Mental Health (Police Procedures)

Kerry McCarthy Excerpts

Thursday 28th November 2013 Westminster Hall

[Mrs Moon]

As always, my right hon. Friend makes excellent information available to the House. I am delighted to hear of the study to be made next year by his Committee, which is highly regarded across the House. He is right to focus on mental ill health among police. It is little surprise, given the amount and range of incidents with which we require them to deal. That is why we must ensure that the police are called to attend only incidents that they can deal with and that they have the skills and capability to manage, so they do not go home at the end of their shift feeling guilty and bereft about an incident that they may perceive they dealt with badly. My right hon. Friend made a most helpful intervention, and I thank him.

The Centre for Mental Health states that police are the first point of contact for a person in mental health crisis and that up to 15% of police incidents have a mental health dimension. Other people have told me that mental health interventions occupy up to 30% of police time. The Royal College of Psychiatrists recognises that in some areas police cells are the routine place of safety, under section 136 of the Mental Health Act 1983, when a mental health crisis requires urgent assessment and management. Many of those detained come from socially deprived backgrounds, and some black and minority ethnic groups are over-represented.

The Royal College reports considerable geographic variation in the use of police cells. During 2012-13, five police areas recorded more than 500 uses of police-based section 136 places of safety, while four areas recorded 10 or fewer uses, and one had zero. The difference was that the latter areas had better health-based services and facilities. Will the Minister undertake to talk with the Department of Health about the urgent need for commissioning boards to provide an adequate number of staffed health-based places of safety in every part of the country? At present, 36% of all places of safety under section 136 are thought to involve police custody. In 2011-12, an estimated 8,000 to 11,000 orders were made, with 347 involving under-18s. Will the Minister ensure that accurate figures on how often and in what circumstances police officers are called to deal with mental health crises are available, so that we can get a clear picture of the problem?

People held by police under section 136 are, as I have said, the most acutely vulnerable. One study found that in 81% of cases involving police-based places of safety, the person was self-harming or suicidal. The Independent Police Complaints Commission found that 35% of deaths in police custody involve people with mental ill health. Alarming reports from Inquest show that a number of those deaths are linked to police restraint techniques, and that 65 people took their lives within two days of leaving a police place of safety. Between 20% and 30% of people held on section 136 detentions in police cells were subsequently sectioned.

The impact on time and costs associated with police engagement in mental ill health has never been calculated accurately, but it is clear that, in a variety of ways, health service costs are being passed to the police services. It is common for police officers taking people in mental health crisis to accident and emergency or medical-based places of safety for an assessment to be told, “There’s no bed available”, “The person is too drunk”, “They are under the influence of drugs”, “They are aggressive”, “They are a child”, or, “They have a learning disability”, all of which condemn that person in crisis to a night in police custody. How much longer can we allow these informal exclusion criteria around drugs, alcohol, aggression, children and learning disabilities to continue?

[Kerry McCarthy (Bristol East) (Lab)]

My hon. Friend is making all the points that are in my notes—although I was intending not to speak in the debate, but merely to intervene. That is exactly what local police officers have said to me. They feel uncomfortable about the police having to perform that role and becoming the place of safety of last resort. Several parents of adult sons who can be difficult and dangerous have come to me. They are reluctant to call for help when they feel that they are under threat or that their son may threaten other people, because they do not want them to be in the police system—they do not want to criminalise them— but they know that there is nowhere else they can refer them to.

[Mrs Moon]

I thank my hon. Friend for her intervention. She makes an excellent case for ensuring that crisis intervention teams are available with the skills and capability to understand and manage mental health problems. These are not the skills that we provide our police officers with; this is the skills base that we provide our mental health nursing professionals with, which is why specialist crisis teams in mental health services must be expanded and made generally available.

Places of safety in bridewells remove police staff from the front line, as they supervise and monitor vulnerable, at-risk individuals and arrange mental health assessments. The Health and Social Care Information Centre found that, even where a place of safety was health based, in 74% of cases transportation was provided by police, not the ambulance service. The police were providing an ambulance/taxi service.

More than 40,500 patients absconded from mental health units in the past five years. Again, police officers are expected to find and return these individuals, even when they pose no risk to wider society. Then there are calls to respond to understaffed mental health units where a patient’s behaviour is deemed to be unmanageable. These are not tasks for police officers. To quote the Police Federation:

“Police officers should not be called to mental health premises to assist in the restraint of aggressive/violent patients. Mental health professionals are trained in the control and restraint of mentally ill patients and have powers to sedate them, whereas police officers are trained to subdue, restrain and arrest violent people.”

