Plenty to be concerned about after the recent inquest in to the death of Lauren Bridges, an occupational therapist from Bournemouth. She died by suicide whilst detained under the Mental Health Act 1983 at a hospital near Stockport, Greater Manchester. This is around 250-miles from her home and imposed an incredible drive on her family if they wished to visit her. Lauren’s mother emailed services to point out how unhappy her daughter was and how is must obviously be in her interests to be transferred to a hospital much nearer her home. Lauren had ‘begged’ for such a transfer, complained that staff wouldn’t sit with her or help her with various tasks like washing her hair and that she was extremely unhappy. Eventually, she fatally injured herself and her placement and its effect on her was noted by the Coroner as a factor in her death.
NHS trusts have been attempting to reduce out-of-area placements for many years. They are known to be problematic for the reasons highlighted in Lauren’s experience but also because they’re extremely costly. They often involve placement in private sector hospitals run by organisations like The Priory or Cygnet, they have been associated with problematic care quality and where patients are placed in NHS hospitals, they are still extraordinarily expensive for the home NHS area. So there is human cost, financial cost and emotional cost for relatives and friends coping with this.
What has this to do with policing, you may quite legitimately wonder?
We know the police are often connected to admissions processes for Mental Health Act (MHA) patients – many vulnerable people are admitted to hospital after they had been arrested for alleged offences or after use of police powers under s135(1) or s136 MHA. We’ve known for years there has been a shortage of beds when compared to the number of people requiring admission in a timely way and I can’t recall the last time I heard of a incident where an officer says “… and then the AMHP said they needed to section him under s2 and they had a bed.” There’s never a bed, in my experience of the last few years – it always takes many hours or even days to identify it and this is made more problematic for the police and the vulnerable people they are detaining by the urge to avoid out-of-area placements.
DELAYED ADMISSION
Where someone has been detained under s136 MHA, for example, an AMHP and doctor has up to 24hrs to make assessment of someone’s needs and ensure those arrangements are made. The needs assessment may not necessarily suggest inpatient hospital admission but where that is the conclusion, they need to find a bed. In an attempt to avoid an out-of-area placement, we know that bed managers make attempts to find solutions locally – perfectly fair comment, that’s what should happen. But when it’s obvious there is no bed in the mental health trust where the patient resides (or where they have been assessed, if different), the question then arises about whether efforts are made to find a bed out-of-area. We know from what is said to the police that out-of-area searches (inc those for private sector beds) are significantly delayed in the hope a local bed can be found after some shifting of the deckchairs before resorting to trying someone else’s provision.
This means the period of time spent detained under s136 can often breach the 24hrs maximum period – and for those under arrest, it can mean someone is released from a police station without being charged, before a bed has been found. It should be obvious how this contributes to risk and people’s rights being compromised. You can’t just keep someone detained for hours (or days) beyond the expiration of the s136 period without it being an obvious breach of Article 5 ECHR. Of course, if someone has to be released from arrest for reasons which are always to do with criminal evidence not bed provision, there are obvious Article 2 or 3 ECHR problems if the person is so unwell there is an immediate risk to life or serious injury. If those risks are prolonged or exacerbated by delays in looking at out-of-area provision once it’s known there are no local beds, then that represents a real problem. But we now know because of tragic cases like Lauren Bridges that reaching for out-of-area provision to casually, risks putting patients hundreds of miles from home, away from family, friends and other support networks, and we can see how that can end.
Figures released last year suggest the Mental Health Act 1983 was used to admit patients to hospital over 53,000 times year. This won’t be 53,000 people because some people are admitted more than once. In commentary on the recent figures, one psychiatrist on social media stated patients are “admitted too late and discharged too early”, hinting towards a system in meltdown. Out-of-area care is just one way in which we can infer potential chaos in play. As with all things in a moving system, when you aim to address one aspect of the chaos (reducing out-of-area placements), you increase pressure on other parts (the police and places of safety, inc emergency departments).
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 