Problems accessing NHS units sees ‘too many’ mentally unwell end up in police cells

People in mental health crisis who have been detained by police officers are being turned away from NHS units due to them being full to capacity or understaffed, the Care Quality Commission has found.

The regulator’s review of ‘place of safety’ units run by 56 NHS trusts and two social enterprises found that a quarter of providers admitted that their place of safety provision was ‘not sufficient’ to meet demand. More than one in 10 units said people were turned away at least once a week because they were already occupied. One in 10 units said people were turned away at least once every three months due to short staffing and almost half said they refused admission to people who were intoxicated.

The ‘place of safety’ units are designed to ensure that people detained by police under the Mental Health Act for their own safety or the safety of others can go to a health setting to be assessed. If the NHS units can’t be accessed, police officers are often left with no option but to detain people to police custody.

In 2012-13, a total of 21,814 people were detained by police under section 136 of the Mental Health Act. The CQC said that 7,761 cases ended up in police cells rather than health-based places of safety. The review also found a direct link between place of safety provision and the use of police cells.

Concerns were also raised that assessments of people admitted to units were being delayed due to a lack of availability of approved mental health professionals (AMHPs) and doctors. The majority of units (72%) said delays were most likely to occur out of hours.

Dr Paul Lelliott, the CQC’s lead inspector for mental health services, said that the findings showed that provision was ‘not good enough’.

“There would be a national outcry if people experiencing a physical health crisis were treated in the same way. Imagine if people who had had a heart attack or stroke, were regularly turned away from an A&E department due to a lack of staff or beds, or if people who had been seriously injured in an accident or attacked were told they couldn’t receive care because they had been drinking or were showing signs of being disturbed,” he said.

Steve Chamberlain, chair of The College of Social Work’s AMHP leads network, said that there were “real issues” around place of safety capacity, particularly as many areas had reduced the number of units available in recent years.

“Many places of safety now serve more than one hospital or acute catchment area, and therefore there is a need to ensure adequate capacity and staffing to receive more than one detainee at a time. I would absolutely support the move to using health based places of safety nationally rather than police cells. This has been the norm across London for many years now,” he said.

Faye Wilson, chair of the British Association of Social Workers’ mental health reference group, said that the CQC’s findings reflected concerns that practitioners’ had been warning about for a long time.

On the issue of delays due to AMHP availability, Wilson said: “There are concerns about AMHP availability out of hours and this reflects the lack of leadership in many local authorities on mental health. It is a statutory responsibility for councils to provide enough AMHPs for a 24 hour service and if this is not happening then serious action needs to be taken. However, we know nationally that some issues delaying assessments are not about AMHPs’ ability to respond in themselves but due to things like lack of bed availability or doctors.”

Home secretary Theresa May said: “We must never accept a situation when a person in crisis is denied care because a health-based place of safety is full or unstaffed, or just because the person is intoxicated. This kind of exclusion is not consistent with the Crisis Care Concordat we launched with the Department of Health in February this year.”