Inquest, Mind and others have highlighted the risks of police restraint, as opposed to mental health restraint techniques. I welcome the Royal College of Nursing study into restraint techniques. I also welcome the nine pilot street triage schemes operating across the 43 police forces where mental health nurses are either available with police officers responding or available to consult. The schemes are making a huge difference, but we cannot wait until 2015 for them to be assessed and reviewed before we put them in place across the public sphere.

We need suitably staffed hospital places of safety in all areas, catering for all age groups and available 24 hours a day, so that police stations are used only in exceptional circumstances. We also need section 136 to be used less by better, improved mental health services generally—however, I want to focus on removing the police from the equation. We need accurate data—a point I have already raised with the Minister—on the use of section 136 in the police service. The report from the independent commission on mental health and policing states:

“We need to ensure the culture within policing is one that recognises their role in supporting people in crisis and their responsibilities under the Mental Health Act.”

There needs to be a higher level of training and awareness for police officers. The online training that is currently available is just not good enough. Some forces have teamed up with community groups, local health trusts and universities, working with mental health patients, to improve their operation. Best practice from these groups needs to be shared and expanded.

The Association of Chief Police Officers lead on mental health says:

“There should be a reduction from 72 to 24 hour detention time…for a”

section 136

“assessment to take place when a police place of safety is utilised… 72 hours should remain for health based”

assessment. The 24-hour period would

“reflect the detention time limits in the Police and Criminal Evidence Act 1984…To support this, a statutory time limit for assessments to be undertaken by all health professionals”

for those

“in police custody should be put in place. The Pace clock should be stopped for 4 hours while assessments are carried out where there are criminal offences to be faced”,

so that police are not restricted in the time that they have to cross-examine someone. I am confident that I reflect the feeling in this Chamber and the wider House today. No one would be turned away from an A and E department if they had had a stroke or broken a limb, if they had had alcohol or were aggressive. We cannot let mental health services operate to different criteria.

I want briefly to focus on what is a growing area. We need to be sure that we have clear guidance and responses in place for the 800,000 people in the UK diagnosed with dementia. A 91-year-old man suffering with psychotic dementia was living at home with the support of his family and the mental health team. One evening, a neighbour called the family to say he was wandering the street looking for his wife, who had died six years previously. His son went immediately to his father and at around 9 pm called the out-of-hours health service for advice. The doctor took the details and asked whether the son wanted to bring his father to the hospital or whether he wanted the doctor to visit the house, but the son said, “No, it’s okay. I’m on top of things. Dad’s okay. I’ve given him a cup of tea and he’s heading for bed.” By 11.30 pm the gentleman was in bed, fast asleep and his son went home.

At 2.30 am, the family had another call from the neighbour, saying, “The police are breaking into your dad’s house.” Why? Because the out-of-hours doctor decided to watch his back and had sent an ambulance, but it did not arrive till three hours after he called it. The man was fast asleep and the ambulance crew felt they had to get a response, so they called out the police. The police climbed on to the ledge over the front door, looked in and saw the man in bed, fast asleep and said, “He’s fast asleep”. The ambulance crew said, “No, we must see him.” The police broke in, terrifying the man, who was greatly distressed—as can be imagined—so they took him to A and E, because they could not handle the situation. That is an appalling situation. The family tried ringing the ambulance service and the police, saying, “Leave him alone. He’s fine,” but they carried on. He was highly distressed when he got to the hospital, and thought he had done something wrong and felt that he was the criminal. This was an appalling case.

There are good ideas and good practice for when people are missing, for example, or have wandered, including using taxi drivers, Citizens Advice and neighbourhood watch to look out for individuals. Police officers need clear guidance on how not to exacerbate a situation by going in, in uniform, and frightening people who are wandering.

We have lost 15,000 police officers in the last three years. The police must prioritise tackling crime, ensuring public safety and upholding the law. It is not the task of police services to fill gaps in an overstretched mental health service. We need to consider how to respond to the most vulnerable in society. The police must build their partnerships with agencies and organisations best equipped to provide appropriate help and support. I look forward to colleagues’ contributions to the debate, to the Minister’s and the shadow Minister’s responses, and to improved quality of services for those in mental health crisis.