Mental Health (Police Procedures)

Debate between Lord Brady of Altrincham and Sarah Wollaston

Thursday 28th November 2013 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

I congratulate all the previous speakers in this debate, and start by declaring an interest: I am married to a full-time consultant psychiatrist who chairs the Westminster parliamentary liaison committee on behalf of the Royal College of Psychiatrists.

Perhaps more relevantly to today’s debate, I should point out that I have been in a police cell in the middle of the night. I hasten to add that it was in a medical capacity, but I congratulate the Secretary of State for Health on advocating work experience for MPs. I would advocate more MPs spending a night in the cells. If they did, they would realise that that is absolutely the last place someone should be if they are acutely distressed by a mental illness.

That is particularly the case for an acutely distressed 12-year-old. Can we imagine a situation in which a 12-year-old child with a broken leg would be taken to a casualty department because there was no specialist orthopaedic surgeon or facility to assess them? That would be utterly unthinkable, yet in Devon and Cornwall alone, on three occasions since the start of this year 12 and 13-year-olds who have been acutely distressed with mental health issues have been held in police cells. That is utterly unacceptable for anyone, but it is particularly unacceptable that on 25 occasions—I would point out to the Minister that this is in Devon and Cornwall alone—children of 17 or under have been in that situation.

If we look at the situation for adults, we see that, shockingly, there have been 674 occasions on which people have been assessed in cells. As we have heard, the average time detained in that situation is 10 hours. On only 277 occasions have those assessments taken place in an appropriate place of safety. Devon and Cornwall is second behind Sussex in that terrible league of shame.

The situation is not the police’s fault. I want to stress that, and I pay tribute to the members of the police alongside whom I have worked in the past, as a forensic medical examiner, for their professionalism. Many police officers have sent me really heartfelt e-mails describing the difficulties they face. The situation is putting huge pressure on the police. It is a totally inappropriate use of resources. As Lord Adebowale has pointed out, it represents very poor inter-agency working, but there is no financial incentive for the NHS to change because the burden of resourcing falls on the police services.

The situation is totally unacceptable on any clinical level. I am disappointed that there is no Health Minister sitting alongside the Minister today, because ultimately the situation requires a total refocusing of services. If we look at the statistics, we see that 82% of those who are detained under section 136 do not go on to compulsory admission to hospital. That highlights the point that many of these situations could be avoided in the first place.

I am sorry to say that some general practitioners will not see patients unless they have registered. Someone who is acutely distressed and has paranoia as a result of mental illness might not recognise that they are unwell and therefore might not register or go to see a doctor. Consultant psychiatrists might refuse to see a patient without a GP referral. Those are all hurdles in the system. Time and again, carers may be desperate to access help for people who are really unwell, but they must fall off the cliff and become acutely unwell in a public place before the police can step in with a section 136 order that could have been avoided.

I thoroughly welcome the pilot project using triage, but street triage should not be necessary because we should pick up such situations much earlier. I would like volunteers who work with the homeless, for example, and who may be aware that someone is slipping into a distressed state, to be able to refer them directly to psychiatric services and bypass primary care. Of course, I would like all primary care doctors to ensure that they deliver the right care at the right time to all their patients, as the good ones do, and directly and actively seek out people who are homeless and vulnerable but who may not come forward to seek help.

Much of the problem is about funding—it would be wrong not to make that clear. The funding of units where people can be seen in an appropriate place of safety is crucial. It is no surprise that the local authorities that have most use of police cells are often in rural areas, where there are additional geographical challenges in providing appropriate places of safety. But if parity of esteem is to have more than just a hollow ring to it, we must ensure that within the NHS cake there is fair distribution of funding for mental health, and we must recognise in funding formulae that rural areas sometimes face extreme challenges. Sparsity must be recognised in funding if there is to be fairness.

Another problem is that mental health beds are running “too hot”. The CQC has said that in 50% of areas bed occupancy is 90%, and in 15% of areas it is 100%. That causes delays throughout the system. Ultimately, there is a problem not just with appropriate places of safety, but beyond that with having beds available when people need admission. On four occasions in Devon and Cornwall, the process of assessment has taken so long that a bed that was provisionally booked was taken by the time the assessment had been made. All those causes of delays in the system must be addressed: the availability of suitably qualified section 12 approved doctors; the availability of psychiatric beds; and, crucially, the availability of appropriate places of safety.

Will the Minister examine the effect on children when medical facilities are not suitable? There may be secure children’s homes— my preference, of course, would be to have a medical facility available, but I can say from personal experience that anything is better than a police cell. Police cells in the middle of the night are desperately frightening places. They are often full of people who are drunk and shouting. It is unthinkable that a child should be in that environment in a police cell. I hope that the Minister will say that if by next year children as young as 12 are still being put in police cells, Parliament will legislate to abolish that.

[Mr Graham Brady (in the Chair)]

Order. I am grateful to hon. Members for keeping to time so well. If the shadow Minister and the Minister take no more than 12 minutes each, there will be a couple of minutes for the hon. Member for Bridgend (Mrs Moon), who opened the debate, to wind up.