Clause
43
Places
of
safety
Tim
Loughton:
I beg to move amendment No. 7, in
clause 43, page 41, line 6, at
end add—
‘(4) In Section
135(6) for the words from “means” to the end of that
subsection
substitute—
“(a)
(i) residential accommodation provided by a local social services
authority under Part III of the National Assistance Act 1948
(c.29),
(ii) a hospital as
defined by this Act,
(iii) an
independent hospital or care home for mentally disordered
persons,
(iv) any other
suitable place the occupier of which is willing temporarily to receive
the patient or, if, in the circumstances of the case it is
impracticable to use any of these
places,
(b) a police
station.”.
(5) In Section 136 (Mentally disordered persons
found in public places) of the 1983 Act after subsection (2)
insert—
“(3)
Where a police station is used as the place of safety the person may
not be detained there for a period longer than 24
hours.”.’.
It
is me again, Mr. Cook. The amendment to clause 43
is slightly longer and it deals with the subject of places of safety. I
know that a number of hon. Members have expressed concerns about the
matter in the past. The amendment is to section 136 of the Mental
Health Act 1983. We want to define places of safety with particular
reference to the use of police stations, which are apparently being
used under the definitions of the Bill far too often and
inappropriately.
So
the purpose of the amendment is to change the definition of a
“place of safety”, to ensure that as far as possible it
should be not a police cell but a therapeutic environment. When a
police station is used as a place of safety, because nothing else is
available, the patient must be transferred to a therapeutic
environment, which is more appropriate, within 24
hours.
I have some
experience of such a situation. I had a surgery case last year
involving a constituent’s son-in-law, who had had a severe
psychotic episode. He had no previous experience or record of any
serious mental illness. He got involved in a quite bizarre incident
requiring a number of armed police and was taken into custody. No one
was hurt, but he clearly had—for want of a better
word—flipped. He was taken to the custody suite of the police
station, where he stayed for several
days.
He was not
transferred to a hospital environment. He was not dealt with properly
at the police station. His condition worsened severely while he was in
custody. The reason why he was not transferred was that the reviewing
clinician—from the Maudsley hospital in south London—was
on holiday and there was no one covering. So, for completely
unacceptable reasons, the son-in-law of my constituent was forced to
stay in that police cell for a number of days—I cannot remember
how many, but clearly too many—while his condition worsened. It
was highly inappropriate and he plainly should have been removed to a
hospital as soon as possible, so that he could start receiving the
medical care denied him for some
while.
Angela
Browning:
In evidence, the Committee received several
reports flagging up the use of police cells, particularly for younger
people. We debated earlier in Committee appropriate placements for
young people, particularly adolescents, especially those between 16 and
18. More often than not, because there is no appropriate hospital
placement for them, they end up being accommodated in police cells, for
fairly long periods, which is quite
inappropriate.
Tim
Loughton:
My hon. Friend is absolutely right. She might be
referring particularly to submission MH57, from Penny Stafford. She
said:
“CAMHS
services do not usually provide any facilities for a ‘Place of
Safety’ for children subject to s.136 of the Mental Health Act,
and even in those areas where there is appropriate ‘Place of
Safety’ provision in the local adult mental health services,
these hospital based S136 Suites do not accept children or young people
under the age of 18, so instead these vulnerable distressed youngsters
are held in police custody suites, an even more inappropriate setting
for them.”
She refers to a “key
recommendation” of a report published by the Mental Health Act
Commission, of which she was a member, that
a
“protocol should be put
in place to allow for children and adolescents subject to s.136 to be
taken to an appropriate place of safety within a hospital setting and
to be assessed by a specialist in child and adolescent
psychiatry.”
We would
agree with that. That is the point of the
amendment.
Mr.
