DMH 206 Independent Police Compliants
Commission
Memorandum from the Independent Police
Complaints Commission
1. The Independent Police Complaints
Commission (IPCC) has been established under the Police Reform
Act 2002 and assumed its statutory powers on 1 April 2004 when
it replaced the Police Complaints Authority (PCA). The scope,
powers and duties of the Commission differ significantly from
those of the PCA and, with substantially greater resources available
to us, the Commissioners and staff now operate from four regional
offices covering England and Wales. We have investigative powers
and staff employed as investigators which are already being used
in a number of significant and high-profile investigations such
as into police fatal shootings and deaths in custody. In addition,
the Commission is required under the Police Reform Act to secure
and maintain public confidence in the system of arrangements for
dealing with public complaints against police and the investigation
of police misconduct.
2. Accordingly, the Commission must be alive
to issues that affect general policing and from our early experience
the importance of mental health as an issue affecting policing
has been widely noted. To reflect this the Commission has made
this topic area one of its main priorities for policy development
and inter-agency liaison and this topic is likely, also, to feature
in the Research and Publications programme of the Commission during
its initial years. We draw your attention to the research undertaken
by the PCA prior to its abolition, which had begun consistently
to draw attention to the presence of those with mental health
problems amongst the 'at risk' groups in contact with the police
service whose behaviour and needs can present some of the greatest
challenges. We wish to make the following observations upon the
contents of the Government's Draft Mental Health Bill.
3. Impact of new powers of compulsion on police
contact with the public
In its philosophy and specific powers, the Mental
Health Bill envisages the greater use of compulsory powers in
relation to patients living in the community. Conventionally,
compulsion in psychiatric treatment has been restricted to institutional
care and nursing staff are neither trained for nor expect to use
forcible treatment methods with regard to patients living in the
community. Accordingly, the police only become drawn to assist
in the apprehension and forcible conveyance of those subject to
powers and requiring compulsory treatment in an institutional
setting. Where the threshold for admission is serious mental
disorder and the person's incapacity to make appropriate health
care decisions for themselves, then the removal to hospital and
involvement of the police may, though often distressing for the
person, nevertheless be reasonably necessary and the police involvement
a necessary precaution. Where, however, a person's failure or
refusal to participate in compelled treatment in the community
(under a non-residential treatment order) triggers their return
to hospital when they are still largely capable of making their
own decisions, then we envisage it will be much more problematic
for the police to become involved in support of psychiatric carers.
This will be so particularly if a person in such circumstances
must be forcibly removed to institutional care and physical restraint
must be used to do so. The IPCC envisages complaints concerning
police involvement to be likely to follow such incidents and,
indeed, for these to pose a high risk of harm where the physical
resistance to action is sustained and police training or resources
deficient.
4. Warrant to take or retake a patient
We note that Clause 225 enables a Constable
to enter premises specified in the warrant issued under this Clause,
if need be by force, and remove the patient there and when they
do so may be accompanied by any person who is a registered
medical practitioner or an authorised person. Later in the Bill
we note that under clause 227 the police presence and actions
are part of a multi-disciplinary intervention, where a constable
must be accompanied by at least one approved mental health
professional and at least one registered medical practitioner
and under clause 228 the constable must be accompanied by at least
one approved mental health professional. There seems no evident
logic to these variations. We would commend to the Committee
this multi-disciplinary approach and the benefits of applying
the principle consistently to all those interactions
when the need to employ police powers brings them in contact with
a patient required to be detained under mental health legislation.
5. Urgent removal to a place of safety
The provisions of clause 228 are a new provision
compared to the 1983 Act providing just such a multi-disciplinary
approach which we commend to the Committee. Information from
an approved mental health professional triggers an intervention
by a constable permitting entry to premises, forced if necessary,
and the removal of the person there to a place of safety for
a limited period of time (6 hours). A Justice's Warrant
may provide for further detention but not beyond 72 hours. It
is an approach which would meet with our approval, save in relation
to the comments below about the period of time for permitted detention.
6. Removal to a place of safety from a public
place
Section 136 of the Mental Health Acts 1959 and 1983
has now been reproduced in Clause 229. Under this power, the
police will continue to arrest and detain for assessment in a
'place of safety', very often comprising a police cell, persons
found in public who appear to be disordered and require some form
of care or control. The possible facilities specified as affording
a 'place of safety are reproduced from the previous legislation.
There is no attempt in the draft clause (it refers back to the
wording of Clause 227) to limit the occasions a police station
will, inappropriately, be used for the detention of a person arrested
in these circumstances. The Commission recognises that, on some
occasions, hospital or other premises are simply not available
and a police station must, as a last resort, be used for the purposes
of temporary detention. However, the draft legislation makes
no attempt to limit the circumstances in which this happens only
to wholly exceptional occasions. Since 1990 the Mental Health
Code of Practice has strongly discouraged the use of the police
station as a place of safety (as does current Home Office guidance),
in the interests of the person detained and to ensure early and
effective assessment. Current evidence suggests that far too
often now a police station cell is the first not last resort,
routinely used for this purpose.
7. If the Committee considers it necessary to
retain a police station under the bill for use on rare occasions
as a last resort then, at least, the Commission considers -
7.1. That there should be a positive duty placed
under the bill upon the relevant health authority to assess need
and provide/procure adequate such facilities (for example, registered
care provision) to act as intermediate care prior to assessment
and a decision on residential detention, in a similar manner to
which other intermediate care facilities are provided for other
patients in need of healthcare;
7.2. That a period of detention of 72 hours in
police station is wholly inappropriate for the purposes of the
assessment needed. An assessment when a police station is used
should be completed within a maximum period of 12 hours.
8. Use of force by police when in hospital
or other institutional settings
The Commission is aware that, from time to time,
hospital or residential care staff seek the assistance of the
police to deal with violent or threatening behaviour by a patient
being treated in that institution. In particular, CS spray has
been used in hospital settings; police officers have been required
to restrain patients brought to hospital for assessment or treatment
for lengthy periods as part of the admission process and police
officers also become involved when moving a patient from one facility
to another or even to quell a disturbance which erupts in a ward
setting. The Commission regards it as generally regrettable when
this occurs since the appropriate response to a person's mental
health crisis is the employment of highly trained and skilled
therapeutic staff who are well-informed as to the cause or causes
of the person's disordered behaviour and are able to use physical
restraint if this is necessary, but within the context of the
person's treatment. It is often entirely inappropriate for police
staff with no knowledge of a patient, who are uniformed and carry
self-defence weaponry, to become engaged in these types of incidents,
particularly in secure unit settings.
9. We would look to the Mental Health Bill, or
to regulations made under it, more closely to regulate the management
of restraint in psychiatry to ensure the human rights of patients
are fully and effectively respected and police officers are not
drawn into these events unnecessarily, inappropriately and possibly
on occasions unlawfully.
10. In addition to improvement of the legislation
there needs to be greater clarity possibly in the code of practice
about application. Too often at present, when a mentally disordered
offender is diverted from the criminal justice system to hospital
it is the police who are called to escort the offender when the
duty rests on the health service.
11. The IPCC wishes to engage fully in the debate
over the reform of mental health law and would be happy to participate
in the Committee's inquiry as it finds useful.
IPCC
27TH October 2004
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