Post-legislative scrutiny of the Mental Health Act 2007 - Health Committee Contents

4  Places of safety


58.  Section 136 of the 1983 Act gives police officers the power to remove from a public place to a place of safety a person who they believe to be suffering from mental disorder. Detention for a maximum of 72 hours is permitted and places of safety include "a hospital, a care home for mentally disordered persons, a police station or any other suitable place whose occupier is willing to receive the patient temporarily."[75] Police officers must be satisfied that the patient requires immediate care or control and the purpose of removal to a place of safety is to assess the patient's condition.

59.  The key reform of the 2007 Act was to allow patients to be removed from one place of safety to another during the 72 hour assessment period. The Department of Health believes that:

this provision has allowed some people detained under section 136 to be moved from a police station to a more appropriate environment for assessment, leading to better quality care during the section 136 detention and better decisions on their future care.[76]

60.  Section 135 of the Mental Health Act allows for the police to remove a person from their own home to a place of safety if they have a magistrates' order. Of 23,907 place of safety orders made in 2011-12 only 338 were under section 135. No removals to police custody were made under section 135 during this period.[77]

Hospital-based places of safety

61.  Since the implementation of the 2007 Act in November 2008 the use of hospital-based places of safety has increased by 66%.[78] Bruce Calderwood, however, did not attribute this growth to the provisions of the 2007 Act but rather to the capital investment in hospitals "to create more places of safety."[79] Dr Chalmers also said that she did not believe that the power to convey had influenced the increased use of hospital-based places of safety. On the capital investment programme, Dr Chalmers said that whilst physical capacity had been made available, funding was not always in place to ensure these facilities are fully staffed.[80]

62.  Dr Chalmers argued that trends in the application of section 136 detentions should be examined. She quoted statistics collected by The Health and Social Care Information Centre (HSCIC) which found that:

an estimated 8,667 orders were made where the place of safety was a police custody suite; this accounts for at least 37 per cent of the overall total of orders (23,569) made under Section 136.[81]

The HSCIC also reported that "there were 15,240 uses of place of safety orders (Sections 135 and 136) in hospitals; this figure is 6 per cent (841) greater than during 2010-11."[82] To put this in context, "there has been an overall 26% increase in the use of section 136"[83] since 2005-06 but a 25% reduction in the use of police stations as places of safety. Over the same period the use of hospital based places of safety grew by 152%.

63.  Supplementary evidence from the Department of Health stated that:

Figures were not collected on the number of transfers from police stations to health based places of safety... Anecdotally, the Department understands that these transfers are not a high proportion of the total number of uses of Section 136.[84]

64.  The Committee heard no evidence to challenge the Department of Health's anecdotal view in relation to the power to convey. In the absence of such evidence the Committee does not favour elaborate reporting processes to prove that no problem exists, but recommends that since the Act has now been in force for five years the Department should commission an independent assessment of the impact of the power to convey in order to ensure that the legislation is working as intended.


65.  Bruce Calderwood told us that although two-thirds of patients now went to a hospital-based place of safety this was:

still not good enough because it is very clear—and the code of practice makes it very clear—that it is justifiable at times to take people to a police station as a place of safety, but it ought to be exceptional.[85]

Dr Griffiths confirmed that less than 20% of those people held under section 136 were detained by clinicians for further assessment.[86] Dr Griffiths added that there was "very variable use of section 136",[87] and this is certainly borne out by the statistics.

66.  People detained under section 136 are often distressed and can be very vulnerable, and the proportion who are subsequently detained by clinicians is surprisingly low. The Committee notes that the CQC has now been tasked with mapping access to hospital based places of safety, and welcomes the further trial of street triage whereby nurses join police officers to deal with incidents involving people with mental health problems. The Committee recommends that Health Ministers should work with their Home Office counterparts and police representatives to improve the operation of the place of safety provisions of mental health legislation. Better application of section 136 would relieve pressure on hospital-based places of safety and allow for a reduction in the use of police custody.


67.  In oral evidence Anne McDonald told the Committee that approximately 300 children had been detained under section 136 last year, although this figure was thought to be an underestimate.[88] She noted that there was little information regarding the eventual outcomes for children detained by the police in this manner[89] and this appeared to include a lack of data regarding the number children who end up being held in police custody.

68.  Bruce Calderwood said that Ministers had been clear that the practice of holding children in a state of mental distress in police custody was unacceptable.[90] He outlined how the Department was approaching this issue and, referring to children held in police custody under section 136, he said:

That is one of the things that we need to work through with the Home Office around what practice is to see if we can reduce to a minimum the numbers of children in a state of mental distress who end up in a police station. Having said that, there will be circumstances where it is the right thing for an individual to do because it is not clear what is wrong. The crucial thing is that something happens fast and that the child is not left in a police station waiting for an assessment, waiting for help to arrive.[91]

69.  The Committee is concerned that there is little information regarding the outcomes of children detained by the police under section 136 of the Mental Health Act. We believe that this form of detention should be regarded as a last resort and that any commonplace use of police custody as a place of safety for children is completely inappropriate. We recognise that circumstances may arise where, for their own safety and the safety of others, police officers may have no option but to hold a child in custody. It is the responsibility of local commissioners to work with providers to ensure that places of safety with suitable child protection and safeguarding arrangements are available to the police when a child is held under section 136.

70.  The Committee recommends that the Department of Health reviews as a matter of urgency the practice of detaining children under section 136 and, that as part of the review, it examines the outcomes for children detained in this way. This review should be undertaken with a view to identifying effective alternative options that can be used by the police and health care professionals.

75   CQC, January 2013, p 17 Back

76   Department of Health, July 2012, p 18 Back

77   The Health & Social Care Information Centre, Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment, Annual figures, England, 2011/12, October 2012, p 18 Back

78   Ibid, p 18 Back

79   Q 141 Back

80   Q 30 Back

81   The Health & Social Care Information Centre, Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment, Annual figures, England, 2011/12, October 2012, p 5 Back

82   Ibid, p 5 Back

83   Q 30 Back

84   Ev 40 Back

85   Q 142 Back

86   Ibid Back

87   Q 147 Back

88   Q 151 Back

89   Q 152 Back

90   Q 155 Back

91   Ibid Back

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Prepared 14 August 2013