Policing, Mental Health
and Criminal Justice
Michael Brown
Author – MentalHealthCop blog
mentalhealthcop.wordpress.com
Section 136 Mental Health Act –
place of safety pathways
s136(1) MHA 1983
If a constable finds in a place to which the
public have access a person who appears to
be suffering from mental disorder and to be in
immediate need of care or control, the
constable may, if he thinks it necessary to do
so in that person’s interests or for the
protection of others, remove that person to a
place of safety.
s136(2) MHA 1983
A person removed to a place of safety under
this section may be detained there for a
period not exceeding 72 hours for the purpose
of enabling him to be examined by a
registered medical practitioner and to be
interviewed by an AMHP and of making any
necessary arrangements for his treatment or
care
Section 136
• Can only be started by the police …
… can only be ended by a Doctor / AMHP
• No-one defines where NHS responsibilities
start …
… or where police responsibilities end.
• Many things MUST be done …
… nothing defines who MUST do them.
Catch 22
• Loads of myths / folklore – too many
• Police lack skills in recognition of mental
illness and training in the use of the power.
• NHS lack legal knowledge.
• Overlaps to acute medical problems
• Complications because of substance use /
abuse.
• Trust!
Myths & Folklore
• You can’t use s136 on someone who is drunk
• Children cannot be detained in a PoS run by
adult services
• Separate provision LD / CAMHS patients
• Remove all aggressive / violent patients to the
cells.
• An Emergency Department is NOT a PoS –
• Anywhere can be a PoS!
Police Use of Section 136
• Section 136 and criminal offending
• Specific considerations for alcohol offences
When do you use s136 and when you should
prioritise a criminal offence?
“An offence is an offence is an offence, isn’t
it?!”
Substantive Victims
• Prioritise the criminal offence and the victim’s
rights, unless –
– A trivial offence, or actually victimless
– The victim is not ringing about crime, but about support
for the person
– In all the circumstances, suspected mental health
problems are the main issue in play
You can reverse a 136 decision; you can’t reverse
an arrest decision.
Alcohol Offences
• Avoid the use of s136 where alcohol is
involved, unless –
There is objective information, concerning a mental
health problem, beyond an officer’s observations.
– Police records indicating a mental health history
– Third party information at the scene
– Broader context from the incident
CODE OF PRACTICE – 2008
• It is important to ensure that a jointly agreed local policy is in
place governing all aspects of the use of sections 135 and 136.
INCLUDING:
• identifying and agreeing the most appropriate place of safety
in individual cases;
• dealing with alcohol or drugs;
• dealing with violence;
• access to a hospital emergency department, where necessary;
[Para 10.16 & 10.17 CoP MHA]
IPCC Research
• First review of s136 across England / Wales
18,000 detained under s136 MHA
11,500 detained in the cells.
Over 65% of the total.
• NHS Figures 2011 / 2012
50 / 50 split – there is a long way still to go.
THE s136 PROBLEM
• Some people arrested under s136 MHA are
presenting both clinical and security risks:
CANNOT be managed by the police alone
CANNOT be managed by the NHS alone
Including where drugs, alcohol and aggression
are involved.
ADDITIONAL CONSIDERATIONS
• ECHR requirements:
– Article 2 “right to life”
– Article 3 “inhuman and degrading treatment”
– Article 5 “right to liberty”
– Article 8 “privacy and family life”
• Health & Safety At Work Act 1974
• Police and Criminal Evidence Act 1984
WHAT WE NEED TO AVOID
PSYCH PoS
EMERGENCY
DEPARTMENT
PATIENT
POLICE STATION
RED FLAGS ON ARREST
• Arrest under s136 Mental Health Act
• Ambulance to EVERY arrest.
• Assess for RED FLAGS
•
•
•
•
RED FLAGS to the Emergency Department
NO RED FLAG to identified PoS provision
Consider improvised alternatives
Police station as last resort.
RED FLAGS (1)
Dangerous Mechanisms:
• Blows to the body
• Falls > 4 Feet
• Injury from edged weapon or
projectile
• Throttling / strangulation
• Hit by vehicle
• Occupant of vehicle in a collision
• Ejected from a moving vehicle
• Evidence of drug ingestion or
overdose
Serious Physical Injuries:
•
•
•
•
•
•
•
•
Noisy Breathing
Not Rousable to verbal command
Head injuries
Loss of consciousness at any time
Facial swelling
Bleeding from nose or ears
Deep cuts
Suspected broken bones
RED FLAGS (2)
Attempting self-harm:
• Head banging
• Use of edged weapon
(to self-harm)
• Ligatures
• History of overdose or poisoning
• Psychiatric Crisis
• Delusions / Hallucinations /
Mania
Possible Excited Delirium:
• Two or more from:
• Serious physical resistance /
abnormal strength
• High body temperature
• Removal of clothing
• Profuse sweating or hot skin
• Behavioural confusion /
coherence
• Bizarre behaviour
POLICE SUPPORT AT THE PoS
• Police Officers remain at ED throughout
• Joint risk assessment at PoS:
Low:
Medium:
High:
left with PoS
case by case, on merit
ongoing police support
POLICY AUTHORITIES (1)
•
•
•
•
Mental Health Act 1983
Code of Practice to the MHA, revised 2008
Police and Criminal Evidence Act 1984 (PACE).
