All Party Parliamentary Group on Mental Health

ALL-PARTY PARLIAMENTARY GROUP
ON MENTAL HEALTH

MEETING ON SECTION 136 - 'PLACES OF SAFETY'

Tuesday 25th November 2008

CHAIR:

Lynne Jones MP (Co-Chair of the APPGMH)

SPEAKERS:

Mr Ian Bynoe – IPPC

Dr Michelle Hampson – Royal College of Psychiatrists

Ms Patricia Chambers – Service User

Lynne Jones MP, the chair, welcomed the speakers, Members and guests to the meeting.

Ian Bynoe from the Independent Police Complaints Commission (IPCC):

Mr Bynoe thanked the chair for her introduction and explained that he was representing the findings of the IPCC’s report into section 136: the report on the use of police custody as a place of safety (POS). www.ipcc.gov.uk/section_136.pdf

He explained that the key data had been kept as simple as possible and focused on the use of police powers to detain people. He went on to explain that detention for the purposes of assessment can be for up to 72 hours. This is a civil act, using civil not criminal powers, and it is often a precursor to full detention. The preferred place of safety is a hospital.

Mr Bynoe explained the two main criticisms of police cells as a place of safety:

1) Cells often exacerbate the distress felt by the individual.

2) The use of a cell can serve to criminalise behaviour which is not criminal.

He gave the following statistics from the IPCC report: For the year 2005/06, 11,500 people were detained in police custody rather than in more suitable accommodation. There were 5,900 detentions in which an appropriate POS were used. In the majority of cases Mr Bynoe strongly asserted that the wrong POS had been used.

Mr Bynoe listed the main problems as being:

1) Lack of access: if the police have a different option they will use it rather than a police cell.

2) Suicide was highly prevalent among those detained.

3) Around 2/3rds of people detained were male and the average age was 36.

4) Black people were detained twice as often as white and the average length of that detention was 9 hours.

He then picked out the main recommendations from the full list of 22 in the IPCC report. He said that there had to be an increase in the number of hospitals used as POS. The report also wanted to see the disparity in the ethnic mix of those detained.

He concluded by saying that the IPCC is working closely with police commissioners to implement their recommendations.

Patricia Chambers – Service User:

Patricia Chambers stated that she has been in and out of police custody and detention for 18 years.

She described how on the occasion of her first arrest she had been experiencing bouts of psychosis and was in the last stages of her relationship with her fiancé who wished to end the relationship. During an argument at the fiancé’s home Patricia broke a window before leaving. Later she was arrested by the police and left in a cell throughout the night with no food or water. She was not charged and released the following morning.

On the second occasion she attempted to get on a bus in Hackney but was arrested after a psychotic episode caused her to behave erratically. She was forcibly handled and taken to a police cell and then released later that afternoon.

The third occasion took place on leaving a night club. As she left she saw a woman and, without knowing why, punched her. Patricia was caught by the woman’s boyfriend who called the police. She was not charged but was placed in a cell, again without access to food or water. After being kept in the cell overnight she was told that she would finally be assessed. She was assessed by a mental health professional who failed to pick up her psychosis and so she was released.

Eventually Patricia received the help she needed but only after family intervention. The main point that Patricia made was that throughout her experience of the police although she was detained she was assessed on only one occasion, despite detention being for the purpose of assessment, and when she was assessed the assessment was inadequate. In relation to a police cell as a POS she made the final point that during detention under Section 136 the person will be vulnerable and scared, and that a sympathetic POS is needed. A police cell is not an environment designed to calm someone with a serious psychiatric problem and so is not a suitable POS.

Dr Michelle Hampson – Royal College of Psychiatrists:

Dr Hampson introduced herself and explained that she had worked with the IPCC on their report and had also liaised and worked with every other group involved with section 136.

She pointed out that the attitude of the police towards mental health is very different from their attitude to physical health.

After recounting a story of somebody she had talked to who had been detained in a police cell (see story, attached), she cited the main issues as being:

1) Lack of access to food and water.

2) Lack of the possibility of action, which since detention can last for 72 hours, can be very distressing.

She made the point that while other organisations had long been campaigning on the issue it was the Police who took the lead in their assessment.

Dr Hampson explained the role of POS according to the Code of Practice. In it police cells are to be used as a POS only in the most extreme circumstances, unfortunately this is not the case in actuality. It is rare that a cell will actually be the appropriate POS and the most important thing is to get the POS right as the individual is not a criminal but requires help. They have to be safe for both the detained person and the health practitioner. Recommendations for how this can be achieved are in the report.

Dr Hampson made the following points regarding POS:

1) The POS has to be an appropriate environment in which to spend 9 hours, as this is the average amount of time spent in a POS.

2) There have to be adequate levels of staffing. She highlighted this as being one of the major issues.

3) The staff present need to be appropriately trained.

4) Police should not be used as a substitute for a mental health professional.

The point was made by Dr Hampson that one of the major criticisms of in-patient wards was the lack of staff. Since a hospital POS is often located next to an in-patient ward the staff that would work in the POS would be available to the in-patient ward as the POS is likely to not be too busy. While good staffing levels are needed for POS the bigger issue is that they will be needed at short notice, if there are more staff in the in-patient ward then this goal of quick assess should be achieved.

Dr Hampson pointed out that the most important fact about a POS is that it is for the benefit of the patient, not of the staff or the police. Connected to this is the need to de-criminalise the system. Doing so would require the limiting of the use of police cells as a POS. The second way to de-criminalise the system is to remove the police from the process as much as possible; rather than have someone with a mental health problem arrested by the police in a public area they should be taken away by an ambulance: a mental health problem is still a health issue and not criminal. The police should, of course, be present in case they are needed.

