The Royal College of Psychiatrists is teaming
up with police forces in three areas of England – Nottinghamshire,
Oxfordshire and the London Borough of Redbridge – to monitor the
quality of care given to people detained under Section 136 of the
Mental Health Act.
Section 136 allows the police to take someone
who they believe is suffering from a mental disorder and in need of
immediate care or control from a public place to a place of
safety.
However, a recent report by the
Independent Police Complaints Commission showed that the majority
of people are being detained in unsuitable police cells – instead
of being taken to dedicated assessment facilities in mental health
units.
Police stations can be frightening places,
especially when people are feeling vulnerable and distressed, and
service users who are taken to police cells may feel both unsafe
and criminalised. On average, people spend about 9 hours in police
custody before being assessed by a mental health practitioner –
although in some cases they may be discharged without ever having
seen a mental health worker.
One service user, giving an account of 24
hours he spent in a police cell, said:
“Within the cell was a dirty metal toilet, a
dirty metal washing aperture in the wall and a bench with a PVC
mat. Meals were offered but had to be taken in the cell adjacent to
an open toilet. I declined all meals. There was no bedding, no
pillow…A police station cell, by its very nature has to be a bare,
controlled environment, for obvious reasons. As a place of safety
for a vulnerable person it offers no comfort, poor communication,
little interaction and a sense of extreme solitude.”
Section 136 is the only civil detention under
the Mental Health Act for which no statutory form is required,
meaning there is a lack of reliable data on the number of people
who are detained, where they are taken and the care they
receive.
Therefore a new multi-agency working group,
established and led by the Royal College of Psychiatrists, has
developed the first ever standardised recording form to monitor
Section 136 detentions.
Over the next few months, the form will be
introduced in the three areas to test its effectiveness, before
being rolled out more widely. The pilot will also provide valuable
information about current practice.
Dr Michele Hampson, consultant psychiatrist in
Nottinghamshire and chair of the multi-agency group, said: “The
Code of Practice to the Mental Health Act clearly states that
police stations should only be used as places of safety in
exceptional circumstances. For too long we have simply accepted the
lack of improvement in the standard of care provided to most people
detained under Section 136, and now is the time to insist on the
provision of adequately staffed facilities in mental health
units.
“This form will give us much-needed data on
the quality of care in three areas of the country and hopefully,
once the form has been piloted, it can be rolled out across the
England. We also hope to work with the Department of Health and the
new Care Quality Commission to monitor standards of care
nationally, including trends in the uses of places of safety.”
Anthony Deery, head of mental health strategy
at the Healthcare Commission, due to merge into the Care Quality
Commission in 2009, said: “There is a clear need to improve the
quality of care and assessment of people who are held in places of
safety under the Mental Health Act and we strongly support
monitoring the situation more closely. Historically, information on
how and when people are detained in a place of safety has been
poor. Without this data it is not possible for local services to
plan future improvement. This pilot is an important step towards
developing a much better picture of what is happening not just in
these local areas but across the country."
The monitoring form is part of a wider set of
Standards on the use of Section 136, published this week by the
Royal College of Psychiatrists. The standards include 24 separate
recommendations focusing on the physical standards of places of
safety, staffing issues, the conveyance of places between places of
safety and local policy.
Key recommendations include:
- There should be sufficient places of safety
in psychiatric facilities to meet need without recourse to police
stations as a convenient option or because the place of safety is
regularly full.
- Police stations should only be used as a
place of safety in exceptional circumstances, as stated in the Code
of Practice to the Mental Health Act.
- Psychiatric Section 136 facilities should
have dedicated staffing, with a clearly identified person in charge
of the facility 24 hours a day.
- Assessments of people by approved mental
health professionals and doctors should begin within three hours –
with a target of two hours in future.
- An ambulance should be used to transport
people between places of safety – not a police car. Such work
should be prioritised by the ambulance service to reduce distress
and embarrassment to the patient.
- The introduction of a standard,
nationally-agreed recording form to monitor Section 136 detentions,
and allow local, regional and national comparisons.
- The new Care Quality Commission should report
annually on the standards of care in relation to Section 136.
Lord Patel of Bradford, chairman of the Mental
Health Act Commission (MHAC), lent his support to the new
standards, saying: “The MHAC is pleased to have been a part of this
project. We will be making sure on our visits that services know
about and implement the new standards, and look forward to real
progress in diverting mentally disordered detainees away from
police cells wherever possible.”
Jim Symington, national lead for legislation
at the National Institute for Mental Health in England (NIMHE)
added: “We are extremely pleased to endorse this new set of
standards led by the Royal College of Psychiatrists. It is no
longer acceptable that people suffering mental distress should be
routinely assessed in police stations, and that we should still
lack a national picture of the use of police powers under the
Mental Health Act.”
Mr Symington continued: “Now is a critical
time to get the implementation of the Mental Health Act right and
to ensure that the standards so clearly set out in the new Code of
Practice to the Act are achieved.”
For further information, please contact Liz Fox or Deborah
Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 6298 or 6127
References:
Royal College of Psychiatrists (2008), Standards on the use of Section 136 of the Mental Health Act 1983. Royal College of Psychiatrists.
Note to editors:
Full versions of the new Standards and the service user’s account, 24 hours in a police cell, are available to journalists on request.
The Standards on the use of Section 136 of the Mental Health Act 1983 (2007) have been developed by a multi-agency group, led by the Royal College of Psychiatrists. Members include representatives from the Metropolitan Police, the Independent Police Complaints Commission, the Royal College of Nursing, the College of Emergency Medicine, the Faculty of Forensic and Legal Medicine, the Ambulance Association, the Healthcare Commission, Mental Health Act Commission, and the National Institute for Mental Health in England.
Section 136 of the Mental Health Act 1983 gives the police powers to remove a person who appears to be suffering from mental disorder and who is “in immediate need of care or control” from a public place to a place of safety. Removal may take place if a police officer believes it is necessary in the interests of that person, or for the protection of others. The purpose of removing a person to a place of safety is to enable them to be assessed by a doctor or interviewed by an allied mental health professional, so that the necessary arrangements can be made for their care and treatment.