Code of Practice, Code C, to PACE, revised
2008
• Human Rights Act 1998
• Data Protection Act 1998
POLICY AUTHORITIES (2)
•
•
•
•
•
•
•
•
•
•
•
Royal College of Psychiatry Standards on s136 (2011) & position statement (2013)
Independent Police Complaints Commission of the use of police cells for
detentions under s136 (2008)
Academy of Medical Royal Colleges Report on Managing Urgent Mental Health
Needs in the Acute Trust (2008)
NICE Guidelines on the Short-term Management of disturbed / violent behaviour
(2005).
NICE Guidelines on Self-harm (2004).
NPIA Safer Detention Guidance, NPIA (2006)
NPIA Guidance on Police Responses to People with Mental Ill Health or learning
disabilities (2010)
Home Office Circular 17/2004
Home Office Circular 66/1990
R v Ashworth Hospital Authority (2005), House of Lords.
MS v UK, ECHR.
RAVE Risks
R - resistance
A - aggression
V - violence
E - escape
Conveyance of Patients –
s6 MHA and Chapter 11 CoP
s6(1) MHA 1983
An application for the admission of a patient
to a hospital under this Part of this Act, duly
completed in accordance with the provisions
of this Part of this Act, shall be sufficient
authority for the applicant, or any person
authorised by the applicant, to take the
patient and convey him to the hospital.
DELEGATED AUTHORITIES
• Duty on CCGs to ensure effective
arrangements for transportation of patients.
• Danger of the expedience argument
• Coroners’ Rule 43 letters, following inquests
• IPCC and ACPO reservations
• No ability to compel the police to accept s6
authorities!
THE LEGAL DUTY OF CCGs
• Para 11.6 MHA CoP – “It is for Clinical Commissioning Groups
(CCGs) to commission ambulance and patient transport
services to meet the needs of their areas. This includes
services for transporting patients to and from hospital (and
other places) under the Act.”
• Para 11.10 MHA CoP – “It is essential to have clear
agreements in place so that people who need assistance in
conveying patients under the Act can secure it without delay.
Authorities, including NHS bodies responsible for hospitals,
ambulance services and the police, should agree joint local
policies and procedures.”
STUCK IN THE MIDDLE
• Para 11.11 MHA CoP – “Policies should ensure that AMHPs (in
particular) are not left to negotiate arrangements with
providers of transport services on an ad hoc basis, in the
absence of clear expectations about the responsibilities of all
those involved.”
• Para 11.16 MHA CoP – “AMHPs should make decisions on
which method of transport to use in consultation with the
other professionals involved, the patient and (as appropriate)
their carer, family or other supporters. “
POLICE SUPPORT
• Para 11.17 MHA CoP – “If the patient is likely to be unwilling
to be moved, the applicant should provide the people who are
to convey the patient (including any ambulance staff or police
officers involved) with authority to convey the patient.”
• Para 11.18 MHA CoP – “If patient’s behaviour is likely to be
violent or dangerous, the police should be asked to assist in
accordance with locally agreed arrangements. Where
practicable, given the risk involved, an ambulance service (or
similar) vehicle should be used even where the police are
assisting.”
AMBULANCE SUPPORT
• Para 11.19 MHA CoP – “The locally agreed arrangements
should set out what assistance the police will provide to
AMHPs and health services in transporting patients safely,
and what support ambulance or other health services will be
expected to provide where patients are, exceptionally,
transported in police vehicles.
• Para 11.20 MHA CoP – “Where it is necessary to use a police
vehicle, it may be necessary for the highest qualified member
of an ambulance crew to ride in the same vehicle with the
patient, with the appropriate equipment to deal with
immediate problems. In such cases, the ambulance should
follow directly behind to provide any further support.”
Other Detentions and Conveyance –
AWOL patients, CTOs and recalls
RECOVERY OF AWOL PATIENTS
• Para 22.13 MHA CoP – “The police should be asked to
assist in returning a patient to hospital only if necessary. If
the patient’s location is known, the role of the police
should, wherever possible, be only to assist a suitably
qualified and experienced mental health professional in
returning the patient to hospital.”
RAVE RISKS!
AWOL PATIENTS
• Re-detention of an AWOL patient should be
treated like a first detention under s136 MHA –
– Arrest > Ambulance > Assess
– Any RED FLAGS to A&E;
– Otherwise return to the original hospital.
– No explicit power to hold in custody.
RECALLED CTO PATIENTS
• Re-detention of a CTO patient is the re-detention
of an AWOL patient and should be regarded as
such –
– Arrest > Ambulance > Assess
– Any RED FLAGS to A&E;
– Otherwise return to the original hospital.
– No explicit power to hold in custody.
Criminal Suspects –
mental health in police custody
PREVALENCE IN CUSTODY
• Police identification = 12-15%
• Nurse identification = 15-18%
• NHS information suggests = 40-50%
DE FACTO DIVERSION
• The single variable which influences
diversion from justice –
–Whether the detainee is
“sectionable” under the MHA ‘83
CUSTODY RECORDS
10,000 custody records
1,076 MH was queried > FME
512
415
FME > MHA assessment
FME said ‘proceed as normal’
– may as well not be ill.
OUTCOMES
Diversion:
x9
x76
x12
Section 3 MHA
Section 2 MHA
Informal / voluntary
Non-Diversion: ‘business as normal’
OUTCOMES
• Offences prosecuted when suspect is
‘sectionable’ under the MHA:
ZERO!
• Offences remaining subject to bail when the
suspect is ‘sectionable’ under the MHA:
ONE!
NEW MODEL
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