Charles Walker (Broxbourne) (Con): Something troubled me
immensely in Broxbourne when I was out with the police once. We were
called to a domestic incident, which involved a 15-year-old child, who
was having some form of—for want of a better word—
episode. The child was clearly mentally disturbed, but was led away by
the police to a police station. That worried me immensely. I do not
know if I have any answers, but it was so obvious to me that she was
mentally ill and it seemed a great sadness and shame that she was taken
the police station when she should probably have gone to a
hospital.
Tim
Loughton:
I think that all of us could relate an
experience such as that among our constituents. We might be talking
about young people who do not have a long experience of mental illness,
for whom psychotic events begin to happen, for whatever reason. It must
be enormously intimidating and frightening for such people when they
are rounded up by the police, perhaps handcuffed, and taken to a police
station for something that was caused by an illness. They might be
dumped in a police cell as a minor, on their own, when they are
confused and ill. That will not help the child, therapeutically, for
those initial hours or days in which they find
themselves—inappropriately—in a police
cell.
Police officers
have a duty under section 136 of the Mental Health Act 1983 to
take
“a person who
appears...to be suffering from mental disorder and to be in
immediate need of care or
control”
from a public
place
“to a place of
safety”.
While such
places are defined in the Act
as
“a
hospital...police station... care home...or any other
suitable place”,
in the
majority of cases, a police cell will be used. A person can be held
under the power for up to 72 hours, although there are cases, such as
that of my constituent, when that is not adhered to. The detention
should be such that the person can be assessed by mental health
professionals.
The
Mental Health Alliance has referred to new research by the Independent
Police Complaints Commission on the use of police stations as a place
of safety. The commission’s initial findings
state:
“During
2005/06 approximately 11,500 people were detained in police custody
under”
section 136. It
also states:
“This figure is likely
to be an underestimate due to the way that police detentions are
recorded”.
Secondly, the
commission found
that
“Rates of
section 136 detentions varied widely across
forces”
ranging
“from 0 to 28 detentions per 1,000
people in custody.”
There is a postcode lottery in operation
so there is clearly something wrong. Is the lottery to do with
different forces operating under different procedures and protocols?
Are the different rates caused by vast differences in the facilities
available to police forces? That is one of the biggest causes for
concern.
Previous
research has indicated that police cells are used on around 80 per
cent. of occasions when section 136 powers are invoked. Police cells
are the norm, not the exception. Most of us would agree, and clinicians
say, that police cells are not the most appropriate place, or so much
as an appropriate place, for people detained under section 136 to be
taken.
The person
detained under section 136 need not have committed any offence, but
simply to have behaved in a way that has given the impression that they
are mentally ill and a danger to themselves or others, so there is a
degree of discretion for the police who take people into custody. A
police cell is not a therapeutic environment for someone experiencing
mental health problems. Being taken into custody may delay the
provision of effective treatment and exacerbate the illness, which is
exactly what happened in the case of my constituent. The use of police
cells as a place of safety also has significant resource implications
for police custody facilities. The police have little training or
expertise in looking after people with severe mental health problems.
Given all the other pressures on the police, this is another problem
that they do not need.
Police station staff are, I
fear, rarely trained to deal with people who are mentally ill. Home
Office circular 66/90, which is in a memorandum to accompany the 1983
Act, and the joint Home Office and Department of Health review of
health and social services for mentally disordered offenders both
suggested that police stations should rarely if ever be used to detain
people under section 136. The NSF on mental health states that
hospitals should be used in preference to police stations, and the
current code of practice states that police cells should generally be
used.
The issue is
of particular relevance to black and minority ethnic communities,
especially African and Caribbean communities. The rates of use of
section 136 orders are disproportionately high for those groups. Two
surveys have been undertaken, one each in Islington and Camden. The
Islington survey found that no fewer than 41 per cent. of section 136
detentions were of black people, when that group makes up only 12 per
cent. of the population. Similar figures were found in Camden. Section
136 powers are being used disproportionately to detain black and ethnic
minority patients, reflecting the disparities, problems and
discrimination that happens across the mental health
service.
