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The Minister for Policing, Criminal Justice and Victims (Damian Green)
I echo the congratulations that have been given to the hon. Member for Bridgend (Mrs Moon) on the way in which she introduced the debate, and to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), in the latter case particularly for his energetic chairmanship of the all-party mental health group. I shall start briefly with the general subject of mental health reform and then move on to the specific policing aspects of the matter. In doing so, I hope to sweep up a lot of the specific questions that have been asked during the course of this very good debate.
Mental health reform is clearly key to the wider programme of health reform, and the Government want to see mental health issues receiving parity of esteem with physical health issues. The mandate to NHS England has a specific objective
“to put mental health on a par with physical health, and close the health gap between people with mental health problems and the population as a whole.”
We have shared our developing work with the Welsh Government, as health, obviously, is devolved, and I know that they, too, are considering these matters.
As a basic principle, which has been expressed by many hon. Members on both sides of the debate, it is impossible to argue that people facing mental ill health should not have their health needs met by professionals who are able to provide appropriate support and treatment. The police are not best placed to provide that, but they may have a key role to play in identifying vulnerabilities among people with whom they come into contact.
Essentially, the police come into contact with four groups of people who may have mental health problems. First, there are people who have committed a crime, or are arrested on suspicion of committing a crime. For those people, it is essential that we strike the right balance between bringing offenders to justice and helping people get access to appropriate interventions in order to tackle factors, such as mental health problems, that may be contributing to their offending behaviour. In the second group are those who come into contact with the police because a member of the public has concerns for their safety or for the safety of others, but when no crime has been committed. In the third are people who may have been reported as missing. As the hon. Member for Bridgend pointed out, they may be elderly and have a history of dementia, or they may be people known to mental health services whose families or carers have reported them as missing. The fourth category is victims of crime or witnesses who may themselves have mental health problems and need support at every stage of the criminal justice system, as my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) pointed out.
I will go through those groups. We have heard about the review by Lord Bradley, who highlighted that a significant proportion of prisoners have some form of mental health problem. One key recommendation was that to make that contact with the criminal justice system work, we needed to put offenders in touch with treatment and other support services that can help stop their behaviour escalating into more crime. There are currently more than 50 adult and almost 40 youth liaison and diversion services working with offenders with mental health problems, substance misuse problems or learning disabilities at the earliest point of contact with the police and courts.
To answer the questions that my right hon. Friend the Member for Sutton and Cheam asked about what is happening next, from April 2014 we will introduce an enhanced core model across a number of selected areas. The aim is to ensure that those services can lessen health inequalities and improve justice outcomes for people who come into contact with the criminal justice system and for whom a range of complex needs are identified as factors in their offending behaviour. My right hon. Friend was right to say that a business case has been submitted to the Treasury. He asked the eternal question of when we will hear back, and I can tell him that the decision is imminent.
We also know that there is a clear link between mental health problems and deaths in custody. That is a very serious issue. Obviously, every death in police custody is a tragedy, and that is a priority matter for the Government. Work in the area is overseen by the ministerial council on deaths in custody. The council’s independent advisory panel has recently awarded a two-year research contract to the university of Greenwich, which will be working on a number of projects to consider the impact of mental health problems on deaths in custody. Those projects will cover a wide range of the issues that have been brought up in individual cases in this debate and elsewhere. That is one stream of work.
Obviously, the Independent Police Complaints Commission has a vital role to play in the investigation of deaths in custody. It must be notified of any death that occurs in police custody, and it is currently carrying out a review of how deaths in or following police custody are investigated. A progress report on the review was published in September, and the final report is due to be published early next year.
Although that is one group of people affected, most of the debate has rightly involved another group with whom the police regularly come into contact: people suffering from mental ill health who have not committed and are not suspected of committing any crime. There may be concerns for their safety or for the safety of others, and they may need to be detained in a place of safety for that reason. However, all too often, those people, who are ill, find themselves in police stations. Many contributors to the debate made that point.
Her Majesty’s inspectorate of constabulary’s report on the use of police cells as a place of safety for individuals detained under section 136 of the Mental Health Act found that in a number of areas, the use of police cells remained unacceptably high. Again, my right hon. Friend the Member for Sutton and Cheam made that point. We know that during 2012-13, almost 8,000 section 136 orders were made for which a police station was the place of safety. As has been said, that is more than one third of the total number of section 136 detentions. Straightforwardly, that is unacceptable, other than in truly exceptional circumstances. Those are people who are likely to be in crisis, and they need and deserve proper care and support from people qualified to provide it.
My right hon. Friend the Home Secretary announced to the Police Federation, at its conference in May, that she was taking action, along with my right hon. Friend the Secretary of State for Health, to ensure that people with mental health problems receive the care, support and treatment that they need, and that police officers are freed up to do their job of fighting and preventing crime. That work has made significant progress. The most visible sign of it will come shortly when the concordat, which has been agreed by almost 30 national organisations, agencies and Departments, is published early in the new year. A lot of work has gone on between the Home Office and Health Ministers on this matter—that relates to a point made by my hon. Friend the Member for Totnes (Dr Wollaston). I am happy to assure her that I have been working closely with my hon. Friend the Minister of State at the Department of Health, who is responsible for care and support and has overall responsibility for mental health policy.
