Police cells as "places
212. Under section 136 of the Mental Health Act 1983
(MHA), someone found to be suffering from a mental disorder and
to be in immediate need of care and control may be removed by
the police to a "place of safety" if this is necessary
in the interests of that person or for the protection of others.
The place of safety may be either a police station or a hospital,
and there is no legal obligation on NHS trusts to accommodate
persons detained under section 136. The MHA Code of Practice of
1983 states however that "as a general rule, it is preferable
for a person thought to be suffering from a mental disorder to
be detained in a hospital rather than a police station".
213. The Police Complaints Authority confirmed to
us that, although the level of suicides in police cells was generally
low, there was a real concern about suicide in regard to place
of safety detentions in police cells. In the PCA study on alcohol-related
deaths in police custody, three out of the 60 deaths studied were
of persons detained under the Mental Health Act.
214. Witnesses generally agreed that the use of police
cells as places of safety was undesirable.
The extent to which it may compromise the safety of patients is
clear from the Coroner's Rule 43 report into the death of Roger
acknowledges that, in practical terms, the restraint imposed by
a police officer on a s.136 detainee may need to differ from that
imposed by medical staff
faced by police officers in a section 136 situation are different
to those faced by healthcare professionals.
have no prior knowledge of the person's psychiatric or medical
history or the same clinical skills for determining competence
and cognitive ability, which may be fluctuating in any event.
There is therefore a gulf between what can be implemented in the
healthcare setting and what can be implemented by police officers
between responding to the presentation of a patient and transferring
them into health care.
215. Mr Sylvester's death, under restraint by police
officers whilst arrested under s.136, which resulted in an unlawful
killing verdict in the Coroner's Court later quashed on appeal,
illustrates the dangers of the use of police cells for these purposes.
216. The Home Office acknowledged that use of police
cells as places of safety was unsatisfactory and states that they
were used only as a last resort.
MIND expressed concern however that "last resort" should
not be interpreted loosely as "where there are insufficient
resources to do otherwise".
217. It emerged from oral evidence that although
use of police cells as places of safety was regarded by all witnesses
except the Home Office to be "widespread" there were
no official figures on the number of place of safety detentions
in police cells. In response to our questioning, the Home Office
contacted 23 police forces to enquire about practice in the use
of police cells as places of safety. They found that 17 police
forces used cells as places of safety under section 136, because
no alternative could be found in the areawithin these 17
forces, an average of 328 people were detained in police cells
under section 136 each year.
The Home Office noted that it was shortly to provide guidance
for local protocols between police forces and local health services.
218. ACPO was sceptical about the reliability of
protocols to address the problem. They considered that a "more
robust approach" was necessary that would identify where
responsibilities lay, and establish clearly that detainees such
as those held under section 136 were not solely the responsibility
of the police but that this was a "multi-agency issue".
219. The Coroner in the Roger Sylvester case recommended
that priority should be given in the allocation of beds to people
who were highly disturbed and could not be managed without the
use of restraint. The Coroner's report also recommended that procedures
should be put in place within the NHS for clinical decision making
so that a section 136 detainee's transfer from police to NHS custody
took place "as a matter of utmost priority with time of the
220. For as long as police cells continue to be used
for these purposes, even in rare cases, the police have obligations
under Articles 2, 3, and 8 to protect the safety of people detained
in this way by addressing their particular needs. Compliance with
Article 2 in the detention of a person known to be seriously mentally
ill, and who may be at risk of suicide, requires informed psychiatric
assessment and treatment, and expert monitoring.
These are standards which it will be extremely difficult for police
custody suites, even the best equipped, to meet. People requiring
detention under the Mental Health Act should not be held in police
cells. Police custody suites, however well resourced and staffed
they may be, will not be suitable or safe for this purpose, and
their use for this purpose may lead to breaches of Convention
rights. In our view, there should be a statutory obligation on
healthcare trusts to provide places of safety, accompanied by
provision of sufficient resources for this by the Government.
221. Ensuring the safety of people detained by the
police is not a single agency problem that can be addressed by
the police alone. It also involves the responsibilities of health
authorities, and requires good co-ordination between health authorities
and the police. Transfers from police cells to hospital must
operate more effectively. We recommend that a statutory duty be
placed on healthcare trusts to take responsibility for people
detained under section 136 of the Mental Health Act
Detention in immigration removal
222. Concerns have also been raised about the detention
of vulnerable and mentally-ill people in immigration removal centres.
The Operational Enforcement Manual, which sets out policy on immigration
detention, lists categories of people "normally considered
suitable for detention in only very exceptional circumstances".
These include people suffering from serious medical conditions
or the mentally ill, and people about whom there is independent
evidence that they have been tortured.
223. The Medical Foundation for the Care of Victims
of Torture, and Bail for Immigration Detainees (BID), reported
that the "exceptional circumstances" standard is not
being applied to all those falling within these categories, and
that torture survivors and the seriously mentally ill are in practice
detained, even where this is recorded in medical reports.
Medical Foundation research shows the particularly detrimental
effects of detention on torture survivors in immigration detention.
BID provided us with details of cases of serious mental illness,
attempted suicide and self-harm in immigration detention, including
cases where detention continued against medical advice, and in
cases where medical advice was that detention was exacerbating
mental illness. They also reported that in some cases, medical
staff's failure to pass on medical information to managers of
detention centres meant that detainees' vulnerabilities might
not be known.
Decisions on continued detention under the Immigration Act
must be fully informed by any relevant medical and in particular
psychiatric information. Where detaining authorities know, or
ought to know (given adequate information exchange) that an immigration
detainee is at risk of suicide, serious self-harm or severe mental
illness as a direct result of continued detention, they will need
to clearly justify such continued detention as compliant with
Articles 2, 3 and 8.
188 Ev 92 Back
Q 93 Back
Q 296 Back
Q 74 Back
Q 148 Back
Ev 93 Back
QQ 74-76 Back
Q 147 Back
Mental Health Act 1983 Code of Practice, para 10.5 Back
Dr David Best & Amakai Kefas, The Role of Alcohol in Police
Related Deaths, Police Complaints Authority, March 2004 Back
Mental Health Act 1983 Code of Practice, para 10.5 Back
Inquest into the Death of Mr Roger Sylvester, Report under Rule
43 of the Coroner's Rules 1984, April 2004, HM Coroner's Court
St. Pancras Back
Inquest into the Death of Mr Roger Sylvester, op cit., Section
3, p. 8 Back
Q 265 Back
Ev 160 Back
Ev 96 Back
Ev 96 Back
QQ 412-413 Back
Inquest into the Death of Mr Roger Sylvester, op cit., Part 3,
p. 9 Back
Keenan v UK, op cit., para. 115 Back
First Report of Session 2003-04, op cit., Ev 69 Back
First Report of Session 2003-04, op cit., Ev 106-107 and Ev 70 Back
Mary Sallinski and Susi Dell, Protection not prison: torture
survivors detained in the UK, 2001, Medical Foundation for
the Care of Victims of Torture Back
First Report of Session 2003-04, op cit., Ev 70 Back