A couple of months back, I wrote a post about the sad death of Ms Rachel Garrett in Sussex. Within, I admitted to having a number of questions about the case and I had to make certain assumptions along the way because the detail in which I was especially interested wasn’t present in the media coverage of her inquest. His Majesty’s Senior Coroner for Sussex has now published a Preventing Future Deaths report and I went to it, hopeful of a little more detail that may address the questions, but it’s a quite curious PFD and whilst it does add some detail, it also still leaves me wondering a few things.
Rachel died after in July 2020 after leaving an Emergency Department and falling from a cliff top near Brighton where she had been known to frequent whilst in crisis. Indeed, Rachel had been found at that location by the police and ambulance service in the days prior to her death and she had been removed to the an acute hospital Emergency Department. In the first post, I wondered whether s136 Mental Health Act 1983 was not considered because it had been unmentioned but the PFD now helps us out: she was detained under s136, albeit taken to an Emergency Department in Brighton rather than to a mental health unit Place of Safety. The reason for that location are not given, but this is not too unusual in all fairness – in some force areas, 50% of those of us detained under s136 MHA are removed to an ED, despite most of us not requiring the kind of acute hospital care those medical facilities are uniquely placed to offer.
But this knowledge about s136 now raises a few more questions for me:
We knew, for example, that during one of the periods of Rachel attending the Emergency Department, there was a discussion about whether the police should remain there with her. The inquest heard how the police constables physically accompanying Rachel expressed concern about being directed to leave the department and their sergeant was quoted as having said they were “prepared to take the risk”, so the police left. Always a tricky decision to take, because in the recent encounters Rachel had placed herself in a a position where she had immediate access to lethal means to end her life and had previously been detained to mitigate the risk of her death. Of course, it’s easy to point this out after we know the very sad outcome and wonder why things may not have been done differently: always important to remember we weren’t there and we’re now looking backwards at this, when the officers dealing were looking forwards and always predict how risk will unfold in the future.
SECTION FIVE
I guess this is why I was curious for more detail, to understand the sequence and the dynamics of all this stuff – many things are not predictable and preventable but somethings are. I hoped the PFD may address this however, but whilst it adds detail, it’s also still most curious. HM Coroner has highlighted the inability of mental health trust staff to use powers holding powers under section 5 of the Mental Health Act whilst working in a liaison role within the Emergency Department.
The PFD states –
“Patients who attend a Hospital Accident and Emergency Department with mental health difficulties are in most hospitals seen by a Mental Health Liaison team (made up of Consultant Psychiatrists and Mental Health nurses) These staff are not employed by the Acute Hospital Trust but are employed by a local Mental Health Trust (in this particular case it was the Sussex Partnership Foundation Trust).
As a result of their employment status the Mental Health Liaison team (who have the best knowledge of the patient having been caring for them) cannot invoke the Doctors or Nurses holding powers under Section 5(2) Mental Health Act (Section 5(4) for nurses). If a patient decides to abscond from the Acute Trust Hospital the Mental Health staff cannot detain/hold the patient. They would have to ask a Doctor within the Acute Hospital to do so. This Doctor may not have any knowledge of the patient and would be unlikely to act immediately in a busy A&E. By that time the patient would have been long gone.
Due to this technical issue around the employment status of the Mental Health Team, those suffering with a deteriorating mental health in an acute setting are at risk in these circumstances.”
Now, I’ve provided a link, above, to a post on section 5 if you want more detail but these are powers which may be exercised in respect of inpatients. Therefore, section 5 MHA may not be used in an Emergency Department and this is something which was a point of discussion during the Mental Health Act Review by Professor Sir Simon Wessely. In the end, Professor Wessely made no recommendation to extend s5 MHA to Emergency Departments but the UK Government did include such a proposal in its response to the review. By the time the Mental Health Bill 2022 was published, there was no further mention of it. So no staff in an Emergency Department may exercise powers under s5 MHA.
Now, in fairness to the Coroner, EDs are sometimes adjacent to things which go by various names like “Medical Assessment Unit” or “Medical Decisions Unit” and they involve people being formally admitted to hospital, pending transfer to an inpatient bed and in such places, section 5 would be in play because the people there have achieved inpatient status. Difficult to say whether this was the case for Rachel and nothing I’ve been able to read suggests it was and it’s for that reason I found the PFD notice interesting: what was the basis for thinking section 5 could be initiated by anyone at the point where Rachel may have decided to leave?
Winner of the President’s Medal,
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions 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
Mental Health Cop 