Policing, Mental Health and Criminal Justice. Michael Brown Author – MentalHealthCop blog mentalhealthcop.wordpress.com. Section 136 Mental Health Act – place of safety pathways. s136 (1) MHA 1983.
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Author – MentalHealthCop blog
If a constable finds in a place to which the public have access a person who appears to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in that person’s interests or for the protection of others, remove that person to a place of safety.
A person removed to a place of safety under this section may be detained there for a period not exceeding 72 hours for the purpose of enabling him to be examined by a registered medical practitioner and to be interviewed by an AMHP and of making any necessary arrangements for his treatment or care
… can only be ended by a Doctor / AMHP
… or where police responsibilities end.
… nothing defines who MUST do them.
Loads of myths / folklore – too many
Police lack skills in recognition of mental illness and training in the use of the power.
NHS lack legal knowledge.
Overlaps to acute medical problems
Complications because of substance use / abuse.
You can’t use s136 on someone who is drunk
Children cannot be detained in a PoS run by adult services
Separate provision LD / CAMHS patients
Remove all aggressive / violent patients to the cells.
An Emergency Department is NOT a PoS –
Anywhere can be a PoS!
When do you use s136 and when you should prioritise a criminal offence?
“An offence is an offence is an offence, isn’t it?!”
You can reverse a 136 decision; you can’t reverse an arrest decision.
There is objective information, concerning a mental health problem, beyond an officer’s observations.
It is important to ensure that a jointly agreed local policy is in place governing all aspects of the use of sections 135 and 136.
identifying and agreeing the most appropriate place of safety in individual cases;
dealing with alcohol or drugs;
dealing with violence;
access to a hospital emergency department, where necessary;
[Para 10.16 & 10.17 CoP MHA]
18,000 detained under s136 MHA
11,500 detained in the cells.
Over 65% of the total.
50 / 50 split– there is a long way still to go.
Some people arrested under s136 MHA are presenting both clinical and security risks:
CANNOTbe managed by the police alone
CANNOTbe managed by the NHS alone
Including where drugs, alcohol and aggression are involved.
Arrest under s136 Mental Health Act
Ambulance to EVERY arrest.
Assess for RED FLAGS
RED FLAGS to the Emergency Department
NO RED FLAG to identified PoS provision
Consider improvised alternatives
Police station as last resort.
Blows to the body
Falls > 4 Feet
Injury from edged weapon or projectile
Throttling / strangulation
Hit by vehicle
Occupant of vehicle in a collision
Ejected from a moving vehicle
Evidence of drug ingestion or overdose
Serious Physical Injuries:
Not Rousable to verbal command
Loss of consciousness at any time
Bleeding from nose or ears
Suspected broken bones
Use of edged weapon
History of overdose or poisoning
Delusions / Hallucinations / Mania
Possible Excited Delirium:
Two or more from:
Serious physical resistance / abnormal strength
High body temperature
Removal of clothing
Profuse sweating or hot skin
Behavioural confusion / coherence
Police Officers remain at ED throughout
Joint risk assessment at PoS:
Low: left with PoS
Medium: case by case, on merit
High: ongoing police support
Mental Health Act 1983
Code of Practice to the MHA, revised 2008
Police and Criminal Evidence Act 1984 (PACE).
Code of Practice, Code C, to PACE, revised 2008
Human Rights Act 1998
Data Protection Act 1998
Royal College of Psychiatry Standards on s136 (2011) & position statement (2013)
Independent Police Complaints Commission of the use of police cells for detentions under s136 (2008)
Academy of Medical Royal Colleges Report on Managing Urgent Mental Health Needs in the Acute Trust (2008)
NICE Guidelines on the Short-term Management of disturbed / violent behaviour (2005).
NICE Guidelines on Self-harm (2004).
NPIA Safer Detention Guidance, NPIA (2006)
NPIA Guidance on Police Responses to People with Mental Ill Health or learning disabilities (2010)
Home Office Circular 17/2004
Home Office Circular 66/1990
R v Ashworth Hospital Authority (2005), House of Lords.
MS v UK, ECHR.
R - resistance
A - aggression
V - violence
E - escape
An application for the admission of a patient to a hospital under this Part of this Act, duly completed in accordance with the provisions of this Part of this Act, shall be sufficient authority for the applicant, or any person authorised by the applicant, to take the patient and convey him to the hospital.
Duty on CCGs to ensure effective arrangements for transportation of patients.
Danger of the expedience argument
Coroners’ Rule 43 letters, following inquests
IPCC and ACPO reservations
No ability to compel the police to accept s6 authorities!
Para 11.6 MHA CoP – “It is for Clinical Commissioning Groups (CCGs) to commission ambulance and patient transport services to meet the needs of their areas. This includes services for transporting patients to and from hospital (and other places) under the Act.”
Para 11.10 MHA CoP – “It is essential to have clear agreements in place so that people who need assistance in conveying patients under the Act can secure it without delay. Authorities, including NHS bodies responsible for hospitals, ambulance services and the police, should agree joint local policies and procedures.”
Para 11.11 MHA CoP – “Policies should ensure that AMHPs (in particular) are not left to negotiate arrangements with providers of transport services on an ad hoc basis, in the absence of clear expectations about the responsibilities of all those involved.”
Para 11.16 MHA CoP – “AMHPs should make decisions on which method of transport to use in consultation with the other professionals involved, the patient and (as appropriate) their carer, family or other supporters. “
Para 11.17 MHA CoP – “If the patient is likely to be unwilling to be moved, the applicant should provide the people who are to convey the patient (including any ambulance staff or police officers involved) with authority to convey the patient.”
Para 11.18 MHA CoP – “If patient’s behaviour is likely to be violent or dangerous, the police should be asked to assist in accordance with locally agreed arrangements. Where practicable, given the risk involved, an ambulance service (or similar) vehicle should be used even where the police are assisting.”
Para 11.19 MHA CoP – “The locally agreed arrangements should set out what assistance the police will provide to AMHPs and health services in transporting patients safely, and what support ambulance or other health services will be expected to provide where patients are, exceptionally, transported in police vehicles.
Para 11.20 MHA CoP – “Where it is necessary to use a police vehicle, it may be necessary for the highest qualified member of an ambulance crew to ride in the same vehicle with the patient, with the appropriate equipment to deal with immediate problems. In such cases, the ambulance should follow directly behind to provide any further support.”
10,000 custody records
1,076 MH was queried > FME
512 FME > MHA assessment
415 FME said ‘proceed as normal’
– may as well not be ill.
x9 Section 3 MHA
x76 Section 2 MHA
x12 Informal / voluntary
Non-Diversion: ‘business as normal’
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