Policing and Crime Bill

Baroness Howe of Idlicote Excerpts

Report: 1st sitting: House of Lords
Wednesday 30th November 2016 Lords Chamber

Does the Minister think it is beyond the capability of various government departments to put them right by April 2019? Surely if it is possible in Merseyside and Hertfordshire, it is possible anywhere. I beg to move.

[Baroness Howe of Idlicote (CB)]

My Lords, I would like to support Amendment 117, moved by the noble Baroness, Lady Walmsley, which would eradicate the practice of police cells being used as a place for safety for people in crisis. It is an important amendment, both because people who are experiencing a mental health crisis and being detained under the Mental Health Act have committed no crime and because, for those in such a distressed state, being linked into health support is critical.

People who are picked up by the police under the Mental Health Act are detained because of a real risk of harm to themselves or others. Regardless of their age, no one should be made to feel like a criminal simply for being unwell; these people are in need of help and support. They are detained in order that a mental health assessment can be made and for any further treatment and care to be put in place. When you are in a mental health crisis, you are likely to feel overwhelmed and extremely distressed. Your behaviour may seem aggressive and threatening to others, but nevertheless you still need support and compassion. In fact, the people who display the most challenging behaviour are often the most vulnerable—those most in need of health support.

Health-based places of safety need to be equipped to manage someone’s challenging behaviour, and areas such as Merseyside and Hertfordshire are able to do this, where police cells have not been used at all for the past year. This amendment acknowledges that achieving a total ban on the use of police cells in some areas is not yet possible, so it gives the Secretary of State the power to determine a date for implementation. This is important because it sends the message loud and clear that all parties agree that people who are extremely unwell should never be taken to a cell. The amendment will be a lever to ensure that health-based places of safety are invested in and that staff are trained to manage challenging behaviour.

Police cells are clearly never appropriate for people in crisis, and we need to challenge the assumption that sometimes they are. We have already come some way in improving the lives of those with mental health problems, so ending the outdated practice of taking someone in crisis to a police cell is an obvious, achievable and important next step. I hope that the Minister can accept the excellent amendment in the name of the noble Baroness, Lady Walmsley.

[Baroness Meacher (CB)]

My Lords, first I must apologise that I was not involved in the earlier stages of this Bill due to a family health problem. However, I want to speak briefly but very strongly in support of Amendment 117, moved by the noble Baroness, Lady Walmsley.

This House was responsible for ensuring that parity of esteem between mental and physical illness is enshrined in law—a point already referred to by the noble Baroness. This was rightly heralded as an important advance which, over time, should transform attitudes to mental illness and change the treatment of those suffering from mental health problems. Is it conceivable that we would send a patient with a severe physical illness, perhaps cancer or a heart problem, to a police cell because no suitable bed was available locally? Of course not. We would all regard that as utterly inhuman.

But to send a patient in a mental health crisis to a police cell is even more inhuman than doing that to someone who is capable of understanding what is going on. The patient will probably be frightened enough by their own thoughts and the voices going on in their head. They may not understand what is happening to them. Handcuffs and strange people in uniform will be even more terrifying to such patients than they would be to a physically ill person. I do not know the figures, but I do know about the extreme distress that these situations generate and I have no doubt that a good proportion of those who survive—not everyone does—will end up with post-traumatic stress disorder.

I draw on my experience of mental health services over many years and my supervision of investigations into deaths in custody during my years with the Police Complaints Authority. I want to refer to a couple of cases from that time that come to mind in the context of this amendment. A young man of about 20 years old was detained under Section 136 with no mental health professional available to him. The plan was to take him to a police cell. The police had been warned that the young man could be violent, so a firearms officer was made available, which is perfectly reasonable. The patient had delusions that the people around him were all dead and that he was the only one who was alive. He said to the police officers, “You are dead”, who took this comment to be a threat to life. The firearms officer took out his pistol and shot the young man, who died.

The other case I want to refer to involved a very unwell man taken, again I am pretty sure under Section 136, to a police station, where he was restrained on the floor. We do not know what terrible thoughts the patient had in his mind, but the more he was restrained the more he struggled to get free, and understandably the more force was used by the officers to control him. The patient died on that floor. These patients would probably have recovered reasonably well over a period of a few weeks and might have lived full lives for many decades. We can imagine the feelings of their relatives.

The police officers suffered terribly during the lengthy investigations. I have to confess that those investigations were always lengthy and I am sure that they still are. They did not know whether they would be found guilty of murder or manslaughter. That is an appalling thing to happen to a young man who had gone to work that day assuming that he would do his duty as always, but without the mental health skills he needed to deal with the challenges confronting him. This situation is not fair either to patients or to police officers.

