Mental Health (Police Procedures)

Madeleine Moon Excerpts

Thursday 28th November 2013 Westminster Hall

[Mrs Madeleine Moon (Bridgend) (Lab)]

I look forward to this debate under your excellent chairmanship, Mr Brady. I thank the Backbench Business Committee for finding the time for this debate on a most important subject and I am pleased to see the interest, that the turnout here today shows.

The poor quality of life and of the services available to people struggling to live with mental ill health has been the subject of previous debates in the House. This debate relates to police involvement with people with mental ill health, particularly during times of mental health crisis. Mental health crisis, as defined by the Royal College of Psychiatrists, is

“when the mind is at melting point”.

It may involve an immediate risk of self-harm or suicide, extreme anxiety, panic attacks or a psychotic episode. How we treat the most vulnerable in society lies at the heart of our values. We made a decision not to hide away the sick and disabled, as we had hidden them away in the past in asylums and institutions, but we still have a long way to go in granting them equal status in society and equal access to justice.

The Mind report “At risk, yet dismissed” shows that those who suffer from mental ill health are three times more likely to be victims of crime. Shockingly, 50% of people with some form of mental ill health have experienced a crime in the past year, and severely ill women with mental ill health are 10 times more likely to have been assaulted. Crimes are less likely to be reported and prosecuted, because people with mental ill health fear being dismissed or disbelieved. Sadly, the evidence shows that more often than not they are. How does the Minister plan to improve police understanding of mental ill health and ensure more accurate recording of such crimes, and will he give a commitment to greater investigation and prosecution for such offences?

Another reason for not reporting is fear of police powers in relation to mental ill health. Too often, between 5 pm and 9 am during the week, at weekends and on bank holidays, police officers are the only first responders available in a mental health crisis, despite the fact that they lack the medical knowledge, skills and training to resolve and manage the crisis. They respond not because there is a real and immediate threat to members of the public, but because mental health services are understaffed, under-resourced and overstretched, and lack facilities.

For example, Miss P, who is 23 and a size 8, is a sweet, loving young girl who has suffered mental ill health for most of her life. She finds it difficult to build relationships and she is lousy at keeping appointments. She does not drink alcohol, except when she is in mental health crisis, and when she does, she turns into a violent and abusive person. Local mental health services concede that she needs a specialist placement, but they cannot find one. In the past five years, police have been called to 130 incidents and attended court to give evidence for 81 offences, resulting in 18 terms of imprisonment. The gaps between her prison sentences are becoming briefer—days, not weeks—and her self-harming and suicide attempts are escalating. The cost to that young girl, her family, the police, the courts, the probation service and the Prison Service is huge. I am told that it approaches £1 million, all for one young girl.

When the Minister sums up, I hope he will address this critical question: how much longer will we expect our police services to process vulnerable people through the criminal justice system due to mental health, underfunding and failures?

[Keith Vaz (Leicester East) (Lab)]

I congratulate my hon. Friend, the hon. Member for Halesowen and Rowley Regis (James Morris) and the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this debate. My hon. Friend will be pleased to know that, as a result of the work done by her and others, the Select Committee on Home Affairs will be looking into this issue, with a possible report next summer.

Will my hon. Friend comment on the study by Nottingham university, published in May this year, which shows that 56% of custody officers suffer from depression and anxiety? It is not just the victims of crime, but the officers themselves. Is it not right that the new College of Policing should carefully consider the issue of training?

[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.

--- Later in debate ---

[Mrs Moon]

I thank you, Mr Brady, for your excellent chairmanship throughout the debate. I also thank my co-sponsors of the debate, because no one could have had better co-sponsors with greater gravitas or greater recognition on both sides of the House for the work that they do in this area. It is extremely pleasant to see in the Chamber at the end of the debate the hon. Member for Broxbourne (Mr Walker), who has also played a huge part in raising mental health issues in the House.

This is a time of consensus. There is cross-party agreement that we must move forward. We all recognise that the police, the voluntary services, the health service and, most importantly, people who suffer from mental ill health want recognition that it is time for change and for a review of the use of section 136 powers for the 21st century.

I thank the other hon. Members who have taken part in the debate. The hon. Member for Totnes (Dr Wollaston) demonstrated her insight into issues involving rural areas and children, and the hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile) paid particular attention to military matters. We all look forward to the concordat being published in the new year. Let us hope that between us, across the House, we can ensure that people who suffer mental ill health have the service that they desire and deserve.