Over the last few years, we’ve seen a massive extension to ‘liaison’ work in mental health services. ‘Liaison psychiatry’ is now a sub-specialism for those psychiatrists who work in acute and other medical settings, giving specialist mental health support to those doctors in Emergency Departments, medical and surgical wards, for patients with co-morbid mental health problems. We see this in mental health nursing too. We’ve known for decades that many of us would like to see more mental health nurses based in police custody and as time has gone on it has increased and 70% of the population of England is now covered by Liaison and Diversion schemes. In just the last few years, we’ve seen this accelerate significantly:
We have mental health nurses in police cars doing ‘street triage’.
We have mental health nurses in ambulance vehicles working with paramedics doing ‘street triage’ without the police.
MH nurses are in police control rooms.
They are also in ambulance control rooms – indeed, they are in ambulance control rooms...
I’ve got to know a fair number of AMHPs in my time – incidentally, it’s pronounced ‘amp’, before we get in to this. In fact, I’m going to come clean on this occasion – some of my friends are AMHPs and I’ve been known to take refreshments with them on a clear evening and Tony now owes me at least one beer for writing this for #AMHP17! I’ve been known over the last few years to go out of my way when they ask for inputs on CPD events because a clear understanding of who these people are, what they do and the circumstances in which the operate is crucial for operational police officers – and I think they need to know more about the police and the learning we’ve gone through over the last ten or fifteen years. I’ve had some of my most interesting professional disagreements with some AMHPs(!) but in all fairness, it was usually based on things I’d learned from other AMHPs who had been kind enough to help me get my head around things when I first started working properly on this stuff.
We hear a lot about partnerships in public services, the need for various agencies to do them, to have them or the need to improve them. Simplifying horrifically, the narrative seems to be that there are gaps and overlaps between different public agencies and if only managers could bridge the gaps and cooperate on the overlaps, all would be well. Indeed, you could argue that this is what sits behind the Crisis Care Concordat, one of the most significant ‘partnership’ documents we’ve seen on the issue of mental health crisis care. Don’t forget: the Concordat came from discussions specifically about policing and mental health, following the tragic case of Olaseni Lewis in south London in 2010. The concern was that it was a failure of the police and mental health services to work in partnership that caused the death of this young man.
Of course, we now know that’s only a part of the story and legal processes rumble on regarding the various parts. What this and several other cases have recently caused me to wonder is whether this...
Six years ago, Nicola Edgington attacked Kerry Clark and Sally Hodkin in south London, seriously injuring Kerry, a 22yr old woman and killing Sally, a 58yr old mother and grandmother. She was prosecuted for murder and attempted murder, convicted in March 2013 and sentenced to life in prison with a minimum recommendation she serves 37yrs. She appealed against this outcome, but it failed. Four hours before the attacks, the Metropolitan Police had contact with Nicola, having been called to a taxi rank in Greenwich and they assisted her to the Emergency Department at Woolwich Hospital where she was seen by a mental health nurse and admitted on a voluntary basis to a nearby mental health unit. She absconded from the unit thirty minutes or so later, and attacked the two victims shortly afterwards as they made their way to work. If you prefer not to read a pile of material, there is a simple, but useful audio / visual summary of this on the BBC news website.
I’m after your views on something! The blog is now approaching 675 posts, as well as various other pages and resources and when the Policing and Crime Act 2017 eventually takes effect, it will render many posts instantly out of date. On previous occasions when I’ve attempted to go through the blog updating every single post on something or changing appearance to make it fit a new ‘theme’ that I’ve used on WordPress, it has taken me a week of effort – and that was when the BLOG was nowhere near as large as it now is.
The BLOG always was intended to help police officers navigate their way through incidents and I’m still getting feedback that it continues to be valued for this. I therefore feel I have to make it clear that pre-PaCA stuff is now potentially out of date so that no-one attempting to use the posts as information falls foul of the update. I’ve been thinking of a few options and I thought it was probably better to ask those of you who are good enough to read, use and circulate this how you’d prefer me to do this from a...
