. Well, overall timescales for detention under s135/6 have changed, considerably; and what I also know, is that following this guidance means you’ll never accidentally drift in to the territory of unlawfully detaining someone.

Remember, you can extend the detention of someone under s136B from 24hrs to 36hrs if the condition of the person prevents their assessment under the Mental Health Act. A delay because of treatment in A&E for injuries or illness would be one of the particular examples in the minds of the legislators – “if there is a hold up because of intoxication or injury, they may need more time, so we’ll give them s136B” or similar, so they’ve catered for the possibility that delay may mean we need slightly more time.

ERRING ON THE SIDE

Of course, there may be opinion out there that this interpretation is wrong – I’m aware of some advice given that suggests it is. It just seems the obvious point to make that the DH/HO also had legal advice on this when it was produced so what we’re left with is a disagreement amongst lawyers who have advised in Wales versus those who have advised in England. What a shock … said absolutely no-one. Having discussed this thing informally with many lawyers over the years, including this week, most don’t understand why the Welsh Code says what it says and agree there are concerns about taking it at face value.

Back in the real world, police officers, place of safety staff and far less occasionally, Emergency Department staff may have to make real decisions about when the 24hrs or 36hrs is ‘up’ and whether they can or should continue to coerce other human beings. All I know is this: if you count it from arrival at ED, you’ll never end up accidentally detaining someone unlawfully. If you do ignore the time spent in ED, you’re awarding yourself extra hours with which to detain someone pending a final decision about them. How many hours is OK? – can we can ignore a 4hr wait; and then still help ourselves to a further 36hrs; what about. a 12hr wait meaning we end up holding someone for 48hrs overall? How lawful would it be to take that 12hrs for ED treatment, then also use the s136B extension to effective take double what parliament intended? … where does it stop?!

Parliament seem quite clear: they want things done and dusted in 24hrs maximum as a standard, 36hrs in extremis – they no longer want people detained for longer than 36hrs under any circumstances. It has always been my view that time spent in ED has to ‘count’, for the reasons given – Parliament has now reflected the idea of delays for urgent illness or injury with a specific provision giving more time where this has been necessary. In the absence of a court ruling on this particular point, I admit I’m at a loss to understand why we just don’t get on with things within this framework and stop arguing about it.

It could just be me …


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

Winner of the Mind Digital Media Award.


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Half-Hour Checks 

Well, it’s all now official: the Mental Health Act 1983 will be amended by the provisions in the Policing and Crime Act 2017 with effect from midnight on 11th December 2017. The regulations were laid in Parliament today for a) commencement of the change; and b) the use of Police Stations as a Place of Safety and we can now stare straight down the barrel of what we know has been coming for around three years.

The big surprise in these developments has been the extent to which it will become very difficult to use police custody as a Place of Safety, at all. We knew the amendments would ban such use for children, but we always understood that police stations could continue to be used for adults in exceptional circumstances. Whilst there were various hints in the consultation document from 2014 and various other clues during the informal discussions which occurred between the Home Office and the NPCC / College of Policing, we obviously couldn’t be certain of anything until such time as the Regulations were published – and that happened today.

We now know it will be a strict requirement whilst police stations are being used for this purpose that detainees’ health is checked by a healthcare professional every half-hour and necessary advice given to custody staff to enable them to ensure the health and wellbeing of the person. This is the amendment which seems to have caused the most shock whilst discussion occurred but I want to be absolutely clear about what I think on this: I wouldn’t want it any other way and I don’t actually think it’s strict enough. Since you’re now wondering, I would have preferred to see a total ban on the use of custody as a Place of Safety and that if there were to be any circumstances in which it occurred, it would be with a constant healthcare presence 1-to-1 for that detainee.

