Independent Office for Police Conduct (IOPC - formerly IPCC)
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IPCC publishes major study on use of section 136
Twice as many people are detained in unsuitable police custody for assessment under the Mental Health Act as those taken by the police to hospital for this purpose, according to research published by the Independent Police Complaints Commission (IPCC) today (10 September).
During a one year period (2005/06) over 11,500 people were detained in a police cell as a place of safety under section 136 of the Mental Health Act. In the same period 5,900 people were taken to and detained in a hospital.
The IPCC's report, 'Police Custody as a "Place of Safety": a National Study Examining the Use of Section 136 of the Mental Health Act 1983', examines the nature and extent of the use of police custody as a place of safety across England and Wales. It is the first time national data on the use of section 136 by all 43 police forces has been collated. The report makes a number of recommendations for the police and health services to improve practice and the experiences of the many thousands of people detained by the police under this power.
Under section 136, police officers can detain people, believed to have a mental disorder, who are in a public place and take them to a place of safety such as a hospital or police station for assessment.
Ian Bynoe, IPCC Commissioner with national responsibility for mental health, said:
"Someone whose distress or strange behaviour causes the police concern needs rapid medical and social assessment in a safe environment. It is therefore intolerable that even though it has been Government policy since 1990 that a hospital is the preferred place of safety for such an assessment our research shows that twice as many people are detained in police custody as in a more fitting hospital environment.
"Police custody is an unsuitable environment for someone with mental illness and may make their condition worse, particularly if they are not dealt with quickly, appropriately and don't receive the care they need. The continued use of cells not only diverts police resources from fighting crime, but criminalises behaviour which is not a crime. A police cell should only be used when absolutely necessary, for example when someone is violent, and not as a convenience."
An estimated 11,500 people were detained in police custody as a place of safety in 2005/06. This compares with about 5,900 people in a hospital environment that year.
The use of section 136 varies significantly between police forces. The average rate of detention across England and Wales was 55 detentions per 10,000 people in custody. Low rates of detention were reported by Cheshire and Merseyside Police (1 per 10,000 people in custody). High rates were reported by Sussex Police (277 per 10,000) and Devon and Cornwall (174 per 10,000).
Just under two thirds of people (61%) detained in police custody were male. The average age of those detained was 36 years, but the ages ranged from 12 to 89 years. Four per cent of detainees were aged 17 or under. Four people were 12 years old.
Almost eight out of 10 (78%) of detainees were White; 4% were Black; 3% were Asian; 2% other ethnic origins and 14% were of unknown ethnicity. When compared to the general population the rate of detention for Black people was almost twice (1.7 times) as high than for White people.
The majority of people (78%) were detained in police custody for 12 hours or less. The average length of time spent in police custody was nine hours and 36 minutes. Ten individuals were detained for over the legal limit of 72 hours. Almost two thirds (65%) of section 136 detainees arrived in police custody outside of normal office hours (between 6 p.m. and 9 a.m.).
Differences across England and Wales
The IPCC's research examined why the rates of the use of section 136 varied so much between police forces.
The strongest factor in explaining the differences in the rates of use of police custody is the availability of alternative places of safety. Alternative places of safety were more readily available and more commonly used in low rate and some medium rate forces, than higher rate areas.
A strong factor in some forces was suicidal behaviour associated with high local populations of transient and deprived populations, along with well known 'suicide spots' such as seaside cliffs in the police force area. These tended to be in areas where there was little or no alternative to police custody and so had the effect of pushing rates of detention up.
A number of people were being repeatedly detained and released under section 136. They were often felt to be more difficult to assess and care for due to the complexity of their problems, for example having a combination of mental disorder and substance abuse. In some areas outreach work was being conducted in order to reach these people and reduce the numbers of detentions in future.
Other examples of differing practice include officers in forces with lower rates of the use of section 136 finding it less bureaucratic to arrest for minor offences such as breach of the peace, compared to officers in higher rate forces where the reverse was true. This could account for some differences in the rates of detention.
Inconsistent and incomplete data recording by police forces means that information is not available on what happened to section 136 detainees after they were released from police custody. This makes it difficult to establish whether the power is being used appropriately.
Mr Bynoe said:
"The strongest factor in explaining the differences in the rates of section 136 use by police is the availability of alternative places of safety. Our research found that alternative places of safety were more readily available and more commonly used in low rate forces.
"When senior police officers and senior staff within health and social care recognise this is a joint problem which requires a coordinated approach it becomes more likely that alternative places of safety will be developed."
The IPCC report sets out 22 recommendations to improve practice
in the future:
NHS commissioners should:
Recommendation 1: work with relevant organisations to develop alternative places of safety to police custody. Consideration should be given to using existing facilities, such as hospital emergency departments and psychiatric units where it may be possible to set aside a space that can be used as a place of safety. These facilities should adhere to the Royal College of Psychiatrists' standards on places of safety (2008).
