This post is about so-called “swing beds”, a term used by the Care Quality Commission in one of its annual reports for the practice of using the space in a “section 136 suite” or Place of Safety (PoS) as a location in which to admit or hold a patient who requires urgent admission, when there is no bed available. The situation can follow on from a few scenarios –
- A person needs to be “sectioned” in the community but no bed, so admission to the PoS as a stop-gap and then transfer the person once a bed is found.
- Someone needs to be “sectioned” after detention by the police under the Mental Health Act 1983 – the person was taken by officers to the PoS but when the 24hr or 36hr period runs out to assess them and make care arrangements, they remain in the PoS under section 2 MHA, for example.
- Someone needs to be “sectioned” from police custody after they were arrested for an offence and the PoS becomes a “swing bed” to get them out of the cells and in to some kind of clinical environment until a ‘proper’ bed can be found.
This topic has proved controversial for more than one reason in difference circumstances and we are reminded this week of one of them, a particularly egregious example which actually does not involved any of the above three common reasons why a PoS can end up acting as a swing bed. A man known in litigation as ‘AP‘ to anonymise him, brought legal action against Oxford Health NHS Foundation Trust after his normal residence required repair and he was held in a PoS for … what for it: 340 days.
GOOD AND BAD IDEAS
I don’t think I know anyone who believes it’s a really good idea to use a s136 suite or PoS as a “swing bed” – in fact, other cases show professionals have declined to do so, even when it was an available option and when there was no other. Last year, I wrote about the Preventing Future Death report after the death of Mr Martyn Stringer, also in Oxfordshire, ironically enough. Mr Stringer had been in an Emergency Department after being detained by the police under s136 MHA and required admission. By the time the 24hr period was up, there was no bed and he was left in ED with NHS staff. It became known the local PoS was not in use but those involved decided not to make an application for his admission to that hospital. He subsequently left the ED and died by suicide.
The coroner was critical of the decision not to use the PoS option, to safeguard the man.
So here we have civil litigation for breaches of human rights (inhumane and degrading treatment, amongst other things) and for negligence leading to a substantial settlement for AP and we have a Coroner critical of not using the option at all to safeguard a suicidal man and these are not the only examples. Those who have followed the detail of the Nottingham attacks from June 2023 may have noticed the fact that Valdo Calocane was held in a Place of Safety for nine days in September 2022 after he had been detained by the police under a s135(1) warrant. It was deemed Calocane required a psychiatric intensive care unit bed and none were available, hence he was detained in the PoS for nine days – initially under s135(1) and then, we should assume, under s2 MHA until he could be transferred to hospital.
SWING BEDS
So as with many complex and nuanced things, we shouldn’t be seeing hard and fast attitudes towards “swing beds” – it clearly has to be preferrable we see actively suicidal patients safeguarded from that risk; but we obviously shouldn’t be seeing anyone detained there for 340-days! I can admit: I usually found myself alarmed to hear people had been held for anything more than a couple of days, but ultimately, it’s a matter for the NHS to determine, as those held in a PoS as a “swing bed” are admitted inpatients and no longer in detention by the police even if arrest or s135/136 preceded the admission.
We rarely hear anything about section 140 MHA in these discussions and in my view, that tends to be because it’s still widely ignored as a piece of legislation. I’ll let you read about that elsewhere if you wish, but suffice to say, sixty-five years after this legislative instrument was introduced, we still know many integrated care boards (local health boards, in Wales) fail to identify hospitals which can receive patients urgently to their colleagues in local social services authorities. Even where they do, we also know the NHS does not manage those hospitals in such a way as to ensure people can be urgently admitted when urgent admission is required.
We end up with this improvised solution to a problem: when nothing else seems feasible, use an existing space as a temporary stop-gap and hope you can move them on before you get in to too much legal difficulty by holding someone for so long, you deprive them of the various rights, entitlements or privileges enjoyed by inpatients in psychiatric units. So on the one hand, I hope this case ensures trusts realise such outrages as 340-days and many things getting nowhere close to that are prevented; but I hope we don’t see more cases like that for poor Mr Stringer who died because someone decided, for reasons which were never made clear, against keeping him safe somewhere as they have for a number of other people.
But eventually, we’ll have to stop talking about insufficient beds and nothing in our imminent future or the current Mental Health Bill will help us with that.
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, 2025
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
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