HIGH RISK DETAINEES

We saw on Monday, publication of the Independent Report into Deaths and Serious Injuries in Police custody (the Angiolini Report) – 110 recommendations to make the world a better place and amongst them was recommendation number 25 which calls for an end to the use of police custody as a Place of Safety. My understanding of the reason why this wasn’t done during the Policing and Crime Act amendments is the ongoing belief that it may still be necessary to hold some people in police custody because they are exhibiting such a serious level of resistance or aggression that an NHS facility would be unable to ensure the safety of staff or other patients; and that the physical infrastructure is not built to police or prison cell standards. In fairness, I’m aware of a few cases where NHS facilities have been damaged by people who were unwell and frightened whilst detained pending assessment – so, does this mean we should be using custody or improving healthcare infrastructure?!

The statutory regulations published today outline the criteria for removal to a police station as a Place of Safety and I published a specific post on that earlier. In case of any doubt at all, for someone to meet these criteria they have to be posing a massive risk – serious injury or death – to themselves or other people. Even then, a police inspector would have to authorise a police station to be used and foremost in that officer’s mind should be the safety of the person. You only need to look to the recent IPCC Report Six Missed Chances or to yesterday’s Angiolini Report to see how the police are repeatedly implored, quite rightly, to encourage to adopt a ‘safety first’ approach to those they detain.

If someone is so unwell because of mental disorder that an officer has intervened by detaining them, there will be at least some level of restraint ongoing and where we start to think that the person’s behaviour could pose “an imminent risk of serious injury or death” we need to be asking proper questions about what might be driving this. We don’t need certainty on it – we need suspicion about what might be driving someone to appear so unwell and pose such risks. We only need to look at history to see various potential reasons: head injuries, encephalitis, acute behavioural disorder, serotonin syndrome, meningitis, strokes, epilepsy and I could go on and on … and, of course, someone could just be so seriously mentally ill that they are quite unable to escape the beliefs, their voices they’re experiencing and detention by anyone could be terrifying: so much so, we could just see a basic, human ‘fight or flight’ instinct kicking in, for reasons that don’t make obvious sense to those of us trying to keep that person safe, but which make perfect sense to the person detained.

CUSTODIAL HEALTHCARE

Have you ever been responsible, legally and literally, for the safety of a psychotically unwell, extremely frightened person who is obviously seeing things and hearing things that are way beyond my realm of perception and who has been jailed up in a cell for days because of a lack of alternative options? I have – and I was absolutely bloody terrified, frankly. I started a night-shift a discovered there was a lady in our cells under s136 because the Place of Safety had refused to receive her. She was one of the most unwell people I’ve ever met in my life and looking at the custody record it was absolutely obvious that no-one had done basic medical checks despite the fact that she’d been detained under s136 MHA. Long story made short, I made it clear that unless someone could tell me that basic medical checks had been done on her, to rule out the need for her to be in A&E, she’d be transferred to A&E to ensure her welfare.

If we are serious about putting patient safety first, we can’t cry that it’s becoming all too difficult where people exhibit challenging behaviours. We wouldn’t do this with a violent person who’d struck their head on a windscreen in a car crash – I’ve even seen convicted drug dealers, who had their heads caved in with metal bars by rival drug dealers over debts and turf get care for their injuries when they were no more or less poorly than some of the people I’ve seen being pushed towards police custody when experiencing a psychiatric emergency. Parity of esteem, if it’s to mean anything at all, has to reach in to the difficult places, too. So if the Mental Health Act (Police Stations as a Place of Safety) Regulations 2017 are highlighting that the only people can should ever be detained in custody are those at most risk then it strikes me that a few considerations should always apply –

  • We only do this where we have no other option at all!
  • If we really are going to think about this(!), we maximise the clinical screening of the person before making a final decision.
  • Once the person arrives there, we ensure close clinical oversight of them – to ensure they fit to be detained in police custody.

