So the chief inspector of prisons has found that most police forces are “dissatisfied” with Mental Health Act assessment services during evenings and weekends. He also warned that police cells are being overused as places of safety for people detained under the Mental Health Act by police.
Does this all ring true to my experience?
Well I’d say that out-of-hours intervention and assistance is piecemeal to say the least. On many occasions I’ve had an emergency duty team (EDT) refuse to come out and assess someone.
Very, very, rarely will they ever deal with a "live" situation. Instead many seem content to ask the police to arrest the person and take them to the cells. We used to do this but we are beginning to refuse.
AMHPs and police need to understand each other’s roles
Why? Well for one thing in very few instances does a power of arrest actually exist. I have been asked more than once to arrest someone for making "threats". The EDT’s expectation is that we will just keep a person in a cell until the approved mental health professionals (AMHPs) are ready to carry out an assessment.
Some AMHPs seem to think that arresting people is something that the police ‘can just do’, just as I suspect many police officers think sectioning people is something AMHPs ‘can just do.’
Neither is true and it’s clear that there needs to be a much better understanding between AMHPs and police of each other’s powers and the legislation that governs our respective roles.
A lack of urgency from EDTs?
Another thing I’ve found is that often response times for EDTs tend to be longer if the person is in a police cell. Is it because someone else is taking care of the patient, so any sense of urgency is gone?
When we detain someone on a section 136 this leads to police officers having to sit with the detainee indefinitely. In fact, the lack of a sense of urgency is something all too apparent in after hours provision - even when a patient is struggling violently.
The ‘overuse’ of police cells as places of safety
The chief inspector of prisons report also flags up issues around the overuse of police cells as a place of safety, rather than clinical NHS settings, when police detain people under section 136 of the Mental Health Act.
The levels to which this applies varies from area-to-area. Some forces, like West Midlands, have managed to get 97% of their section 136 detainees into a clinical place of safety after many months of hard strategic work. Other forces are nearer 50-60%.
The remainder go to cells. This is abhorrent. The Independent Police Complaints Commission have recommended more than once that a police cell should never, ever be used as a place of safety apart from as a last resort.
'Hospital staff slam the phone down without offering any plan B'
So why does it happen? Well to be blunt because often your place of first resort – a mental health hospital – will have one bed. You can be told it’s “unavailable” and the staff just slam the phone down without offering plan B. That’s when things get difficult.
It shouldn't be right that a mental hospital can simply say "we can't accept" and that's it as far as they are concerned. They shouldn’t be able to simply say finding a place of safety for a distressed person is “someone else's problem”. Yet this happens all the time.
There should be no reason why a modern, enlightened society should be placing sick people, who have committed no crime, into a police cell. Yet it IS happening - the proper alternative simply isn't available and progress in addressing the problem is painfully slow.
It is not acceptable to place sick people in cells
I have lost count of the number of requests we have had to remove a disturbed patient from a clinical setting into a police cell. We now routinely refuse.
The government is currently assessing police involvement in mental health cases with a view to heavily reducing the amount of work police have to do. I’m sure they will be looking at whether police cells should continue to be used to hold persons detained under the Mental Health Act.
If they decide they shouldn't then there will be a massive black hole in provision which mental health care providers will struggle to make up quickly.
Cells don’t have the right equipment or staff
Another problem with police cells is that there isn't the right equipment or staff on hand to deal with prolonged restraint. Prolonged restraint isn't ideal anyway but it can be positively frightening when you know that the EDT are operating to their own agenda and refuse to prioritise this crisis over what they are dealing with already.
Police cells have been used as places of safety for mental health patients for too long. The sooner the decision is taken to stop using them the better for all of us - police, AMHPs and, most of all, the sick people in need of help.
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