4 Places of safety
Background
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.
USE OF POLICE CUSTODY
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.
DETENTION OF CHILDREN UNDER SECTION
136
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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