CONFLICTS OF LAWS

Remember, the use of police custody for any purpose is subject to a well-established body of laws – the Police and Criminal Evidence Act 1984 (PACE), plus the associated Codes of Practice to PACE, especially Code C on detention in custody. (If you’re a healthcare professional who is less familiar with this territory, I wrote a few small guides for a non-police audience.) Those frameworks already oblige the custody officer to have regard to someone’s medical welfare and it is already the case that where someone arrives in police custody, either under arrest for an offence or detained under the MHA via these new Regulations, the custody officer must decide whether the person requires clinical attention and they must either, call an Approved Healthcare Professional (a specific term for custody healthcare, and NOT the same thing as an AMHP); or they must call an ambulance or transfer the person to hospital. Depending on specifics, it is quite feasible that decisions (or preferences!) to use custody after detention hit up against the solid brick wall of a confident, knowledgeable custody sergeant who genuinely believes that PACE frameworks mean they must, in all conscience, transfer that person to hospital.

Here was my own personal reaction to the Regulations when I saw them in their final form, bearing in mind I’ve been the duty inspector who was involved in overseeing and directing the early decisions after someone is first detained; I’ve been that custody sergeant to whom the vulnerable were carried because (at that time) officers had nowhere else to go; and I’ve been the police constable detaining people under this Act and being nervous for days on end that the decisions I was forced to take through the want of properly established pathways weren’t going to backfire for reasons beyond my control and I’d find myself investigated (or worse) for manslaughter.

As a police inspector and bearing in mind what I’ve learned doing all the work I have on policing and mental health, I cannot think now of a single, solitary situation in which I would authorise removal directly to a police station from the point of arrest. I’d question the ability of any healthcare professional to tell me, in a street, during a restraint that someone presenting in the way the Regulations describe didn’t need careful screening in a medical setting, prior to it being considered ‘safe’ to proceed to custody and hold them in a small concrete room, healthcare checks or not! So, for me, if no paramedic has come to the scene when officers are thinking about these Regulations: to an Emergency Department we will go! Even if a paramedic attends, I’d have questions for them if they were saying it’s OK to go to custody with anyone who poses “an imminent risk of serious injury or death” to themselves or others. Same would apply to any suggestion in ED that someone should be taken to custody. It would be whether the professional’s judgement was maintaining nothing in these documents indicated the person needed to remain in that or any other kind of healthcare setting –

There are some big words and complicated ideas in that lot – probably best that cops aren’t trying to disentangle this stuff and sort it out, until we know people are going to be safe. My thinking is unable to take me very much further than that, quite honestly, which may be my bad but you only need to pay attention to the news to see why.


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

Winner of the Mind Digital Media Award.


PaCA – The Statutory Regulations

This blog is part of the series which will cover, in detail, the amendments to the Mental Health Act 1983 within the Policing and Crime Act 2017. This post is one of several which relates not the amendments themselves, but to the implications arising from them.

For background to the series, see the introductory post which outlines why I’m doing this and what other specific issues will be covered concerning laws that will come in to effect in the next few months. Current Home Office estimations of timescales suggest late November / early December – but this is subject to a number of factors and may change.


The Mental Health Act (Police Stations as a Place of Safety) Regulations 2017 have been much awaited. (Also see the UK Government guidance document.) The Regs will now be much debated, I suspect, because we now know how the Government are framing the future use of police custody as a Place of Safety. Starting at the very beginning, for those who are not sure, statutory Regulations, issued by a Secretary of State under authority from an Act of Parliament are ‘the law’ in just the same way as the Mental Health Act is the law. It has the same force, but the matters within can be changed or updated much more easily, as the Secretary of State sees fit. My best guess is: the degree of restriction on the use of a police station and the caveats which must apply to its use to ensure safety and wellbeing, will be a surprise to some NHS staff and will cause the need for an quick-time assessment of preparedness. I’ve already had conversations with some forces who have read the Regulations and feel they will never, be able to lawfully rely upon a police station because of their inability to meet the caveats without NHS support which they suspect will not be forthcoming because of the resource implications for mental health or ambulance services.

Good luck with that!