The concordat will be an extremely important document in taking us forward. It will provide national leadership by setting out the standard of response that people suffering mental health crises and requiring urgent care should expect, and key principles around which local health and criminal justice partners should be organised. It will leave agencies in both the criminal justice and health fields in no doubt about what is expected of them.
There has been a lot of talk about places of safety. I know that interim arrangements have been made in North Yorkshire—the only police force area without a single facility at the time of the Home Secretary’s announcement—and that health-based places of safety will open in York and Scarborough early next year.
The hon. Member for Bridgend asked about exclusion criteria. The concordat will state that people suffering a mental health crisis should be supported in a place of safety, and that there should be no automatic criteria that exclude individuals, although their safety and the safety of others is the paramount consideration. She and others, including my hon. Friend the Member for Halesowen and Rowley Regis, mentioned the street triage pilots, which have obviously been extremely beneficial. The pilot by Sussex police went live on 16 October and other forces are having their launches in December. West Midlands police is moving along with this, and so is the Metropolitan police. Rather than all the pilots coming to an end at once, and there then being an assessment and then something else happening, what seems to be happening is that other areas are picking up the benefits and expanding the system. I am conscious that it is being expanded in the east midlands as well.
The point has been made that too often, the police end up transporting people who ought to be transported by ambulance. The Association of Ambulance Chief Executives is drawing up a national protocol on the transportation of people in mental health crisis, which I hope will act as a catalyst for wider change and improvements.
My hon. Friend the Member for Halesowen and Rowley Regis made a pertinent point about the need for a review of the operation of sections 135 and 136 of the Mental Health Act 1983. Options for a review of those sections are currently being examined, and I expect that work to get under way this financial year.
There has been much mention of children in the debate. The practice of routinely holding in police custody children in a state of mental distress is, of course, unacceptable. Again, that will be dealt with in the coming concordat. Obviously, I take the point that young people and children are central among all the groups of people for whom it is inappropriate that they should find themselves in a police cell in the middle of the night during a mental health crisis. That is one of the changes that we need to see.
There was a request from the hon. Member for Bridgend for better data collection. The College of Policing, which, incidentally, will be doing much of the training work that the Chairman of the Home Affairs Committee, the right hon. Member for Leicester East (Keith Vaz), asked for, recognises the important issues surrounding mental ill health and policing. In its short period in existence, it has already held an awareness event with deputy chief constables. They have agreed on the need not just for clearer guidance about the use of restraint—again, I take the point made throughout the debate about the difference between mental health restraint and police restraint—but for better capture of data and evidence about the operational demands on police. The college now has a national group working to take that forward.
The third group that I mentioned was missing people. It is estimated that four out of every five adults who go missing are experiencing a mental health problem when they disappear. If those people have dementia, they may be frightened, be unable to find their way home or exhibit aggression. The police will often be the first port of call when someone goes missing, so in responding to such calls, the police need to work closely with health services and other agencies to ensure that people can be safely transferred to the most appropriate place.
Our missing children and adults strategy highlights the importance of local areas considering whether they need to be doing more to protect children and vulnerable adults who go missing, and provides a framework for them to do that. The move to bring together the Child Exploitation and Online Protection Centre and the UK Missing Persons Bureau in the National Crime Agency will result in improved integrated working by law enforcement across the UK, including missing persons investigations.
The last group that I mentioned was victims and witnesses. The new victims’ code, which will be implemented the week after next, will ensure enhanced support at every stage of the criminal justice system, including a new entitlement to ask that special measures be used in court and to be provided with information about the support that registered intermediaries can provide.
As the usual gateway to the criminal justice system, the police will have a duty to conduct an early needs assessment to identify victims who may be particularly vulnerable—including those with mental health issues—and therefore eligible for enhanced services. Such victims will be advised of the availability of pre-trial therapy, and access to such therapy will be facilitated if needed.
We are legislating to provide police and crime commissioners with the power to commission support services for victims of crime. We intend that, from October next year, the majority of emotional and practical support services for victims of crime will be commissioned locally by PCCs rather by than central Government. PCCs are well placed to consult, and identify the needs of, victims in their local area and to determine how best to meet those needs.
Responding to people with mental health problems is not something that any agency or organisation can do alone. In many areas, PCCs are already playing a pivotal role in encouraging agencies to come together to address the issue. The work that I have talked about highlights the importance of joint working nationally and locally in order to make a real difference.
It is obvious that the police have, and will continue to have, a key role in dealing with mental health issues as they arise. They need to be adequately trained to identify vulnerabilities and behaviours that require further intervention, but they are not and cannot replace health professionals. Both types of professionals should be left to do the job that they are best at doing and trained to do, because that, in the end, will be the best response for mental health patients themselves.