UPDATE (August 2023) – we now know some more detail abotu this case after publication of the Preventing Future Deaths report. The post below was based on media reports and you will see I’ve pointed out certain questions and made certain assumptions because of a lack of detail in the coverage. The PFD helps us with some of that detail and you should understand this post needs to be read in conjunction with a subsequent post about the Coroner’s notice.
An inquest recently concluded in Sussex will lead to a Coroner writing to NHS England and it touches upon a number of issues which feature regularly on this blog. Rachel Garrett, from Hove in Sussex died after falling from a cliff top in Brighton in July 2020 when police officers and a mental health nurse were attempting to safeguard her. She had been in crisis for a number of weeks, making six suicide attempts and her family had been battling to see her admitted to an inpatient setting for safety and treatment. HM Coroner for Sussex returned a narrative conclusion saying there had been missed opportunities to save her life and she has undertake to write to NHS England about the case. The Preventing Future Deaths report was published in August 2023.
The day before her death, Rachel had been found on a cliff top and was taken to Royal Sussex County Hospital (an acute hospital) and not long after midnight, she absconded from the hospital. She was found by police shortly afterwards and taken home where her parents wanted the police to detain Rachel under the Mental Health Act 1983 (MHA) or for her to be sectioned but instead she was then returned to the Emergency Department for assessment. Despite being placed under one-to-one supervision by hospital staff and amidst the mounting evidence of increasingly risky, suicidal behaviours, Rachel was able to leave the hospital again and was reported missing again.
She was found around an hour later, on the same clifftop as the previous day by police officers and a mental health nurse (I’m assuming the were a street triage team if there was a mental health nurse in company with the police, but I can’t find that confirmed in coverage). They began to talk to her but Rachel moved towards the cliff edge and fell. It’s beyond tragic and the independent psychiatric expert in the case suggested there were three missed opportunities to save her this young lady’s life.
LEGAL POWERS
Various things occur to me about the law, reading coverage of the inquest conclusion. Emergency Department staff do not have obvious legal powers to stop someone leaving the department. There was some talk in the Government’s response to the 2018 Mental Health Act Review by Professor Sir Simon Wessely that powers under section 5 MHA would be extended to Eemrgency Departments but this wasn’t widely welcomed and there is no mention of it in the Mental Health Bill before Parliament. It also occurred to me to wonder about section 136 MHA – which went unmentioned in the coverage of the inquest and so I cannot know what consideration was given, if any, to the question of whether the power was considered during police encounters.
For example, Rachel was encountered on the same clifftop the day before she fell and officers who encountered her took her to an Emergency Department. I admit I would be interested in knowing more about the decision not to use s136 MHA and remove Rachel to a more secure Place of Safety setting where she would then be assessed by an AMHP and a doctor, potentially with a view to full assessment for admission under the Act. One might also ask the same question about s136 MHA after the police took Rachel home. For the avoidance of all doubt: there may well be reasons and justifications for those decision, it’s literally impossible to say otherwise without hearing the evidence, but I admit to nothing more than wondering, based on the summaries available.
Lawyers and charities supporting Rachel’s family commented after the proceedings about their dismay. Her parents described services playing “Russian roulette” with her life and their lawyer stated it was “contrary to common sense” that a highly vulnerable person can pay repeat visits to a clifftop and not be detained and cared for because we know Rachel had been found on a clifftop about ten days prior to the events leading to her death, again by police officers and a mental health nurse (so again, I wondered whether this was the street triage team which operates in Sussex). She was taken to police custody on that occasion, alleged to have assaulted a police officer and whilst in custody, she further harmed herself.
POLICE CUSTODY
The coverage from inquest states something curious I would like to further understand about detention in custody: it states “she was released three days later despite her parents’ expressing serious concerns about her safety”. I’m wondering what the precise circumstances or legal basis was of three days in custody – you cannot be detained under arrest or under s136 MHA for 72hrs. But when Rachel was taken to hospital prior to absconding and falling to her death, evidence was heard of a particular discussion that needs focus. The police having arrived at the Emergency Department (and I will have to infer from what I can read they had not used powers under s136 MHA to take her there), discussion took place between the officers dealing and their supervisor about whether the police should remain in ED with Rachel pending the conclusion of any assessment process.
Now, on the one hand, if the police have not used powers under s136 MHA, then nothing specific obliges them to remain. On the other hand, having had to intervene with someone who was apparently suicidal and with imminent access to a lethal mechanism to complete, it might be wondered whether powers should be used and / or whether the police should remain with the person pending conclusion. It was heard at the inquest how the officers expressed concern about being directed to leave the department and a sergeant was quoted as having said they were “prepared to take the risk”, so the police left. Rachel later left the department and returned to a clifftop, from where she was taken home and then back to the Emergency Department.
The question of police remaining with people after assisting them to healthcare locations is a topic that was in discussion on social media after last week’s Metropolitan Police letter to NHS partners in London about reducing the amount of emergency mental health calls they will answer. Of course, all the calls in this example are immediate risk to life calls – someone on a clifftop, apparently suicidal. But the Met’s leaders have made mention off the inordinate amount of resource being spent waiting in Emergency Departments – 10.5hrs per person, on average.
RISK MITIGATION
Other forces report similar amounts of time – usually two officers with the person and this rings true of my own experience at the moment. But of the course there’s a distinction to be understood: there is a difference between the question of whether you agree to deploy to something in the first place (on whatever legal or other criteria you establish) and the question of how long police officers then must remain involved with supporting someone, once they have agreed to deploy and handled the immediate aspect of an incident.
Rachel’s death is not the only one where officers take a decision to withdraw once someone is in a healthcare setting but this incident shows how precarious that decision can be. A lot of careful factors need weighing up when deciding to leave someone at liberty to make their own choices when they have been found in a precarious position, potentially with suicidal ideas and we’ve seen this before in a slightly different but where the principles are similar. There was a case in Essex where police were called to a private dwelling to a young man who had made very real preparations for his own death. Officers recognised the suicidal, mental health emergency within and called the ambulance service, but then decided against following the ambulance to an ED which meant no consideration was given to whether or not someone may need to remain in ED to manage any escalation of risk, potentially by police application of s136 MHA. That case ended badly and led to an inquest where I also had questions about the approach to risk mitigation where life may be at risk. Indeed in that case, once the man left ED and was reported to the police, he was not treated as missing either.
An extract of Rachel’s diary which was read to the court during the inquest, she had written: “I am rapidly deteriorating… I don’t understand how bad you are supposed to get before they help you?”
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2023
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
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