Three criteria must exist in order to allow police stations to be used: NB, this is about police stations as a whole, not just police custody areas –

  • The detaining offfier must reasonably consider that the behaviour of the person poses an imminent risk of serious injury or death, either to themselves or another person
  • The officer must believe that no Place of Safety in the police force area could safely manage that risk; AND
  • Reliance upon the police station must be authorised by an officer at the rank of inspector, unless the detaining officer is already of that rank, in which case no further authorisation is required.

Once the person arrives in police custody, there are then several things to bear in mind –

  • Use of police custody is still subject to the custody officer’s normal set of considerations in terms of authorising detention.
  • It is the custody officer’s legal decision to detain further and if the inspector who authorised use of the police station disagrees with any decision by the sergeant, PACE states this must be referred to an officer at the rank of superintendent.
  • Once detained, the custody officer must ensure several things happen —
  • A check by a healthcare professional every thirty minutes.
  • Wherever possible, there should be a constant healthcare presence throughout the duration that person is detained.
  • If the original grounds for using the police station cease to apply, the person must be transferred elsewhere.
  • If the custody sergeant is not able to ensure the relevant frequency of health checks, the person must be transferred elsewhere.

CALLING ALL POLICE INSPECTORS

As you might imagine, I have several thoughts about all of the above! Firstly, and speaking as a police officer who is at the very rank expected to authorise use of a police station: I simply can not imagine a single scenario where I would ever do so. I would caution all inspectors to get their heads around this, because that crucial decision will be one that is crawled over by the IPCC or a Coroner if things go awry. It was the decision to take someone to custody and not to hospital that contributed to the reaction and consequences arising from deaths in custody case over the last fifteen years. Most usually, a police inspector will not be at the scene of an incident where s136 is used – so you can imagine this all being done by phone or police radio discussion and the officer shouts up, “Boss, can we take this guy to custody please?” Maybe they just think the grounds are met, maybe they’ve been advised to do so as part of the pre-detention consultation or perhaps they’ve taken the person to a health-based place of safety or A&E and been declined entry, for whatever reason. I can imagine me saying something like, “Tell me why I should authorise it – have you called an ambulance to this incident; and what else have you done or considered before asking me for this?!”

If no ambulance has been called, I’m going to want that tried unless there is good reason not to do so. That will probably have to be that the person needs urgent assessment or treatment by an Emergency Department and it would be quicker to crack on getting him there, than wait for an ambulance. (That happened in the Rafael Delezuch case, in Leicester – fully supported by the IPCC as a sound decision.) I’d also be asking about how this person is presenting – the officer would need to be able to quickly describe how this person is presenting to justify the “imminent risk of serious injury or death to. themselves or another” thing. Without that, use of a police station would be unlawful and inappropriate. So it immediately means, that if officers have been told or assumed that consumption of alcohol prohibits access to an NHS location, the decision MUST be that use of the police station is not authorised, because it can’t be in those circumstances. I’d be dispatching a sergeant to the job to discuss that with the NHS face-to-face.

Finally on this point, there is the whole thing about the risk of an adverse event: anyone who is posing such an imminent risk is probably going to be subject to at least some form of restraint, which raises the risk. If the incident involves a particularly ‘high-intensity’ restraint, then fears should step up again. I’d be thinking about making sure the detaining officer had enough colleagues to quickly and speedily transfer the person to whichever healthcare building the paramedics thought appropriate; and if no paramedic was on scene, it would be ED, for my money. I’d then head down there to discuss and would be telling the officers I’m not authorising use of a police station until someone with the letters ‘N,H and S’ on their ID badge has considered the relevance of applicability of NICE Guidelines, ABD Guidelines and the patient safety alert from NHS England (December, 2015). If all of that has happened as well still have an ‘imminent risk’ situation, then and only then would I consider authorising use of a police station, and only where there is that constant healthcare monitoring.

