An Approved Mental Health Professional emailed me a while ago having had a fairly frustrating day at work and they wanted to point something out which had wasted their morning. It raises an important point about the RCRP programme and information management about MHA status. It goes something like this –
Police force A receives a 999 call one afternoon – members of the public are concerned about a man who appears delusional and is exhibiting some concerning behaviours in a retail area, running in and out of traffic, seemingly talking to people who are not there. Officers respond and locate the man, they agree with the public’s concerns for his welfare and feel they have little option other than to detain him under section 136 Mental Health Act 1983 (MHA) and remove him to a local Emergency Department – the health-based Place of Safety (PoS) is in use.
A PNC check on the man had revealed he is “known to the police”, but is not wanted for arrest or missing and there is a little risk information on there suggesting he is known to have mental health problems of some kind, but we know the officers have worked that out for themselves anyway. His last known address is in police force B, about a hundred miles away.
Having arrived in ED and waited to be triaged, the patient is sat down in a cubicle but still in distress, indicating he does not want to be there. He makes occasional attempts to walk out stating he wants to leave and the officers have to remain, actively managing this situation and physically preventing him from absconding prior to his 136 assessment. The have to remain in ED all evening and overnight because a shortage of AMHPs in local authority A at the point of arrival in ED means assessment is deferred to the following morning and our frustrated AMHP-friend starts her duty after 8am the next day.
AMHP RESEARCH
When our AMHP hero learns the patient’s details, they try to start collecting background information as all good AMHPs do. All police force A can tell them is the circumstance of the 136 detention, they know nothing about the man beyond a few convictions on PNC from years ago and nothing more about his background or home address, they know nothing about his family situation or his mental health history and neither does mental health trust A to which he is entirely unknown. Given the apparent seriousness of the patient’s condition, the AMHP’s instinct is its unlikely they are entirely unknown to NHS services so they ring mental health trust B, in the area where the patient seems to live.
You might be able to guess where this is going … the day before use of s136 by police force A, mental health trust B had reported their patient missing. He had absconded the previous morning from a psychiatric hospital whilst detained there as a section 2 MHA patient – he was acutely unwell after admission under the Act a week or so earlier and they had serious concerns about him when he absconded. The hospital informs the AMHP they had reported him AWOL & missing to police force B who listened to the circumstances and declined to deal, citing the Right Care, Right Person programme – phase two covers hospital walkouts, including patients AWOL under the MHA, in case you were not aware.
Consequently, no-one in police force B had created a marker on PNC to suggest the man was a s2 MHA patient who was now AWOL and able to be re-detained under s18 and returned to hospital. The section 136 detention, the work by ED to triage and oversee him, all the hours spent by police force A with two operational response or neighbourhood officers off the road across two busy tours of duty, the notification to an AMHP asking for a s136 MHA assessment in the ED and the search for one or two doctors (inc a “section 12” doctor), both of whom could have claimed a statutory fee if it had reached the point of undertaking a formal assessment … it had all been a massive waste of time and money.
He could and should have just been re-detained as AWOL under s18 MHA by police force A after the PNC check at the point of encounter and then returned to the original hospital, which is sometimes easier said than done but even so: it remains much easier than what ended up happening.
AMHP DILIGENCE
Just think: if our intuitive AMHP had not explored the background because of their instinct and experience, discovery of the patient’s AWOL status may have occurred even later still, after an even greater waste of time and money. Imagine if the incident to which police force A had been called had occurred in a private premises where the patient could not be safeguarded under s136 MHA so they had ended up arrested instead and removed to police custody, it would have been even worse for them – even more stigmatising an experience than was necessary.
And all because no-one created a simple PNC entry to say the person was missing and ensure their legal status under the MHA could be known by any subsequent police or other legal officers officers who may need to deal with them. It might have meant a patient with a passport could leave the UK and we know what a nightmare that can be because extradition processes to or from the UK do not include the return of MHA AWOL patients.
Imagine if the encounter by the police had not been an encounter which made it obvious the person needed detention under s136 or an arrest were not justified? Imagine if the fears of mental health trust B had been realised and there had been a serious untoward incident like suicide or, much less likely, a homicide after police contact and the subsequent reviews or inquests like those we’re seeing after Nottingham had told us there had been encounter by police force A a few hours or days before something disastrous happened?!
Worth remembering: the ECHR duties owed to vulnerable people are not owed by individual agencies – they are owed by the state as a whole so it’s just unfathomable! Anyone reading this can suggest such outcomes are unlikely, but they are well within the realms of what might happen, all for the sake of an information marker.
All tragedies where lessons end up need learning are unlikely.
RIGHT CARE, RIGHT PERSON
For a while, some have been talking about unintended consequences of RCRP and here’s another.
It seems the police, having decided to predicate their involvement in mental health matters on Article 2 and Article 3 ECHR obligations, are not always going to circulate missing patients on PNC – meaning officers in that police force as well as others won’t know about always know about AWOL status and their easy option to safeguard someone who may well be at risk during or after an encounter.
And in all fairness, this isn’t a point about the patient travelling a hundred miles away. If the encounter leading to s136 had been within police force B just up the road from the hospital trying to report him AWOL, the local officers dealing wouldn’t have known his legal status either. They’re no less likely than officers in police force A to end up burning ambulance, ED or PoS as well as AMHP, doctor and their own resources, for the simple lack of a quick piece of legal information which could still be included on PNC even if police force B had decided – however rightly or wrongly – they are not responding to the matter.
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.
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 