Policing and mental health - Home Affairs Contents

Conclusions and recommendations

1.  Police forces work with all members of the communities they serve. Working with those with mental health problems will always be a core part of that work. However, we are concerned by the extent to which frontline officers are increasingly spending their time helping people with mental health problems. For many people experiencing an acute health crisis, a police officer is not the professional best placed to help them, nor is dealing with acute health crises the best use of police officers' time and skills. We believe that the police should not be filling gaps in mental health services. (Paragraph 6)

2.  The use of section 136 of the Mental Health Act 1983 and reducing the detention of people in police cells is widely seen as an indicator of a police forces' performance in relation to mental health, and it has focussed attention on the problem. We support the Government's commitment in the Crisis Care Concordat to see the number of detentions in police cells under section 136 halved in two years compared with 2011-12. (Paragraph 11)

3.  We recommend that the specific reference to a police station should be removed from the definition of "places of safety" in s. 135(6) of the Mental Health Act 1983. We recognise that there are concerns over the lack of health-based places of safety that exist in some parts of the country, particularly rural areas. However, this proposal has been under discussion for some time now and commissioners should have started commissioning appropriate place of safety provision before now. All areas need to do so, and be able to demonstrate that they have made progress by July 2015. The Government should immediately re-issue guidance to police forces and health trusts defining the exceptional circumstances in which police cells may be used as places of safety. The presumption should clearly be the health facility not the police cell. (Paragraph 15)

4.  The Government's own review of s. 136 recommended ensuring that police cells can only be used as a place of safety for adults in situations where the person's behaviour is so extreme they cannot otherwise be safely managed. Following the general election a new government should set out what they will do to ensure this happens if it will not amend the Mental Health Act 1983. (Paragraph 16)

5.  We commend the work by Inspector Michael Brown, and others who have championed the cause of mental health within the Police. His work online has been particularly impressive. (Paragraph 19)

6.  It is clear that too many NHS Clinical Commissioning Groups are failing in their duty to provide enough health-based places of safety that are available 24 hours a day, seven days a week, and are adequately staffed. CCGs must not only acknowledge local levels of demand and commission suitable health-based places of safety, they must also design local backup policies to deal with situations where places are occupied. Relying on the police to fill the commissioning gap not only imposes non-negotiable, external costs on forces, but it increases the risk to highly vulnerable patients. We recommend that the Department of Health, together with the Home Office, issue clear guidance to CCGs about the appropriate number of health-based place of safety places, having regard to local circumstances, within three months. (Paragraph 20)

7.  The NHS would not turn away a patient with a physical illness just because they were intoxicated. People with mental health problems have exactly the same right to NHS care as everybody else and it is shocking that patients are excluded from health-based places of safety on the basis of informal exclusion criteria. The guidance that people with mental health illness should be treated in a mental health facility needs to be repeatedly reinforced. (Paragraph 24)

8.  We note that the Government review of sections 135 and 136 said they would explore alternative places of safety. The fundamental reason for a place of safety is to keep someone safe until they can have a mental health assessment and a judgment can be made as to their future treatment. Where there is a clear gap between demand and provision, then we agree that alternatives should be considered. Anywhere used as a place of safety must adhere to relevant guidance and be able to secure the confidence of patients and their families. In particular, the staff, especially if they might be called upon to restrain someone, should receive validated training. (Paragraph 26)

9.  We agree with the proposal to amend the Mental Health Act so that the powers of s. 136 could be used anywhere other than a private home. This would give the police power to deal expeditiously with people on railway lines and in high places to which the public do not have access. We believe that extending the range of settings in which the power could be used to include private homes would be a step too far. Extending police powers must be done with caution, as it is important that this does not reinforce the need for police involvement in mental health cases, as we believe it is important that it should be kept to a minimum. (Paragraph 30)

10.  The fact that children are still detained in police cells under section 136 reflects a clear failure of commissioning by NHS Clinical Commissioning Groups. The de facto use of police cells as an alternative relieves the pressure on CCGs to commission appropriate levels of provision for children experiencing mental-health crisis. We support the Government's proposals for a change in the law to ensure that children can never be held in a police cell under section 136 of the Mental Health Act 1983, which we recommend should be included in the next Queen's Speech. In the interim, guidance on the detention of children in police cells under s. 136 must be made clear—that it is unacceptable and must stop. This guidance needs to be distributed to those working in the police and in the health service. (Paragraph 34)

11.  The fact that a place of safety is attached to an adult ward should not preclude its use for children, particularly when the alternative is a prison cell. The Mental Health Act Code of Practice is clear on this point, and we recommend that the Department of Health draw this to the attention of all providers of health-based places of safety. (Paragraph 35)

12.  Though early indications of the effectiveness of the Street Triage scheme are very positive, it is important that the scheme is fully appraised against a range of clear success criteria, including an analysis of the relative merits of different models of provision, and the results published. In particular, it will be important to understand why the number of s. 136 detentions has fallen in some areas but not to the same extent in others following the introduction of the scheme. That information will inform the analyses that HMIC has asked each force to produce with a view to adopting some form of Street Triage. We note that different forms of Street Triage are funded in different ways and that it is not clear what guarantees are in place to secure funding at the end of the pilots. We recommend that the Government give a clear commitment that funding will be made available for schemes which have been proven to be cost-effective. (Paragraph 39)

13.  Similar to Street Triage, Liaison and Diversion services are intended to ensure that a person with mental health problems who does come into contact with the police and the courts receives appropriate treatment. The prevalence of people with mental illness within the criminal justice system is a scandal and any initiative that addresses this should be welcomed. However, its success will clearly rely on the availability of appropriate mental health services to which clients can be referred. (Paragraph 41)

