A few weeks ago, the Sunday Times published an article (£) by their crime correspondent, Shaun Lintern about mental health killings linked to the lack of mental health beds. It brought a focus which I think is welcome, to section 140 of the Mental Health Act, a provision which I’ve been writing about now for well over a decade and which is still widely unknown or disregarded. The Sunday Times last weekend included an editorial which followed on from the article, highlighting the killing of Kim Harrison by his own son, James in south Wales.
The figure two hundred and thirty-three was used by Shaun in his article to show how many people have died because of a lack of beds. In fact, this is the figure which the Times and the charity Hundred Families thinks have been killed by a mental health patient for the lack of a bed – ie, homicides. If you then think about the number of suicides which may be linked to a lack of beds, you’ll instantly understand Mr Lintern is in fact only emphasising a minority of the examples of those who have died. I’m not aware of data which specifically helps us understand how many suicides took place whilst patients who had been assessed under the MHA were waiting in the community for a bed to be found, but I can give something which shows the potential for it to be a far, far higher figure than the homicide figure.
The Times article, coincidentally, began by outlining the death of Mr Nigel Abbott in Birmingham in 2018. When the Birmingham coroner issued a Preventing Future Deaths report after Mr Abbott’s inquest, he included reference to no fewer than nine other inquests in that coronial district in the previous eighteen months where patients died whilst awaiting a bed. In April 2024, the Independent reported on leaked NHS data suggesting as many at 15,000 patients dying in a single year, whilst under community mental health services. Now, it won’t be the case that for every homicide incident like Mr Abbott’s there will be nine suicides like those listed in the PFD and it won’t be the case all of those 15,000 patients will have already been assessed as requiring MHA admission, but it gives at least some sense of things and no doubt justifies further, more detailed examination.
SECTION 140
I’ve now written about section 140 for over a decade, having been banging on about it for almost as long before that. There is another post about it ready for publication later in the year when we hit the sixty-fifth anniversary of it receiving Royal Assent in the Mental Health Act 1959. It’s not too baffling why we see so little compliance with it and its implications or that we see deaths linked to the issues which surround it – it’s because no-one’s really heard of it. In the work I’ve done over twenty years, I can’t count the number of occasions you make reference to as the law of the land in the company of senior mental health professionals of all kinds – psychiatrists, mental health nurses or AMHPs – and they then ask, “What is section 140? – I’ve never heard of it.” I’ve also made dozens of Freedom of Information applications for copies of joint policies which should exist on it (see para 14.80 of the MHA Code of Practice in England, for example) – they sometimes write back again saying, “We’ve never heard of this.”
Almost ten years ago, the Crisp Commission looked at the availability of inpatient psychiatric beds in England and found there had been a significant reduction in the decade up to 2015 whilst at the same time there had been a significant rise in the number of patients who were ‘under’ the secondary care, mental health trusts – fewer inpatient beds for more patients can only mean a couple of things: a higher threshold for admission in practice, leading to fewer admissions; and shorter stays for those who did manage it. Somewhere in there, we have the kinds of cases being highlighted by the Times, including the deaths of Mr Abbott and Mr Harrison (neither of which were really examples, by the way, supporting the Times’ point: of patients who killed whilst waiting for a bed after MHA assessment).
We can only keep chipping away – primarily, that might need to be at the actual knowledge of senior people in the services who are managing this, because it’s all too often insufficient and over-simplified. But we also need those who ‘police’ things to try doing exactly that – if a MH trust is inspected, are the Care Quality Commissioning asking about s140 arrangements, joint policies and the role of the Integrated Care Board in properly commissioning urgent pathways to care for those at risk of homicide and suicide.
You’d have to suggest not, as things stand.
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, 2024
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Government legislation website – www.legislation.gov.uk
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