Royal College Of Psychiatrists And Police Join Forces To Monitor Care Of People Detained Under The Mental Health Act

Main Category: Mental Health
Also Included In: Psychology / Psychiatry
Article Date: 30 Sep 2008 - 2:00 PDT

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The Royal College of Psychiatrists is teaming up with police forces in three areas of England - Nottinghamshire, Oxfordshire and the London Borough of Redbridge - to monitor the quality of care given to people detained under Section 136 of the Mental Health Act.

Section 136 allows the police to take someone who they believe is suffering from a mental disorder and in need of immediate care or control from a public place to a place of safety.

However, a recent report by the Independent Police Complaints Commission showed that the majority of people are being detained in unsuitable police cells - instead of being taken to dedicated assessment facilities in mental health units.

Police stations can be frightening places, especially when people are feeling vulnerable and distressed, and service users who are taken to police cells may feel both unsafe and criminalised. On average, people spend about 9 hours in police custody before being assessed by a mental health practitioner - although in some cases they may be discharged without ever having seen a mental health worker.

One service user, giving an account of 24 hours he spent in a police cell, said:

"Within the cell was a dirty metal toilet, a dirty metal washing aperture in the wall and a bench with a PVC mat. Meals were offered but had to be taken in the cell adjacent to an open toilet. I declined all meals. There was no bedding, no pillow…A police station cell, by its very nature has to be a bare, controlled environment, for obvious reasons. As a place of safety for a vulnerable person it offers no comfort, poor communication, little interaction and a sense of extreme solitude."

Section 136 is the only civil detention under the Mental Health Act for which no statutory form is required, meaning there is a lack of reliable data on the number of people who are detained, where they are taken and the care they receive.

Therefore a new multi-agency working group, established and led by the Royal College of Psychiatrists, has developed the first ever standardised recording form to monitor Section 136 detentions.

Over the next few months, the form will be introduced in the three areas to test its effectiveness, before being rolled out more widely. The pilot will also provide valuable information about current practice.

Dr Michele Hampson, a consultant psychiatrist in Nottinghamshire and chair of the multi-agency group, said: "The Code of Practice to the Mental Health Act clearly states that police stations should only be used as places of safety in exceptional circumstances. For too long we have simply accepted the lack of improvement in the standard of care provided to most people detained under Section 136, and now is the time to insist on the provision of adequately staffed facilities in mental health units.

"This form will give us much-needed data on the quality of care in three areas of the country and hopefully, once the form has been piloted, it can be rolled out across the England. We also hope to work with the Department of Health and the new Care Quality Commission to monitor standards of care nationally, including trends in the uses of places of safety."

Anthony Deery, head of mental health strategy at the Healthcare Commission, due to merge into the Care Quality Commission in 2009, said: "There is a clear need to improve the quality of care and assessment of people who are held in places of safety under the Mental Health Act and we strongly support monitoring the situation more closely. Historically, information on how and when people are detained in a place of safety has been poor. Without this data it is not possible for local services to plan future improvement. This pilot is an important step towards developing a much better picture of what is happening not just in these local areas but across the country."

The monitoring form is part of a wider set of Standards on the use of Section 136, published this week by the Royal College of Psychiatrists. The standards include 24 separate recommendations focusing on the physical standards of places of safety, staffing issues, the conveyance of places between places of safety and local policy.

Key recommendations include:

- There should be sufficient places of safety in psychiatric facilities to meet need without recourse to police stations as a convenient option or because the place of safety is regularly full.

- Police stations should only be used as a place of safety in exceptional circumstances, as stated in the Code of Practice to the Mental Health Act.

- Psychiatric Section 136 facilities should have dedicated staffing, with a clearly identified person in charge of the facility 24 hours a day.

- Assessments of people by approved mental health professionals and doctors should begin within three hours - with a target of two hours in future.

- An ambulance should be used to transport people between places of safety - not a police car. Such work should be prioritised by the ambulance service to reduce distress and embarrassment to the patient.

- The introduction of a standard, nationally-agreed recording form to monitor Section 136 detentions, and allow local, regional and national comparisons.

- The new Care Quality Commission should report annually on the standards of care in relation to Section 136.

Lord Patel of Bradford, chairman of the Mental Health Act Commission (MHAC), lent his support to the new standards, saying: "The MHAC is pleased to have been a part of this project. We will be making sure on our visits that services know about and implement the new standards, and look forward to real progress in diverting mentally disordered detainees away from police cells wherever possible."

Jim Symington, national lead for legislation at the National Institute for Mental Health in England (NIMHE) added: "We are extremely pleased to endorse this new set of standards led by the Royal College of Psychiatrists. It is no longer acceptable that people suffering mental distress should be routinely assessed in police stations, and that we should still lack a national picture of the use of police powers under the Mental Health Act."

Mr Symington continued: "Now is a critical time to get the implementation of the Mental Health Act right and to ensure that the standards so clearly set out in the new Code of Practice to the Act are achieved."

The Standards on the use of Section 136 of the Mental Health Act 1983 (2007) have been developed by a multi-agency group, led by the Royal College of Psychiatrists. Members include representatives from the Metropolitan Police, the Independent Police Complaints Commission, the Royal College of Nursing, the College of Emergency Medicine, the Faculty of Forensic and Legal Medicine, the Ambulance Association, the Healthcare Commission, Mental Health Act Commission, and the National Institute for Mental Health in England.

Section 136 of the Mental Health Act 1983 gives the police powers to remove a person who appears to be suffering from mental disorder and who is "in immediate need of care or control" from a public place to a place of safety. Removal may take place if a police officer believes it is necessary in the interests of that person, or for the protection of others. The purpose of removing a person to a place of safety is to enable them to be assessed by a doctor or interviewed by an allied mental health professional, so that the necessary arrangements can be made for their care and treatment.

Royal College of Psychiatrists