14.  People encountering a mental health crisis should be transported to hospital in an ambulance if an emergency services vehicle is needed. Transportation in a police car is shameful and in many cases adds to the distress. Those affected, and their families, are clear that they wish to see ambulances used as transport to hospital. It enables the patient's health to be monitored on the way and improves access to healthcare pathways. (Paragraph 45)

15.  Reliable data on the use of ambulances to transport people under s. 136 is poor, but it is clear that the use of ambulances in these circumstances varies across the country. The relationship between the police and ambulance service at the local level is pivotal to how this can be improved. Forums that enable each to understand the priorities, roles and responsibilities of the other, such as partnership working and Street Triage, have been shown to work. To get to a point, such as in the West Midlands where 75% of people are taken to hospital under s. 136 by ambulance, require the ambulance service and the police to develop that local relationship. The Government must examine what the barriers are to poor performance of those ambulance services with regard to transporting people to hospital under s. 136. It must work harder to make sure examples of best practice are spread throughout the country. (Paragraph 46)

16.  Improvements can be made in how mental health crisis calls are received and processed by the 999 call handler. Such improvements can reduce the use of s. 136 and in turn reduce the demand on ambulances. (Paragraph 47)

17.  We recognise that there is a huge demand on all 999 services at a time of restricted budgets but, fundamentally, mental health needs to be seen on a par with physical health, and local commissioning of health services, including ambulances, must reflect that. (Paragraph 48)

18.  We recommend that the Government bring forward an amendment to the Mental Health Act 1983 to provide that a person detained under section 136 may be detained for a maximum of 24 hours. In tandem with this change, we recommend that the Government introduce specific time targets within which mental health assessments must be carried out, whether in a hospital or a police station. We recommend a target of three hours, in line of the standard of the Royal College of Psychiatrists. (Paragraph 52)

19.  There is a need for better data on what happens to people following detention under s. 136 if they are not later admitted to hospital. The person could receive treatment in a variety of ways, and the treatment plan could involve several NHS or community agencies, so understanding if the person received the most appropriate care after contact with the police is difficult. If we are to move beyond using s. 136 as a measure of performance, there needs to be more information to determine if the person received the care they needed. (Paragraph 54)

20.  The coalition government has recognised the poor state of current mental health services and it has made a commitment to put mental health at the same level as physical health. In addition to resources, there is a clear need for improved coordination between the organisations that come into contact with mental health sufferers. The Concordat has shown potential for bringing the relevant organisations together. Its success will be measured by how effective it is in those areas of the country where such relationships are not well developed, where there is an absence of local leadership, and where the commitment to addressing the issues is absent. (Paragraph 59)

21.  Data collection around the use of s. 136 must continue to improve. People who suffer a mental health crisis and come into contact with the police are receiving different care in different parts of the country. Reliable data is important to assess where issues remain and fed back into discussions about mental health priorities. (Paragraph 61)

22.  We welcome the work being carried out by HMIC and the Care Quality Commission in collecting data on policing and mental health, and in particular on the use of s. 136 to detain people in police cells. We fully support the Care Quality Commission decision to measure the performance of mental health care providers' care for people in mental health crisis. (Paragraph 62)

23.  We recommend that data on police sickness absence due to mental health issues is collected better. This would enable more effective examination of whether the work undertaken by police has a significant impact on their mental health and would help efforts to respond to these health concerns. (Paragraph 64)

24.  There is a need to improve training for police officers and civilian staff in identifying the signs that someone might be suffering from mental illness. This should be mandatory for all front line officers and include staff in the police control room. This is particularly important for custody sergeants, who must be adequately equipped with the skills to effectively deal with mental health patients who come into custody suites. Police staff then need to be able to get advice from a mental health professional—a social worker, doctor, or nurse—who is better placed to recognise medical conditions and illnesses, and is able to refer the person for further treatment. Such advice needs to be available to the police at all times, given that they operate 24 hours a day. (Paragraph 68)

25.  Mental health is clearly a large and growing element of modern police work. The current amount of training for new recruits is not enough. Some forces have developed their own training to address perceived gaps. There needs to be a national strategy for mental health training for all police. It needs to be updated on a regular basis. As a minimum, it should include awareness of common mental health illnesses, techniques in de-escalation, safe restraint, and awareness of what mental health services are available locally. Mental health awareness training should include a component that addresses why some people who are ill might be perceived as violent, and how these perceptions impact upon the BME community. (Paragraph 75)

26.  This needs to include joint training with mental health nurses, paramedics and Approved Mental Health Professionals, and training involving mental health charities and people who have been detained under s. 136. We commend those police forces that already do this, including Greater Manchester, West Yorkshire and Leicestershire. Joint training should include de-escalation training, to make sure police officers are familiar with the techniques taught in mental health services. (Paragraph 76)

27.  Restraint should only be used in limited circumstances. Improved training should be given to correctly identify the range of behaviour of someone having a medical emergency rather than automatically presuming that behaviour means they are violent. The training should be aimed at reducing the presumption to use force and restraint on someone who is ill. (Paragraph 77)

28.  The best way to reduce the number of people suffering from mental health issues and who then die in custody is to reduce the number of people with mental health problems entering custody. All that can be done, needs to be done, to ensure that people going through a medical emergency are treated like someone going through a medical emergency. This includes providing sufficient resources to ensure mental health crisis care is available 24 hours a day, seven days a week. (Paragraph 79)

29.  The recent increase in suicides following custody is highly alarming. The police must make sure that those who have been identified as vulnerable in custody are notified to medical staff. There must be a formal method by which this done and it must be followed. This will require additional training for custody staff but it also requires improvements in access to mental health nurses and doctors in the custody environment. (Paragraph 82)

previous page contents next page

© Parliamentary copyright 2015
Prepared 6 February 2015