Dr Hampson called for more resources and research into the use of police cells as POS. Reliable data can help to bring about real change. The main focus has to be on increasing the discretion and safety of the person who is being detained and to ensure this there needs to be consistent evidence.

Discussion from the floor:

John Metcalfe opened the discussion by asking if the report dealt with differentiating between those who are acting irrationally due to intoxication but have no mental health problems and those who do have mental health problems.

The second question from the floor was about the importance of looking at wider social issues. The speaker felt that a psychotic episode will not be spontaneous but will have a cause and wanted to know if the report addressed the need for the recording of these wider social issues.

Ian Hayes made the point that useful assessment often takes months rather than hours and wanted to know if the issues of training were being addressed.

Ian Bynoe, in response to the first question, stated that the police need more training to be able to distinguish between mental health problems and intoxication. The attitude of the police is one that sees problems as something to be taken away from them rather than dealt with by them. He wants to see greater co-operation between services. He cited the example of Merseyside as an area where increased co-operation has seen substantial improvements. In regard to the second problem Mr Bynoe stated that it is not surprising that the issues are a low priority in central government. He does, however, want to see this change. As for the issue of training Mr Bynoe pointed out that the training was not for medical professionals but rather for the police so that they would have a wider knowledge base.

Michelle Hampson said that it was imperative we did not lower our standards of section 12 for medical professionals and psychiatric assessment. In order to have section 12 training a lot of psychiatric experience is needed and this is necessary. What we need is a larger number of psychiatrists with section 12 training as most section 136s occur out of hours when psychiatrists are not easily available. In regard to the issue of intoxication Dr Hampson stated that the person should be arrested and then assessed. If the police think that mental health and not alcohol is the problem then they can use section 136 but if in doubt they should be arrested. She called for greater co-operation between services.

Lynne Jones called for greater research and increased assertive outreach (AO). She gave examples from her own experience and made the point that the reason people found themselves in need of a POS was that earlier signs of psychosis, often reported by relatives who are most attuned to recognise them, were ignored – hence the need for more AO.

Fiona Mactaggart stated that when she was a Minister in the Home Office she was unaware of the use of police cells as POS until she was questioned about it in Parliament. She called for increased debate on the issue and said that silence on the subject is the main problem. She called for more research and people to tell their stories to help make an impact.

Marcia Rigg-Samuels expressed regret that the profile of the issue is low and that if it were higher then maybe her brother would not have died in police custody. She stated that the police were informed by her brother’s psychiatrists of his problems but failed to take notice of her expert opinion. He was arrested hours after leaving hospital and died in the back of a police van.

Jonathan Naess voiced his opinion that the timing of the report was a cynical exploitation of the fact that police cells are overburdened at the moment due to their being used as over flow prison cells. He stated that he had mixed treatment from the police himself and that this has shown him the importance of adequate police training. He also reinforced the issue of BME groups receiving undue focus from the police regarding the use of section 136.

A member of the audience made the point that it is not just police officers that need more training but the police call handlers as these will often be the first port of call for those who contact the police.

Michelle Hampson replied that the police in general are better than they were 20 years ago but admitted that they had a long way to go. She would like to see service users and carers training police and informing them of personal experience. She would also like to see more multi-agency training.

Ian Bynoe responded that we should not be cynical about the timing of the report. In regard to training he said that there are some national schemes being introduced by the Association of Chief Police Officers and that they are working on a best practice guide. This will be issued in January for a public consultation.

A student in the audience voiced the concern that section 136 could be open to abuse by criminals who could trick the police into thinking they have a mental health problem in order to avoid being arrested.

Michelle Hampson replied that if the individual commits a crime then they should be arrested and then assessed. She also pointed out that the assessments are carried out by professionals.

A member of the audience called for mental health advocacy to be supplied in all cases by the state to ensure the rights of the person detained are looked after. She pointed out that nurses and doctors are often ill-placed to fulfil this role. She wanted to see more advocacy training to get more people out of the criminal justice system. She has found that the police do not tend to take mental health problems as seriously as they do physical health problems and would like to see this addressed.

Philip Dixon-Phillips said that he had heard people talk of being left outside a hospital by police but not in the right place. These people were violent and could have been restrained by police but nurses were not trained to deal with such extreme cases. This was dangerous for all involved. He also wanted to know why if the police actually take this issue seriously there is no representative of any police force present at the meeting. He took this to be indicative of the lack of attention the police show to the issue.

Lucy Smith raised a concern over a new police consultation which spoke of holding cells being placed in areas such as shopping centres. She was worried that these cells could become regarded as a suitable POS.

Ian Bynoe ended his contribution by reiterating the importance of research to implementing change. He also pointed out that sometimes a hospital can be a terrible place as well so shifting the issue of detention from a police cell to a hospital is not necessarily going to end problems of detention. He did accept that as a POS a police cell was inadequate and seriously outdated.

Michelle Hampson ended her contribution and the meeting by saying that the report placed an emphasis on the role of local monitoring groups. She felt that the local PCT should review what happens “on the ground”. This should involve service user and carer surveys. She emphasised the importance of information and the rights of detained people. However she also felt that because of financial constraints staffing levels must take priority over advocacy. The group agreed a form to be tested in terms of information gathering and although this has some problems, particularly with the format, the Home Office has given it a lot of support. The Mental Health Act Commission has also declared an interest in the scheme.