12
noon
Nick
Hardwick, the co-chairman of the Independent Police Complaints
Commission has estimated that 50 per cent. of deaths in police custody
have involved people with mental health problems. He stated:
“Whatever a police cell
is, it is not a place of safety for people with mental
illness.”
The IPCC gave
evidence on the 2004 Bill and said that,
“the legislation makes
no attempt to limit the circumstances in which [the use of detention
orders through police cells] happens only to wholly exceptional
occasions.”
The Police Federation of England and Wales
supports the removal of police stations from the legal definition of a
place of safety altogether, as does the Association of Chief Police
Officers. The Mental Health Act Commission has repeatedly stated in its
biannual report, as many other stakeholders have mentioned, that police
stations should not be regarded as places of
safety.
The Government
have agreed to consider monitoring the use of police cells as places of
safety. I am not quite sure how that will happen but I am sure the
Minister will enlighten us in detail as soon as I sit down with a
progress report.
Although
welcoming the new power included in the Bill to allow transfers between
places of safety, the Police Federation, the Association of Chief
Police Officers and the Independent Police Complaints Commission have
told the Mental Health Alliance that, unless this is accompanied by
other safeguards to ensure that patients are transferred quickly, then
the overuse of police cells as a place of safety is likely to
continue.
In
particular, there is a fear that, with the new power to transfer, PCTs
will be less likely to prioritise a search for a hospital bed for
section 136 patients because they know that they will be able to
transfer them at a later date. This could have the unintended
consequence of increasing the use of police cells for mentally
disordered patients. That is the case that they are making.
There was
some debate on this in the House of Lords. I know that the Government
were concerned that the wording of the original amendment was overly
restrictive. Amendment No. 7 has taken on board the Government’s
concerns. Amendment No. 7 provides that police cells should be used
only if “it is impracticable” to use a therapeutic
environment. The amendment is supported by the Police Federation, the
Association of Chief Police Officers and the Independent Police
Complaints Commission.
So there is a great deal of
weight behind the amendment. It addresses a problem that is happening
all too often and one that we are all aware of. The Minister and other
members of the Committee share the view that it should not be
happening, but we are discussing how we should prevent it from
happening. The amendment will send out a serious message about the
undesirability and inappropriateness of this form of detention. It will
also act as a serious spur to reconfigure services so that police cells
are used only as a fallback position and not as the position of
preference, as happens in about 80 per cent. of cases. As such, I hope
that the Minister will take the amendment
seriously.
Dr.
Pugh:
I want to add just a few comments, as the hon.
Member for East Worthing and Shoreham has put the case exhaustively and
has covered most of the angles.
I have some difficulty in
equating police stations with places of safety full stop because of the
things that happen in police stations from time to time. It is
understandable that people who have mental health crises will
occasionally end up in police stations. It is also perfectly
comprehensible that most policemen are not trained therapists and
therefore find such problems difficult to deal with, and that the
police station is not
an ideal therapeutic environment in any sense. Police stations are
useful facilities for all sorts of purposes. The stark reality is that
they are now used as prisons and used far more than the Government wish
them to be. They could clearly be overused as places of safety for
people who should be elsewhere.
The amendment
is unashamedly designed to drive up standards. One can almost
anticipate the Minister’s response, which will be something
along the lines of, “Yes, it’s good to have higher
standards, but hey, we’re going to lose flexibility and if there
is no place of safety we may end up releasing people straight out on to
the streets.” That is all well and good, but it is
indistinguishable from an argument for lower standards; someone arguing
for lower standards would make exactly the same point.
The amendment’s cutting
edge is the restriction to 24 hours. If the Minister has a
difficulty with that, and if 24 hours is thought to be too short a
period because places might not always be available in that time scale,
we could adopt a more sophisticated amendment whereby the 24-hour
provision would be the norm, with a requirement for exceptional
permission to be sought if a longer period were required. Such
amendments are an attempt to drive standards up and deal with an
unjustified ill. Surely the Minister can warm to
that.
