Under pressure social workers, NHS agencies and police need investment to improve the response for patients who are detained under section 136 of the Mental Health Act, argues Steve Chamberlain, chair of The College of Social Work’s Approved Mental Health Professional (AMHP) network.
This is clearly unacceptable; most of all for the detained people who are having to wait to be assessed and a decision made regarding their detention.
It is also a terrible waste of police time, and feeds into the views put forward by the Home Secretary last May.
The length of delays reported in Merseyside – including an exceptional, but sadly not unique, case of a 48 hour wait – are way beyond those I’ve seen first-hand in my own practice.
But the AMHP Community of Interest at The College of Social Work is aware of concerns over the responses to section 136 assessments in some areas and we’re involved in several projects looking into this issue.
Feedback from AMHPs and other agencies suggest that response times vary across the country.
Many areas have clear agreements with the police on how long officers will remain with a person who has been detained under the Mental Health Act after they have arrived at a place of safety.
It is a requirement of the Mental Health Act Code of Practice to have a jointly-agreed multi-agency policy regarding section 136, and the respective roles of the different agencies should be included in that.
From my own knowledge, many policies specify a wait for assessments of an hour or 90 minutes maximum. This would only be extended with the agreement of the senior police officer on duty.
Very frequently the police can leave much quicker than this – sometimes within minutes – where there is sufficient trained staff cover available at the hospital.
But clearly, as last week’s report by the chief inspector of prisons on Merseyside reminds us, this isn’t the reality in every case.
Improving 136 responses is a multi-agency responsibility. The truth is that every agency – local authorities, NHS and police – needs to address how these situations are dealt with.
Adequate resources are key to improvements. At the moment all of us – AMHPs, health teams, police and ambulance staff – are being asked to work with less and less.
Here are just some of the types of issues that need improvement, and investment, across agencies:
1. AMHP services: Many AMHP services have limited resources out-of-hours.
That means section 136 assessments sometimes have to compete in priority with other emergencies, such as child protection enquiries. Increased resources out-of-hours could ease this part of the problem and reduce delays.
2. Police: Some forces could do with improving training in understanding the law around mentally disordered individuals, and alternatively drunken individuals, in public places.
AMHPs in some areas report that only about 15% – 20% of people brought to places of safety need admission, suggesting that the vast majority are wrongly identified as being mentally unwell.
3. NHS (place of safety) resources: Hospital-based places of safety need to be resourced with sufficient staff to ensure the person is received and looked after securely.
This would allow police to leave as soon as they have handed the person over to the hospital staff.
Reports from AMHPs suggest that many places (often outside the major metropolitan areas) still do not have health-based places of safety.
That means people detained under section 136 are taken to police cells. It also unnecessarily criminalises mental disorder, and fills cells when they should be available for criminal justice purposes.
4. Availability of doctors: In some instances AMHPs report that doctors of sufficient seniority (section 12 doctors) are not available in a timely manner at places of safety to assess a person. This adds to delays in dealing with the person, completing the assessment and either admitting them or releasing them from custody, if necessary.
5. NHS bed availability: This is possibly the biggest issue across the country, and one about which the AMHP Community of Interest at the College is currently surveying our members.
Many AMHPs report that in parts of the country it is extremely difficult to obtain a bed for an acutely mentally ill person, even after it has been established that it is needed.
The Care Quality Commission mentioned this explicitly in their recent annual report on the Mental Health Act.
6. Ambulance service: The police are concerned in many places that they are forced to take people to the place of safety in police transport, rather than an ambulance, often due to a lack of resources.
This not only adds to the criminalisation and stigma placed on people with mental ill health, but adds to the risk of harm to the person who may be in an acutely ill condition but forced to travel in the cage at the back of the police vehicle.
There is some interesting research which identifies a direct relationship between the reduction in acute psychiatric beds and the increasing use of detentions under the Mental Health Act.
I am only too aware that we are living in an environment of increasing financial strictures, and I fear that the overall situation will not get better, although there are things which can be done to improve multi-agency working.
Steve Chamberlain is chair of The College of Social Work’s AMHP community of interest and an AMHP in London.
What do you think needs to be done to improve social work’s response to s136 detainees? Leave a comment below.
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