Health CommitteeSupplementary written evidence from the Department of Health (MHA 03)

FOLLOW-UP NOTE TO EVIDENCE GIVEN BY DR HUGH GRIFFITHS, BRUCE CALDERWOOD AND ANNE MCDONALD

1. Q146 Valerie Vaz

The latest figures on use of Section 136

USE OF HOSPITAL BASED PLACES OF SAFETY UNDER SECTION 136

Year

Male

Female

total

2007–08

4,037

2,998

7,035

2008–09

4,893

3,602

8,495

2009–10

6,778

5,260

12,038

2010–11

7,839

6,272

14,111

2011–12

8,532

6,370

14,902

DETENTIONS UNDER THE MENTAL HEALTH ACT 1983 FOLLOWING USE OF SECTION 136

Year

Detained following
Section 136

Proportion of total
number of people taken
to a hospital based place
of safety

2007–08

2,020

28.7%

2008–09

1,753

20.6%

2009–10

1,922

16.0%

2010–11

2,376

16.8%

2011–12

2,561

17.2%

Included in the Health and Social Care Information Centre publication Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment, Annual figures, England, 2011–12 were experimental figures collected by the Association of Chief Police Officers (ACPO). These show that during 2011–12, an estimated 8,667 orders were made where the place of safety was a police custody suite, these account for 37% of the overall total of recorded orders (23,569) made under Section 136.

This national count is an estimate, based on figures provided by local police forces. The criteria for searching custody databases to produce these counts was not standardised.

Figures were not collected on the number of transfers from police stations to health based places of safety and ACPO tells us that to collect those numbers would require a manual trawl of police records. Anecdotally, the Department understands that these transfers are not a high proportion of the total number of uses of Section 136.

2. Q157 Valerie Vaz

Meeting between Home Office and Department of Health on mental health and policing on 13 March

This meeting took place on 13 March, and included representatives from the Department of Health, the Home Office, ACPO, the NHS and the Care Quality Commission.

These will be regular meetings, co-chaired by the Department of Health and the Home Office, developing national steps which can be taken to support local partnerships between the NHS and police to commission and provide improved services for people suffering from mental ill health in the community.

The group has identified the following aims as its priorities for people subject to detention under Section 136 of the Mental Health Act 1983:

Helping to ensure people receive the most appropriate support by the most appropriate agency or organisation at the right time.

Reviewing transportation and chaperoning, which should be provided by the most appropriate agency.

Working towards a reduction in incidents that escalate and cause harm to the individual or others.

Achieving further reductions in the use of police custody for individuals detained under section 136, so that police custody is used only in exceptional circumstances and for the shortest possible period.

Ensuring that national guidance is followed and effective local protocols put in place and supporting relevant local agencies and organisations to work in partnership, with a shared understanding of roles and responsibilities.

At the meeting there was a discussion about the role of CQC in monitoring and regulating compliance with the Mental Health Act 1983 Code of Practice on police powers and places of safety and the potential for strengthening this to support the aims above.

In addition, the Royal College of Psychiatrists circulated a draft of Guidance for commissioners: service provision for Section 136 of the Mental Health Act 1983, which had been prepared by an inter-agency working group on Section 136. It is envisaged that the final version of this document, which is due shortly, will support local health and police partnerships in taking joint action to understand local needs and commission services to meet them.

3. Additional Written Question

The Act’s impact assessment published at the time estimated that 10% of Section 3 detentions could be avoided by using supervised community treatment orders (CTOs) and we would like to know if this has been achieved. The impact assessment also said that by 2014–15 CTOs would save £34 million per annum through reduced use of beds. The Committee would be interested to know if this saving is likely to be realised and if it would be possible to provide a note on the true costs/savings associated with CTOs?

At the time of the Act it was expected that the use of community treatment orders (CTOs) would build up gradually over five years, so that by 2013 around 3,000–4,000 people would be on CTOs at any one time. The Health and Social Care Information Centre reported 4,764 patients on CTOs in England on 31 March 2012. It does not appear that the number of patients on CTOs had reached a “steady state”(ie the numbers of patients going onto CTOs being matched by the numbers being discharged or revoked) sooner than predicted, which suggests that the steady state numbers will be higher than predicted at the time of the Act. The greater than expected numbers of patients on CTOs will have an impact on the true costs and benefits of CTOs.

There has been a continuing fall in the total use of Section 3 detentions since 2007–08. This may be due to a number of factors, including the introduction of CTOs, but also the increasing use of Section 2 detentions which do not result in a further detention under Section 3.

Year

2007–08

2008–09

2009–10

2010–11

2011–12

Total use of Section 3

23,660

23,176

23,024

21,823

21,674

Detentions following revocation of CTOs

143

779

1,018

1.469

The Oxford Community Treatment Order Evaluation Trial (OCTET), examines the efficacy and cost-effectiveness of CTOs as part of a Randomised Control Trial and this should provide better information on the true cost effectiveness of CTOs.

22 March 2013

Prepared 9th August 2013