It’s no good demanding to be let out… there’s no where else to go

June 1, 2006 in Mental Health

At 1.30 on a spring morning last year, Lorraine Kelly was picked up by the police after a passer-by reported traffic dodging a naked body in the road.

She was taken to a police station, where she was handed a 3ft crochet blanket, before being locked in a cell.

Thirteen hours passed. Kelly was then given clothes from a lost property box and, three hours later, she was released.

“I have no idea how I ended up in the road without a stitch on but after I was released I went into a deep depression,” recalls Kelly. “I wanted to kill myself because I realised I had no control over what was happening and no choice about where I was taken.”

Niall Campbell* has had similar experiences. Twice he has fled his home in a state of panic and tried to direct traffic on the street where he lives. At times like these the police are called and he is taken away, sometimes in handcuffs.

He has been detained by the police four times. On three of these occasions he was locked in a police cell, where he stayed for a couple of hours before being compulsorily admitted to hospital.

“I can remember vividly each time hammering on the door and demanding to be let out,” says Campbell, adding that the experiences have left him with traumatic memories for years afterwards.

He and Kelly are among thousands of mentally ill people detained in a police cell every year under section 136 of the Mental Health Act 1983. This gives the police powers to detain people whom they believe have a mental disorder and are in need of immediate care or control at a place of safety for assessment.

Under the act, police stations should be used only when no alternative accommodation can be found. But Home Office figures show that in 2004, 20 of the 43 police forces in England and Wales were routinely using cells as places of safety.

In its report into deaths in custody in 2004-5, the parliamentary joint committee on human rights concluded that police custody suites were not suitable or safe places in which to detain people and that their use could lead to breaches of human rights.(1)

Campbell does not blame police officers for the distress he experienced. “There is no way that they should be put in the position of looking after people in a mental health crisis. They are not trained for it and police stations have no facilities for it.

“Picking up people under section 136 can be and usually is a valuable service. The police should be supported to do this in the most sensitive way possible and deliver the person to a place of safety that is properly fitted out and staffed by mental health workers, particularly nurses.”

Moira Fraser, head of policy at the Mental Health Foundation, sees the high use of police cells as a straightforward case of organisations’ failure to take on their responsibilities. Mental health trusts – cash-strapped and burdened by competing priorities – do not focus their resources on people detained under section 136, who are often seen as difficult, she says.

“Where we allow police cells to be used they become overused. There needs to be much better monitoring and trusts should be called to account, as should the police, if they are used inappropriately.”

Trusts in London have, on the face of it, made the greatest progress in developing ways of dealing with section 136s, unsurprisingly given that 38 per cent of them occur in the capital, where the geography and dense population make it easier to set up services.

But reports of police turning up at an assessment centre with someone they have detained under section 136, only to be turned away because the person is drunk or smells of alcohol, have come to light.

Nine mental health trusts in London contacted by Community Care denied that they had policies barring people who are intoxicated. Yet cases of what is dubbed “doorstep triage”, whereby people are breath-tested before being admitted, have been uncovered by the Mental Health Act Commission (MHAC).

Inspector Paul Bather, who has front-line experience of 136 cases, admits: “It is a nightmare. You might then have to drive miles to another assessment centre or be forced to take them to a police station. The person is already distressed and it’s terrible for them and it’s terrible for the officers.

“If someone is taken somewhere to be assessed then they should be assessed.”

He adds that it can also be problematic when somebody is admitted to a unit, only for it to be found that they have a physical health need that needs attention, because they then have to be taken to A&E.

“Wouldn’t it be great if we had places where physical and psychological needs could be addressed under the one roof?” says Bather, who has been working with the London Development Centre on a review of the pan-London guidance for section 136.

Outside London provision is distinctly patchy. Devon and Cornwall police arrested 925 people under section 136 between March 2005 and March 2006, of which 879 were detained at police stations. Just one place of safety exists in Cornwall; Devon has none.

Devon Partnership NHS Trust has submitted a bid to the Department of Health for 400,000 to build a suite for people detained under section 136. The DH last year made 130m available for mental health trusts to provide places of safety.

Pressure to use resources efficiently may be one reason why many trusts struggle to meet their responsibilities.
Hari Sewell, director of social care and substance misuse at the Camden and Islington Mental Health Trust, says: “There are peaks and flows around section 136s. One weekend at University College Hospital we had nine section 136 assessments. Then we may have nine over three evenings so there are issues about efficiency.”

He adds, however, that there is “erratic” use of services elsewhere but their quality and availability are maintained.
Cash alone is unlikely to lead to improvements. “So often money is siphoned off for something else,” says chief executive of the MHAC Chris Heginbotham. He adds: “If trusts are to prioritise this we need something from the centre that says they have a mandatory duty and the number of places of safety will be counted.”

He and many others, including those directly affected, such as Kelly and Campbell, back the parliamentary committee’s recommendation of a statutory duty on trusts to provide places of safety.

“I’m not a criminal so why was I treated as if I had committed an offence?” asks Kelly. An uncomfortable question that the government looks set on avoiding, for as long as it continues to allow people like Kelly to be kept in police cells for 16 hours – or longer.

* Not his real name.