AMHPs making greater use of Mental Health Act powers to tackle crises or suspected abuse or neglect

    Use of section 135 powers of entry rose by 8% last year and by a quarter on pre-pandemic figures, though Home Office stresses data should be treated with caution

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    Photo: Time to Change

    Approved mental health professionals (AMHPs) are making greater use of powers of entry under the Mental Health Act 1983 (MHA) to tackle significant mental health crises or suspected abuse or neglect.

    There was an 8% year-on-year rise in detentions of people under section 135 of the MHA in 2021-22, with the number up 23% on pre-pandemic levels (2019-20), according to Home Office figures released last week.

    The provision was used 2,901 times in 2021-22 with over half of these cases being in London (1,539), showed the figures collected from 38 of the 43 police forces in England and Wales. The Home Office said that the figures should be treated with caution as some of the forces had raised concerns about the quality of their data.

    Under section 135, a magistrate may issue a warrant, on the application of an AMHP, enabling a police officer to enter premises to remove a person who appears to have a mental disorder to a place of safety, or to keep them at one. The AMHP’s application must show that there is reasonable cause to suspect that the person has been, or is being, ill-treated, neglected or kept “otherwise than under proper control”, or is unable to care for themselves, in the premises in question.

    The person can be removed for up to 24 hours, for the purposes of a mental health assessment, with the possibility of this being extended by 12 hours if the doctor judges that this is necessary for the assessment to be completed.

    Racial disparities

    Similarly to the use of other sections of the MHA, the data identified significant racial disparities, with 28% of those detained being black African, Caribbean or British, compared with 3.3% of the population of England and Wales as of the 2011 census. Eleven per cent were Asian or Asian British, compared with a 7.5% representation in the population.

    The Home Office said this may reflect the large proportion of detentions having taken place in London, where 40% of people identified as being black, Asian or from an ethnic minority, as of 2011.

    The data also showed an increase in the use of separate police powers, under section 136 of the MHS, to detain people who appear to have a mental disorder in a place of safety, generally from a public place.

    These are used if the person is deemed by the police to be in “immediate need of care and control” and detention is considered necessary in the person’s interests or for public protection. Unlike section 135, section 136 does not require a warrant from a magistrate, but police officers are expected to consult an AMHP, doctor, nurse, occupational therapists or paramedic before using the provision, if practicable to do so.

    There were 36,594 detentions under section 136 of the MHA in 2021-22, up 8% on the previous year on a like for like basis. The number of section 136 detentions grew from 2018-2020, but fell back during 2020-21, the first year of the pandemic.

    Use of police stations as places of safety

    In the light of longstanding concerns about people being removed to police stations, the figures showed that this happened in 264 (0.8%) of cases, with 68% involving removal to a health setting and 29% to an accident and emergency department. The current draft Mental Health Bill would end the use of police stations as a place of safety.

    People are expected to be taken to the place of safety in an ambulance, but this happened in just 41% of known cases in 2021-22, down from 52% in 2020-21, with police vehicles used in 54% of cases, up from 44% the previous year. Of those cases where the police recorded their reasons for using one of their vehicles, half were because an ambulance was not available, up from 28% the previous year.

    Black people were also overrepresented in section 136 detentions in 2021-22, accounting for 8% of cases, more than double their representation in the population (3.3%).

    Separate figures on the use of section 136, published last month by NHS Digital as part of annual MHA statistics, showed black people were more than twice as likely than white people to be detained under the provision.

    ‘Unacceptable’ rise in detentions

    Responding to the section 136 figures, mental health charity Mind said the 8% year-on-year rise was “unacceptable”, and also criticised the overrepresentation of black people. The head of its legal unit, Rheian Davies, said they were “more likely to access mental health support via uncomfortable and ‘sharper’ routes like the criminal justice system, often due to being turned away at earlier preventative stages”.

    She added: “Although just under 1% of detainees were taken to a police station as a place of safety, this still means that 264 people, while at their lowest, were for all intents and purposes treated like criminals. This can be deeply traumatising and humiliating for people in crisis, who have not committed a crime and instead need therapeutic care in an appropriate environment.

    “This data shows how urgently overdue reforms to the Mental Health Act are.”

    Hospital detention figures

    Overall, NHS Digital found there had been 53,337 detentions in hospital under the MHA in 2021-22, an underestimate because not all providers submitted data. This was a slightly higher figure than in 2020-21, but NHS Digital said that, because of changes in data quality year on year, it could only compare numbers based on a subset of providers, and had estimated the number of detentions had fallen by 5.7%.

    This follows estimated increases in each of the previous two years.

    As in 2020-21, the detention rate for black people was more than four and a half times that for white people (341.7, compared with 72.4, per 100,000 population).

    Racial disparities were also broadly constant in relation to the use of community treatment orders, with CTO use highest for black people (75.5 times per 100,000 population), more than 11 times the rate for white people (6.8 per 100,000).

    The government’s planned reform of the MHA, as set out the draft Mental Health Bill, is designed to reduce the number of detentions in hospital and CTOs and their disproportionate impact on groups including black people, by tightening the criteria for both.

    A committee of MPs and peers is currently scrutinising the draft bill and holding evidence sessions involving mental health leaders, professionals, academics, campaigners and experts by experience.

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    5 Responses to AMHPs making greater use of Mental Health Act powers to tackle crises or suspected abuse or neglect

    1. Alice November 27, 2022 at 5:59 pm #

      Beats working with people before they experience a crisis I suppose. Fight the fire rather than prevent fires. Or as the AMHP lead in my service said, “we are not case workers, it’s not our role to prevent people having problems”.

    2. Steve November 29, 2022 at 10:58 am #

      The headline is somewhat misleading, I think. While the legal grounds for an application for a s135 warrant include ill-treatment or neglect, the vast majority of warrants are obtained due to a concern regarding the person’s mental health and some evidence of acute mental ill health.
      The wording of this section of the Act is pretty archaic and hasn’t been changed for over 60 years.
      The quote from the AMHP lead mentioned above is certainly less than helpful. The shortage both of preventive services to support people and help avoid deterioration, and also the woeful lack of alternatives to hospital admission for people in mental health crisis means that once a person has reached a crisis point, there are often few options other than hospitalisation. And even then there are frequently no local hospitals in which to admit the person.

      • Mithran Samuel November 29, 2022 at 11:37 am #

        Thanks Steve, that’s really helpful and is taken on board. I’ve made a tweak to the headline and introduction to reflect that and will bear it in mind for future coverage.
        Cheers, Mithran

      • Mithran Samuel November 29, 2022 at 11:38 am #

        Hi Steve, thanks for your comment – that’s really helpful and taken on board for future reference

    3. Marianna November 29, 2022 at 12:06 pm #

      Surely “vast majority” suggests there is a minority where the primary reason is “suspected abuse or neglect”. Not sure why AMHPs using powers to safeguard having satisfied a judge that they are making an informed professional application is “misleading”. But I am not an AMHP so may missing the nuance.