The BBC is covering news of a new Mental Health Bill, to be introduced to Parliament soon and their emphasis is on the removal of police stations as a Place of Safety (PoS). Anyone who has followed this blog in the thirteen years it’s been running will know I’ve always thought police stations should never be used as a Place of Safety – and I do mean never. We’ll get back to this.
The main problem we will have with a change to the law is the preparedness of the NHS – not because there is a large number of people going to custody now who will need to be accommodated in NHS settings, but because there already is evidence of significant dysfunction in the PoS process and it’s been there since the last time the law was changed. I’d only scanned the BBC news article to spot the historical and statistical errors within it, that I thought a post might help because this is not the news story it appears to be, but there are things police forces and NHS organisations are going to need to think about.
THE NUMBERS
Firstly, it’s not correct to say there were 34,685 detentions under s136 MHA – the latest data, published only a few weeks ago, shows there were 31,213, 322 of those leading to removal to police stations (or someone already there being kept at a police station) – not the 314 claimed by the BBC who are busy quoting the previous year’s figures. However, neither sets of figures are telling us everything we’d need to know about the implications on the NHS of those numbers, because almost half of the 322 were one force using s136 on people already under arrest for an alleged criminal offence who were then additionally detained under s136 and kept in custody even though the current statutory regulations for using police stations as a PoS were not met.
The argument goes: because the person is also under arrest for a criminal allegation, the Regulations banning use of police cells do not apply. So I can only assume police forces inclined to think that and use the power in this way, will argue the criminal arrest continues to trump the total ban on the use of police stations – interesting argument which I’ll return to in another post if and when the law changes. For what my view is worth, I’ve always thought we should never have people under arrest for an offence AND detained under s136 MHA at the same time – it’s not that this is unlawful, it’s just that it’s a really bad idea which complicates things unnecessarily – pick a process, run it to its conclusion and then decide whether you need to go the other way.
So this all means, just over half of the 322 who went to custody will not be able to be held there (Greater Manchester Police should note this – they use police statioins the most in circumstances where their inspectors believe the criteria are met .. and I really doubt they are) and we must therefore ask where they will go? Well, in the last data, 42% of all the people detained by the police under this provision were removed to an Emergency Department (ED) – that’s over 13,000 people per annum. I’ve said before, I doubt very much all 13,000 of those had additional physical healthcare needs necessitating treatment in ED before removal to a mental health unit Place of Safety (MH-PoS). Emergency Departments were really unfairly hit by this demand after the 2017 changes which introduced Regulations for use of a police station and now, almost half of people go there as a first resort, including because of weird ideas in some mental health unit Places of Safety about people needing to be “medically cleared“.
THE HISTORY
The Policing and Crime Act 2017 is the legislation which changed the police parts of the Mental Health Act 1983 – it received Royal Assent in January 2017 and commencement of the MHA changes for the police was in December 2017. The Act was in progress through Parliament for almost two years, following a formal review of these provisions by the Home Office and Department of Health in 2014. So by the time we hit Monday 11th December 2017 and things changed, we’d all had a sense this was coming for well over three, almost four years – and we also knew, police use of s136 MHA had been rising pretty consistently for at least as long as any kind of data had been kept. By the time we got to the commencement date, the NHS had not expanded PoS provision to any notable degree, to cope with the additional numbers which had come from increased use of the power OR from the impending restrictions on the use of custody.
And this had been in train as an idea for even longer.
Contrary to the BBC article’s assertion this ban on the use of custody had not first been proposed “in a wide ranging review of mental laws published in 2018” – this is reference to the Wessely Review (2018). In fact, the idea of banning use of police custody entirely, was within the Mental Health Bill 2004 which was formally introduced to Parliament during the Blair Government. That Bill fell because of various arguments about treatment for personality disorder and ideas about “dangerousness” and detention without treatment so the police station proposal was lost amidst other unrelated arguments about the broader Bill.
So this ban on use of police cells has been coming since at least 2004, despite not being recommended by the Richardson Review (1999) of the Mental Health Act, which expressly stated it should not happen.
THE FUTURE
We will soon see a new Bill – we’ll have to see the precise wording of it, but the implications should be small. The problem to be faced already exists which is the serious under-commissioning of non-ED based Places of Safety to cope with the demand now faced after decades of increased reliance upon the police and I can see a few problems with this areas will need to think about in additional to ensuring MH-PoS services don’t simply shout “medically cleared” and bounce people to ED.
Firstly, numbers on s136 MHA have fallen for two years in a row – they peaked in 2021/22 at over 36,000 and are now back towards 31,000. The National Police Chiefs Council were quoted after the last figures claiming that the Right Care, Right Person (RCRP) programme is responsible for the reduction in the use of the power. Plausible point, obviously as RCRP is about responding to fewer incidents, but the problem with that analysis is a number of forces already running with RCRP saw increases in their use of s136 MHA, not reductions. The Metropolitan Police did see a significant reduction, but from everything known to me it seems the Met have really gone hard on declining calls for service, perhaps explaining their 27% reduction in the use of the power – and the Met being so large, such a significant reduction by them was always going to skew national data, which shows a 10% reduction. Take out the Met reduction and it’s barely a reduction at all.
The NHS’s commissioners in Integrated Care Boards (with emphasis on the word integrated) need to get busy with existing problems – of why so many people detained under the power are removed to ED without obvious reason and in a context of knowing this problem will becomes worse, if only slightly, once any new Bill drives home the change which has been coming for twenty years. The police, meanwhile, probably need to think more deeply about their use of this power: we know RCRP is driving more “voluntary” detentions which not voluntary at all (see various television programmes for evidence of this claim) and ensuring partnerships are properly grounded, without the “medically cleared” nonsense they should be challenging and where officers understand this legal power and where it’s very necessary and totally inappropriate.
Of course for that, you’d need to provide decent mental health training, which certainly wasn’t delivered to all officers in my 27yrs of doing it – and during my service, I never authorised the use of police custody as a Place of Safety, ever.
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.
I am not a police officer.
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