Police ‘dissatisfied’ with out-of-hours Mental Health Act assessments

The majority of police forces are “dissatisfied” with the Mental Health Act assessment services being delivered during evenings and weekends, the chief inspector of prisons has warned.

In his annual report Nick Hardwick said that the process of Mental Health Act assessment was “usually efficient during the day” but said most police forces “were dissatisfied” with the out-of-hours service being offered by emergency duty teams (EDT).

In an article for Community Care, a policeman who writes under the pseudonym Nathan Constable, said that out-of-hours assistance from EDTs is “piecemeal to say the least”.

“On many occasions I have had an EDT refuse to come out. Very very rarely will they ever deal with a “live” situation. 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,” he wrote. 

The policeman added: “Some AMHPs seem to think that “arresting” people is something that the police ‘can just do’ – much as I suspect many police think sectioning people is something AMHPs ‘can just do’.”

“There needs to be a much better understanding of each others powers and the legislation for both sides.”

Inspector Michael Brown, who works for West Midlands Police and runs a blog on mental health policing that has been nominated for the Mind media awards, said:

“I hear many frustrations about the time taken to respond to requests for MHA assessments. Timescales in excess of 12hrs are not rare. I think it is worse out-of-hours but also frustrating within hours. I’ve heard similar frustrations from A&E and wonder whether some areas are fulfilling the legal duty of having sufficient AMHPs available?”

Daisy Bogg, an AMHP who works in EDTs and a member of the national AMHP leads network, said:

“The EDT response can be piecemeal but it’s largely because of resourcing issues. There’s also the issue that, although some police officers are absolutely fantastic on mental health, we often find that many won’t be and will often pick up drunk people on section 136s.”

“That does lead to an atmosphere between police and EDT AMHPs – we think ‘oh not this again’ and in the midst of all sorts of triage work piling up it can slip down the list. ”

Bogg said that the issues surrounding EDT responses highlighted training gaps in both police and AMHP services.

“A lot of AMHPs don’t have enough understanding of substance misuse which has an impact because a lot of EDT response involves some kind of intoxication. But equally some police get half a day on ‘this is what mental health is’ and that’s it,” she said.

Overuse of police custody as place of safety

The chief inspector of prisons report also raised concerns about the overuse of police custody as a place of safety when patients are detained under section 136 of the Mental Health Act.

The Home Office has previously stated that police stations are not “a suitable place of safety” for section 136 detentions, apart from as a last resort.

But the report found that some forces were struggling to find NHS alternatives. In areas including South Wales, NHS suites for section 136 detainees “were unavailable”.

“The inspectorate has begun work, alongside the Care Quality Commission and HM Inspectorate of Constabulary, to inform a Joint Ministerial Review of the use of section 136 in England and Wales,” Hardwick wrote.

Inspector Brown said: “The lack of place of safety facilities frustrates no end as do place of safety facilities which operate outside policies and guidelines, sometimes outside laws.”

He added: “It is actually not something that is impossible to sort and quite possibly it is cheaper to do it properly when one counts the cost of displacement and failure. West Midlands Police get over 97% of their s136 detentions into NHS assessment areas.” 

Robert Nisbet, an independent social worker and BASW member, said:

“I think there have been improvements but a big issue with section 136s is the question of who takes responsibility when someone is brought in under a 136.”

“Many mental health trusts are saying that police must be present while an assessment is ongoing. If the police are waiting around for hours and hours with someone that they have brought in on a 136 that is an enormous pressure on police time.”

“Over the years there has been a considerable amount of money put in to building dedicated NHS places of safety but in some places there has not been funding to staff them.”

“In some very busy urban areas you may get the throughput to make it financially viable but in others it’s resource intensive so how do you get the resource to ensure assessments can be undertaken in a timely way?”

He added: “I find it very difficult when I hear about all the work that goes into cutting the time people spend in A&E waiting rooms but that doesn’t seem to extend to people that are admitted under the Mental Health Act in extremely distressful situations. They are too often left waiting and waiting.”