Along with other Peers, I very much welcome the ban in this Bill on the use of police cells for those aged under 18 and the plan to reduce their use for adults. Without Amendment 117, my fear is that it could be many years before the aspiration to end the use of police cells as so-called places of safety is actually achieved. The noble Baroness, Lady Walmsley, has been sensitive to the resource pressures, which I certainly understand, in proposing that April 2019 should be the date by which this aspiration must be achieved. This is a modest amendment that simply reinforces the direction of travel of the Government, which I applaud. I hope that the Minister will give it the serious consideration it deserves and bring forward an amendment at Third Reading.

--- Later in debate ---

[Viscount Hailsham]

That is not what it says in the amendment. Had it been so, I would not object, but we are talking about a piece of legislation, and it is coercive. If the police officer has to do it, presumably the child has to co-operate. You are not dealing just with young children, either. You are dealing with people up to the age of 18 and I would have thought that there were a substantial number of cases where the child would not want to be assessed and would find it pretty traumatic if he or she was. While there may be a strong case for putting in place a voluntary system for doing it, there is absolutely no case for making it coercive. I really hope that the House will not think of pursuing such a policy.

[Baroness Howe of Idlicote]

My Lords, I think I will leave aside the contribution of the noble Viscount, Lord Hailsham. I do not really agree with what he said. My name is on this amendment and I support it because it would create a clear and explicit referral pathway for child victims of a sexual offence or other forms of child abuse for an assessment of their mental health needs.

As we have heard, the amendment would deliver on the Government’s own commitment in Future in Mind and work to put in place policies that go a step towards creating parity between physical and mental health. The Government say that they want to develop:

“A better offer for the most vulnerable children and young people”,

including by ensuring that,

“those who have been sexually abused and/or exploited receive a comprehensive assessment and referral to the services that they need, including specialist mental health services”.

The amendment would deliver on that ambition.

It is important to recognise that the Government have made welcome steps in this area, in particular through their investment of £1.4 billion over the course of this Parliament in children’s and young people’s mental health services. However, there is evidence to show that this is not yet reaching the most vulnerable. According to research from the Education Policy Institute, in the first year of funding, of the expected £250 million only £143 million was released—and of that, only £75 million was distributed to clinical commissioning groups. For 2016-17, £119 million has been allocated to clinical commissioning groups—but this has not been ring-fenced, risking that it will be spent on other priorities.

It is clear from the evidence available and what we have heard today that these young people are at extremely high risk of developing a mental health condition. Lifelong difficulties can result in drug and alcohol abuse, mental ill-health, homelessness, gang affiliation and/or disability if the underlying trauma of their experiences is not met with swift and appropriate intervention. Research has found that up to 90% of children who have experienced abuse will develop a mental illness by the time they are 18. In the spirit of parity between physical and mental health to which we all aspire, in a comparable physical situation people would be screened and have regular check-ups, yet we do not offer the most vulnerable children the same opportunity to receive the help they so vitally need.

National policy is increasingly focused on the social determinants of long-term health. Evidence has shown that adverse childhood experiences are a key risk factor for poor outcomes such as worse health, coming into contact with the criminal justice system and worse employment and educational outcomes over the life course. Children who are victims of a sexual offence are often left without support for their mental health difficulties, which are likely to develop into more entrenched mental health conditions later in life, because they do not meet the thresholds for clinical interventions or because a suitably trained professional does not properly assess their mental health needs.

This amendment would provide national consistency, as we know that the situation across the country is inconsistent and young people are not always getting the holistic assessment they need to meet their needs. Thresholds for mental health clinical interventions are inconsistent across the country and referral routes into CAMHS are varied, with some areas not allowing the local voluntary sector to refer directly. Some sexual assault referral centres refer children for mental health support, but others do not.

In her response in Committee, the Minister mentioned the commissioning framework for adult and paediatric sexual assault referral centre—SARC—services, published in August 2015. However, case-tracking evidence from the Havens in London found that, of the 24 children under 13 who were reviewed, only three were referred to CAMHS and that, of the 56 young people aged 13 to 17 who had their cases reviewed as part of the study, only five were referred. It was acknowledged in the same report:

“Few children are referred to CAMHS from the Havens, most likely as interventions are generally at the forensic examination stage and it is difficult to determine longer term emotional support needs at this … stage”.

It is therefore necessary to ensure that other agencies have a duty to refer for a mental health assessment, in order to guarantee that a young person’s holistic mental health needs are assessed after their traumatic experience.

Alongside providing national consistency, this amendment would introduce a referral for an assessment and enable better understanding of the level of support that needs to be provided both by CAMHS and outside CAMHS. This will lead not only to better responses and referral routes for young people but a greater understanding to inform commissioning at local level, so I hope that the Minister will be able to accept this amendment.

[Earl Attlee (Con)]

My Lords, I accept the principle in the amendment of the noble Baroness, Lady Walmsley, in cases of persistent abuse but I am afraid that I am with my noble friend Lord Hogg. There is—