Mr.
Walker:
I made a brief intervention earlier, but I think
that the incident that I described deserves more than an intervention,
so I hope that the Minister will not mind if I expand on it. About this
time last year, I spent a morning with the police, during which there
was a call-out to a “domestic” in my constituency. When
we arrived the situation was unclear; there was a hell of a row, with
plates breaking and cutlery being thrown. It sounded as though some
enormous person was out of
control.
Dr.
Ian Gibson (Norwich, North) (Lab): Just like at the
Walkers’.
Mr.
Walker:
Well, occasionally the Walker children get out of
control. The police entered the home and their performance was
outstanding from beginning to end despite their not being trained to
deal with such situations. After about half an hour, they emerged with
a tiny girl of about 14 or 15 years who could not have been more than 5
foot nothing. She was crying softly between two enormous policemen.
Clearly, as I said earlier, she was mentally disturbed. Indeed, she was
well known to our mental health services, the Hertfordshire Partnership
NHS Trust, and has had a long history of engagement with doctors and
nurses in the trust. I spoke to her parents and they were clearly at
their wits’ end, but I did not feel that they really understood
mental illness—the symptoms had not been explained to
them.
I asked the
police what would happen to the young person, and they told me that she
would be taken to the local police station to be detained and charged.
At the risk of sounding repetitive, I point out that it seemed totally
wrong that someone who was clearly mentally ill and who was known to
the mental health services should spend a period—maybe the
entire day or
longer—in a police station, to be charged for an episode that
within a day or two she would, I discovered, not even recall. I do not have the answer, but I
am sure that the Minister has heard hundreds of such stories. If we
could improve such situations, I and many other people would be
extremely
pleased.
Ms
Winterton:
I should say first that the stories Opposition
Members have told are all tragic. I completely understand why people
feel that the situation needs addressing, and I agree. That is one
reason why the Government introduced the amendments in the other place,
so that transfer would be permitted. Transfer was one of the real
problems that was highlighted at my meeting with the Police Federation,
whose representatives said that they would certainly welcome the
inclusion in the Bill of scope for transfer from one place to another.
Everyone agrees that police stations are absolutely not the right place
in which to detain someone who appears to be suffering a mental
disorder, and that hospital facilities are likely to be more suitable.
However, the hon. Member for East Worthing and Shoreham touched on the
truth, which is that we must recognise the current limited availability
of adequate place of safety facilities other than police stations. The
availability also varies from area to area, and we are trying to put
that
right.
James
Duddridge (Rochford and Southend, East) (Con): Although I
agree that police stations are inappropriate as places of safety, may I
ask whether any moves are being made to create specialisms in
conurbations such as London, Manchester or Birmingham? Staff at
particular police stations could be trained in dealing with such mental
health patients, so that they could be temporarily detained there,
rather than in an area with no awareness of mental health issues or
specialisms.
Ms
Winterton:
There is a host of steps that we can take. An
important one is not always touched on: we need to look more carefully
and at why for some people the first point of contact might be the
police, as opposed to the mental health services. How some people end
up in police stations, as opposed to being taken to somewhere provided
by the NHS, is quite an issue. Hence the importance of allowing the
transfer between police stations and other places of safety, because
too many people were going through the police system instead of always
going through the mental health
services.
The hon.
Member for Southport anticipated me, but I hope to reassure him that
this approach is correct. Coming back to the point raised by the hon.
Member for East Worthing and Shoreham and his constituent’s
five-day wait, the maximum period of detention in a police station is
72 hours, so he might wish to take that up. I should emphasise that
that 72 hours, which I am sure many people would say is too long, is an
upper limit. Recently published evidence, emerging from a study being
undertaken by the Independent Police Complaints Commission, suggests
that the average amount of time in police custody under section 136 of
the Act is 10 hours and that the vast majority of detainees leave
police custody within 18 hours. That is reassuring, but it also makes
it clear that a small
number of people have been detained in police cells for longer than 24
hours. The amendment would make that
impossible. As we said
in the other place, the issue is about whether we feel that imposing
statutory restrictions is the way to address the understandable
concerns that the amendment seeks to tackle. We believe that the right
way forward is to limit the use of police stations by facilitating the
good practice that we know occurs in some places. The hon. Member for
East Worthing and Shoreham said that it was interesting how the figures
are very low in some parts of the country, but in others they seem to
be greater.