DETENTION IN CUSTODY

Secondly, phrased in the way they are, some forces will be simply unable to comply with these Regulations or use police stations, ever. They do not have a constant healthcare presence in any of the custody areas and cannot guarantee thirty-minute checks under their existing healthcare arrangements. Of course, if NHS partners were willing to provide a healthcare professional to undertake this function, then they could use the police station, but that would be subject to their agreement on a case by case basis. How many MH trusts will be able to supply a nurse within 30 minutes for the duration of a 24hrs detention; will the ambulance service be willing to leave a paramedic in custody; is there an NHS liaison and diversion service in custody for at least some part of the day whereby this could be achieved? All local discussions to be had, but without those thirty-minute checks: the custody officer is obliged to transfer the person elsewhere.

What is also interesting about the Regulations is that they are focussed on police stations, not just custody, but they repeatedly refer to the [custody sergeant or custody officer] which is a position only relevant in police custody.  What happens in the rest of the station is a matter for the officer in charge of it. So the ability to ensure the thirty minute checks will determine whether a particular police station can act as a Place of Safety, and not all (PACE) designated custody areas will be able to do so. Thinking of my own force area when I first joined, we had 22 small, local custody areas, some with just 6-8 cells, others with 16-18 and one large one in central Birmingham with 40-odd. Over the years, the force has restructured to having three very large ‘super-blocks’ of 50-60 cells and each of those has 24/7 nursing or healthcare support. However, we still operate some of the smaller custody areas and they do not have 24/7 healthcare.

My best guess is that West Midlands Police will have to say if anyone requires detention in a police station under the MHA, it must be one of the ‘super-blocks’, because they can deliver on the Regulations, smaller custody areas could not. All hypothetical for us, in fairness: custody wasn’t used once last year! Whilst this is a boast, because I worked for so long on getting people out of custody that this achievement (from the continued hard work of others in the force since I’ve moved to the College of Policing) is one the things I’m most proud of. But I also mention it for another reason: to show that a large, demanding, urban area can achieve what some think is literally impossible if they have the will to do it and they build the partnerships to match. If Birmingham and West Midlands can do this: anywhere can (and should). I hope the Regulations contribute to forcing this issue in areas that have just written it off as impossible – it demonstrably isn’t!

MONITORING IN CUSTODY

The healthcare checks that are required, must occur every thirty minutes – the Regs don’t seem to mind whether this is done by a doctor, nurse or paramedic, etc.. An AMHP would not be able to do this, unless they were also a registered nurse – most AMHPs are mental health social workers, and not healthcare professionals for the purposes of these Regulations. In addition, the custody sergeant must undertake an hourly check of the detainee in the normal way and is at liberty to impose a regime of enhanced observations, as they see necessary nad influenced by healthcare advice. This could mean, 1-to-1 obs by a police officer; or even 2-to-1 obs, if necessary – all supplemented by those healthcare checks.

The Regulations do allow for this one-hourly check to be relaxed on healthcare advice, to three hourly checks if the person is sleeping. I’d also like to sound another alarm-bell here: if someone came in to custody because of the ‘imminent risk’ criteria and the person is now sleeping, it’s doubtful that the criteria still apply and the person should be transferred, as per Regulation [X]. It is also something to be wary of, medically speaking – is the person who is now lying on the floor actually asleep, or are they unconscious or worse?!  Doctors I have discussed this with have said they would have elevated their level of concern about someone who was so agitated they met the criteria for removal to a police station who was then at the other end of hte behavioural spectrum, by appearing to have gone to sleep.

My own view, having read over many of the cases where people have died in custody, is you can’t over-monitor someone’s health whilst they’re detained; we’ve been found wanting by having under-monitored some people and that this has been used as the basis for the criminal prosecution of police officers in some examples. I would want forces to be really careful about any decision to bring someone to custody so agitated, especially where restraint has been involved and the higher the level of distress, fear and agitatedion, the higher the intensity of restraint, the older the person, the heavier the person and so on, the more alarm bells should be ringing about ensuring appropriate clinical screening of need before we ask the custody officer to authorise detention. And having been that custody officer: I’d be thinking very carefully about authorising it unless I was happy with everything that had gone before, that the health service had become involved and that this was the last resort.


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

Winner of the Mind Digital Media Award.