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29 November (now (5 December) with esteemed Tweets of appreciation from @MentalHealthCop)
@THEAGENTAPSLEY A fairly weak BLOG, you must admit - it fails to consider history, law and practice in light of how services have evolved.
— InspMichael Brown (@MentalHealthCop) December 5, 2014
One would have to read Hansard, the verbatim record of the business of the Houses of Parliament, to know what was on the mind of MPs and Peers when they enacted the Mental Health Act 1983 (since amended), and, within it as a sequence of numbered enactments, section 136, which begins (quoting sub-section 1) :
Mentally disordered persons found in public places
(1) If a constable finds in a place to which the public have access a person who appears to him to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, remove that person to a place of safety within the meaning of section 135 above.
Not exactly normal English ! However, if they can interpret it, our police are given a power by this sub-section (s. 136(1)), but only if the criteria apply for it to arise – one could infer a concomitant duty to act by using this power, though, if so, one should be able to justify one’s thoughts…
Usually, the police can hold you for <24 hours before they have to charge you with a crime or release you : not under Mental Health law ->— THE AGENT APSLEY (@THEAGENTAPSLEY) December 25, 2014
-> Is it right that, just because one was in a public place and an officer *thinks* one has a mental disorder, detention can be for <72h ?— THE AGENT APSLEY (@THEAGENTAPSLEY) December 25, 2014
The test of whether someone is ‘suffering from mental disorder’ is a subjective one, i.e. what appears to the constable. Fair enough, but how has the constable been trained to recognize ‘mental disorder’*, and does the constable even know what happened last time that he or she exercised the power (please see below for how often officers are wrong) ? If not, how does he or she know whether that had been a case of ‘mental disorder’ and so learn from it ?
Or should we even be putting a responsibility on the police to construe mental-health legislation and to assess the appearance of a person on public property as to whether there is mental disorder ? One has to ask, because (under s. 136(2)), the person with the appearance of mental disorder can be detained (i.e. against his or her will) for as long as 72 hours. Sub-section 2 specifies what that period of time – longer, by far, than the period for which someone can be detained, on such authority, because of suspected criminality – is to be used for :
(2) A person removed to a place of safety under this section may be detained there for a period not exceeding 72 hours for the purpose of enabling him to be examined by a registered medical practitioner and to be interviewed by an approved mental health professional and of making any necessary arrangements for his treatment or care.
The sub-section is therefore quite precise about what the purpose of the detention is, but the Act fails to make any link between sub-section 2, and exercising the power to take the person (against his or her will) to a place of safety under sub-section 1 : where is the link, except temporally, for up to 3 days in detention within which to arrange the specified matters ?
The Act is not explicit, but one is essentially looking at an assessment to see whether the person should be detained under ss. 2, 3 – but giving this period of 72 hours in a so-called place of safety to do it. As can be seen above, s. 136(1) refers to s. 135 in this connection for a definition, where s. 135(6) says :
(6) In this section “place of safety” means residential accommodation provided by a local social services authority under Part III of the National Assistance Act 1948..., a hospital as defined by this Act, a police station, an independent hospital or care home for mentally disordered persons or any other suitable place the occupier of which is willing temporarily to receive the patient.
Pretty broad, one would think – so why do commissioners of mental-health services not have standing arrangements with, say, independent hospitals for them to be places of safety in case of need ? Why, if NHS Trusts do not have the beds, is someone not paying for them to be provided in this way – somewhere that would also have staff trained to know mental disorder when they see it ?
And we are relying on officers on the street, etc., to determine what appears to be mental disorder, when – even if they could all be given training in Mental Health First Aid – it would probably be far better for them to call someone who is versed is mental disorder – except that we seem to jump straight to the ‘place of safety’, often enough a police-cell, and then no one stirs themselves, because the medical practitioner and / or AMHP (approved mental health professional) have three days in which to call by.
Would a police officer be trusted to move someone with a suspected broken neck in the back of a police-car ? No, of course not ! An ambulance would be called, and one would rely on those trained medical staff to deal with assessing the person’s injuries and moving him or her.
If there were a crowd or other situation, one would keep the person safe at the scene until the trained staff arrived, and then assist them in carrying out their duties or treatment on site and of taking the person to an appropriate hospital. Why – just because so many people view those who may have a mental disorder as nutters ? – should the status quo equally not be maintained until appropriately trained mental-health professionals can arrive, rather than ‘carting the person off’ ?
Allegedly, we have parity of esteem under the NHS (Health and Social Care Act 2012) for mental and physical health, so why is the person suspected of a breakdown not treated in the same way as for a broken neck ? So, X fell from a balcony in a shopping centre – we clear the area and keep him or her out of harm until the ambulance crew arrives – and the same should apply if X had been reported to be behaving bizarrely in that shopping centre, keeping X safe until the trained personnel come.
A Briefing Note by the Centre for Medical Health makes a point relevant to how s. 136 is being used, quoting this statistic given by a report from 2013 by Her Majesty’s Inspectorate of Constabulary, Care Quality Commission, Health Inspectorate of Wales, and Her Majesty’s Inspectorate of Prisons :
It also noted that 80% of those detained under section 136 are not admitted to hospital for treatment. This suggests an urgent need for better working relationships and knowledge between the police and mental health services.
Thus, in just 1 in 5 cases, the officer was right. Hardly a good enough percentage on the basis of which – even if it were not otherwise problematic – to continue as we are ?
But we must end as we began, with sage words - albeit of denial - from @MentalHealthCop... :
.@THEAGENTAPSLEY Did I ever say that?!
— Insp Michael Brown (@MentalHealthCop) December 5, 2014
* If one wants to know what that phrase means, the much-amended s. 1 tells one…
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Unless stated otherwise, all films reviewed were screened at Festival Central (Arts Picturehouse, Cambridge)