Mr.
Walker:
On a connected point, what sort of access to
psychiatric services does someone in a police cell or station have? Do
they have access to review by a trained clinician? What happens when
they leave? Do they go
home?
12.15
pm
Ms
Winterton:
Basically, the individual will be waiting for
an assessment. Once the assessment is made, a decision is taken on what
to do with the patient. We therefore need the assessment to be made as
quickly as possible so that, if necessary, proper treatment can
commence. It is the issue of getting the assessment that the hon.
Gentleman is trying to
address.
Mr.
Walker:
On a point of interest, would that assessment
involve the person’s clinician who had been supporting them
prior to their admission to the police
station?
Ms
Winterton:
Yes, a clinician and social worker would be
involved in the decision to detain somebody under the Mental Health Act
or to provide other
care.
As
I have said, by allocating approximately £42 million in capital
spending, we are trying to improve the NHS mental health
estate to ensure that proper places of safety are available. We are
putting in a further £58 million this year. We have
specifically asked people to look at the issue of places of safety. As
the hon. Member for East Worthing and Shoreham said, the local
protocols that are in place are often what is important. The Police
Federation made the point that if we can ensure close co-operation
between the police and the health authorities, we could see real
changes in the use of police cells as places of safety. That is why we
introduced the amendments in the other place that, in effect, allow a
patient to be transferred elsewhere. Currently, if someone ends up in a
police cell, that is where they stay. The Government amendment made in
Lords allows a transfer to take place.
We want to reinforce that
approach by strengthening the guidance in the code of practice The
current code states that police stations should not generally be used.
In the revised code, we want to stress that police stations should be
used only as a last resort: for example, only if nowhere more suitable
is immediately available, and even then, only if such use is compatible
with local agreements on the use of places of safety.
We want to ensure that local protocols are in place and to
stress the points that I have just made in the revised
code. We will consult
very widely on the revised code. We will involve representatives of the
police, including the Police Federation, in the drafting of the
guidance. I understand that similar arrangements will be made in Wales.
The National Institute of Mental Health in England is working with the
Association of Chief Police Officers on the development of guidance on
joint working between police and health services in dealing with people
with a mental disorder. I know that that is general, but it is an
important matter. Getting the process right at local level and
understanding how each other’s work can take place and be
improved is the best and most appropriate way forward.
I hope that that reassurance,
combined with guidance on moving people from one place of safety to
another more appropriate one, will encourage the hon. Member for East
Worthing and Shoreham to withdraw the
amendment.
Tim
Loughton:
This has been a useful debate. I am particularly
pleased with the Minister’s assurances about consultation in
reference to the code of conduct. That will probably be the swiftest
way of bringing about improvement. In particular, it will address the
deserts of best practice that appear to exist and ensure that protocols
that work at the moment work everywhere. I see no reason why that
should not happen. Promoting a local agreement is the best way to
proceed, so that there is mutual benefit and trust and a good
relationship between clinicians, police, the Prison Service, social
workers and all the other agencies involved.
Our amendment stipulates an
upper time limit of 24 hours. That should not be a problem,
because the Minister has said that the emerging IPPC research indicates
that the average stay is 10 hours. Having taken her assurances that a
lot is happening—discussions with the police, improvements to
the code of conduct, and so on—in relation to the provision of
services, I beg to ask leave to withdraw the amendment.
Amendment, by leave,
withdrawn.
Clause 43 ordered to stand
part of the Bill.
Clauses 44 to 46 ordered to
stand part of the Bill.
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