I was recently asked whether RCRP addresses the issues flagged in the Code of Practice to the Mental Health Act 1983 (MHA) which require joint protocols on five topics between the police and statutory partners like mental health trusts, acute trusts (who run the Emergency Departments), ambulance and the local authority (who licence the Approved Mental Health Professionals).
No – it doesn’t. There is some overlap, but it’s partial. It’s worth remembering, that RCRP as outlined by the College of Policing and covered in the National Partnership Agreement from June 2023 is about four strands of work
- Welfare checks – which is nothing specifically to do with the operation of the MHA.
- Hospital walkouts – which could included MHA patients becoming AWOL but is much broader than that.
- Conveyance – which could include MHA patients but it’s broader than that.
- Section 136 MHA – this topic should have a joint protocol but my understanding of the RCRP emphasis is that it’s looking at the end-game aspect so officers can leave health settings after delivering someon to the NHS who has been detained. A joint protocol should be wider than that.
Compare and contrast those four issues with the five topics from the Code of Practice (England 2015, Wales 2016) MHA –
- Section 136 and places of safety – partly covered by point four of RCRP.
- MHA assessments in private premises, inc 135(1) warrants where required – not covered by RCRP.
- AWOL patients, inc 135(2) warrants where required – partly covered by point two of RCRP.
- Conveyance – partly covered by point three of RCRP.
- Section 140 MHA and urgent admission – not covered by RCRP.
NB: nothing in the Code says this has to be five documents or five separate agreements, merely that these five topics should be subject to an agreement. My view has always been four documents (or sections or a large document) – weave the conveyance issue throughout the other topics, as necessary because almost all of them require conveyance at some stage. Any stand-alone conveyance document would be a succession of sections about how conveyance works in the various required circumstances of the other protocols.
OVERLAPS
So, there is overlap between RCRP and the Five Protocols – aspects of s136, AWOL and conveyance, but there are aspects of those things which RCRP leaves untouched.
For example, MHA assessments in private premises is not one of the four ‘planks’ and yet it could be, because RCRP is about use of a ‘threshold’ to determine whether police involvement is appropriate in a given incident. You could imagine an Approved Mental Health Professional asking for police support at an assessment and two obvious questions being –
- Is there an immediate risk to life / risk of serious injury? – if so, threshold met because of Article 2 / Article 3 ECHR obligations?
- Does the AMHP have a warrant under s135(1) MHA – if so, regardless of threshold there is an obligation on the police because only police officers can use that warrant to force entry and / or remove someone.
But the RCRP threshold in the NPA doesn’t talk about the threshold being engaged when police-only powers are met, the NPA merely states “nothing prevents” Chief Constables still deploying to such things.
But what if there is no A2/A3 ECHR obligation and no warrant (for whatever reason that may be) but the AMHP still anticipates a crime or breach of the peace? Well, it’s important to remember that if even if the risk thought likely is a relatively minor assault, the AMHP and others are not obligated to tolerate ANY risk of assault in the course of their work and many serious assaults (and therefore A3 incidents of immediate risk of serious injury) occur when offenders aren’t intending to injure anyone severely. Remember the potential for one-punch incidents to end fatally, even if that’s because the victim tripped moving backwards and hit their head. Well, that’s not covered and arguably, it would need to be during a jointly agreed protocol on MHA assessments so that AMHPs understand what the police can and can’t or will and won’t do.
NOT ONE OR THE OTHER
I was further interested to wonder why RCRP doesn’t cover police attendance in hospitals in connection with MH patients. We know some high-profile disasters in policing, including the deaths of Seni Lewis and Kingsley Burrell, have involved psychiatric units calling for police assistance to disturbances on a ward and requesting various things, from “do something” to requests for arrest and prosecution or simply, a request to “take them away – we can’t cope.” Again, you might imagine RCRP would be interested in this in order to manage expectations about how a threshold would apply to those calls, when balancing off the fact that some of these incidents can involve NHS staff being assaulted or even weapons being involved.
This topic is not something which is required to be covered by either RCRP OR by a joint protocols for the Code of Practice, underlining the point the we need to remember complex things can require clarity by training or policy, notwithstanding the programmes in play or the requirement for protocols.
The point I’m making here is simple enough: RCRP is not attempting to solve everything so even on its own terms, it won’t. We need to make sure we keep thinking about the entirety of the topic and even by recognising the five protocols are broader in scope, they still won’t cover everything and therein lies the challenge for individuals officers to be up to speed for themselves and for forces to think more widely than RCRP or even the MHA protocols to ensure policy and guidance exists where it needs to do so.
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
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