Your Mental Welfare Commission has recently published a snapshot report about Police Scotland’s use of ‘place of safety orders’ under the Mental Health (Treatment and Care) Act (Scotland) 2003 – the MHA(S), if you prefer. Section 297 MHA(S) is the equivalent power to section 136 of the Mental Health Act 1983, the MHA(EW), if we’re being consistent. The report is just a three-month snap shot but it raises several questions which the Commission themselves are openly asking. It is precisely because they have made a direct comparison and reference to the use of Place of Safety orders under English and Welsh law that I thought a short blog may be helpful, flagging some learning we’ve gone through in England, but also contrasting certain parts of England to help think through how culture and evolved practice affect the police’s use of powers.
It’s worth reading the report – it’s only 13 pages long and that includes the cover and a blank page as well as plenty of tables and white space!
Can a police officer detain a person under s136 MHA if that person is already affected by mental health law in some way?
Imagine a police encounter where the officers are told by someone the person they have concerns about is on leave from hospital, with permission — or maybe living in the community under one form of restriction or condition? Can they use section 136 if they feel the grounds for it are satisfied?! Yes, absolutely they can – there is no doubt whatsoever about this but the post will explore why a straightforward-enough question can get complicated and will thrash out a bit of detail that may help to win any argument if officers encounter problems. Oddly enough, the inspiration for this was an officer who contacted me having encountered problems!
I can think of a couple of situations where very similar legal questions arise, in addition to the one highlighted by the officer, so it’s worth considering a few situations –
A person has been granted s17 leave from hospital and is at liberty for a few hours or a few days, with the...
Imagine you’re the front line police officer called in to a mental health ward. Reports have been received from a patient’s family that the patient is being held on the ward without legal authority and they want the police to assist in extricating the patient from their hold, alleged to be unlawful. The control room sergeant has spoken to the caller who said, “The patient is my brother, his mother is with me and she is his nearest relative. Four days ago she gave written notice under s23 of the Mental Health Act that she was ordering the discharge of her son from hospital and as the hospital authorities have not issued a barring notice within 72hrs, they are obliged to release my brother – they are refusing to do so and he’s being held against his will, unlawfully.”
A few questions, then! –
Is this actually any responsibility of the police?!
Can the man’s mother actually order her son’s release against the wishes of the hospital?
This is a written version of a talk I gave last night, where I had fifteen minutes to summarising my thoughts on the overall topic of policing and mental health. It’s a while since I had such a short period in which to condense my thoughts and it was a useful exercise in rooting out the extraneous junk from my mind!
If you look around the world at adverse incidents that cause us to discuss the police roll in mental health issues, you see a range of problems:
The extent to which the police are relied upon as first- responders
Problems in the use of force:
Restraint related deaths
Fatal police shootings
Controversial use of things like Taser
Normalisation of the police as a de facto crisis service
Criminalisation of vulnerable people:
Prosecution almost entirely for the purposes of accessing clinical services
Incarceration in prison where upstream interventions would have prevented the need.
From that lot and much more besides, you can start to form your own view about whatever it is that you think the fundamental problem might be. Whatever...
Earlier today, the Royal College Nursing voted at their National Congress in Liverpool “to lobby to ensure that Emergency Departments are no longer designated places of safety for the purposes of mental health legislation”. So, I’ll cut straight to the chase: that’s not a really thing – in the sense that the word ‘designated’ does not appear in the Mental Health Act, and only appears four times in the whole Code of Practice to the MHA, never in relation to sections 135 and 136 which relate to police powers and places of safety. It’s just not a thing around which to have a meaningful debate because, as a police officer, I simply don’t need to care whether somewhere is designated or not. Those who urgently need ED care because of the nature of their medical needs are going to go there under s135/6 regardless of designation; and those who are detained and don’t require ED in the strict medical sense but where no alternatives exist, may also end up there, especially after the Policing and Crime Act amends the Mental Health Act later in...