Recommendation 2: consider applying for Department of Health funding to set up purpose built facilities where necessary; taking into account how they will staff these facilities using their existing resources. This funding does not apply to Wales and health boards there will need to consider local funding arrangements.
Recommendation 3: consider what preventative outreach work might be conducted to help individuals who are detained under section 136 frequently. Such outreach work may help to prevent some section 136 detentions and ensure that at risk individuals receive appropriate care and treatment.
Recommendation 4: use specialists, such as community psychiatric nurses, to provide outreach services to police custody and arrange mental health assessments. Joint funding from both the police and primary care trust/NHS commissioner would increase staff availability outside normal working hours.
Police forces should:
Recommendation 5: consider ways to improve the co-ordination and timeliness of mental health assessments. For example, where specialists such as community psychiatric nurses are not available to arrange assessments, agreements could be made for approved social workers to co-ordinate assessments.
Recommendation 6: raise any problems with lengthy delays in mental health assessments in hospital emergency departments with the relevant primary care trust/NHS commissioner to see if a solution can be agreed - for example, the implementation of target times.
Recommendation 7: ensure that officers on the street have adequate training to recognise symptoms of mental disorder, understand their powers under the Mental Health Act 1983, and know what their local arrangements are for places of safety.
Recommendation 8: agree with other agencies that officers can contact individuals with mental health expertise, such as approved social workers, to get advice on particular individuals.
Recommendation 9: ensure that custody officers and staff receive refresher training on mental health symptoms and section 136 processes so that detainees held in police custody receive appropriate care and attention.
Police forces and NHS commissioners should jointly:
Recommendation 10: meet at a strategic level to review the current arrangements with regard to section 136 detentions in their area. This should include a review of the effectiveness of existing protocols and agreements, if they exist. Section 136 should be seen as a joint problem and joint solutions should be sought.
Recommendation 11: review their arrangements for detaining under section 136 people who are intoxicated and/or violent to ensure that they get the most appropriate care. It might be possible to provide a non-police facility where individuals can be safely detained and assessed with police officers present.
Recommendation 12: look for solutions that improve the availability and/or timely attendance of doctors approved under section 12 of the Mental Health Act 1983, where this is a problem. Forces should require their forensic medical examiner provider to ensure that sufficient forensic medical examiners are section 12 approved. This could be particularly helpful in increasing the availability of specialist doctors outside normal working hours.
Recommendation 13: accurately and consistently record section 136 detentions both in police custody and hospital environments. The records should include key demographic details such as age, gender and ethnicity, along with the length and outcome of the detention (for example, whether the individual was taken to hospital). We support the Royal College of Psychiatrists' (2008) suggestion that one national recording form for England and Wales is introduced. Police forces should also work to ensure that offenders with mental disorders are captured on their systems in order to identify the true scale of the detention in police custody of people with mental disorders.
Police forces, NHS commissioners, ambulance services, and social services should jointly:
Recommendation 14: agree a policy on the transportation of section 136 detainees being admitted to hospital following an assessment (within the wider conveyance policy required under the Mental Health Code of Practice). This should include detainees being held in police custody and at alternative places of safety. Ambulances should generally be used for transportation, unless there is sufficient risk to ambulance staff due to the violence of the individual. In such cases it may be acceptable to use a police vehicle. It is imperative that the transportation of a detainee occurs as promptly as possible, so as not to prolong their detention in police custody. It is therefore important that appropriate and realistic target times for transportation are set, agreed and adhered to.
Recommendation 15: agree a policy on the transportation of section 136 detainees being released back into the community (when transportation is necessary). This should include detainees being held in police custody and at alternative places of safety. The policy should specify which organisations are responsibility for transportation in the different circumstances, and which is responsible for paying for the costs involved in using taxis.
Recommendation 16: monitor section 136 detentions by multi-agency groups at a local level to identify any problems. This should include monitoring of the new power to transfer between places of safety to see how it is being used in practice.
The Healthcare Commission, and its successor, the Care Quality Commission, should:
Recommendation 17: collate annual data on section 136 to improve data collection and increase understanding of the use of section 136. If a national form is adopted for recording all section 136 detentions in custody and alternative places of safety, as suggested by the Royal College of Psychiatrists (2008), this information should be collected locally. The information can then be provided to the Care Quality Commission for collation.
Recommendation 18: conduct analysis into the data gathered on section 136 detentions, such as the make up of the detainees, length of time they are detained and the outcome of section 136 detainees to see what happens to the individuals. This will help to determine whether this power is being appropriately used across police forces. The data should be presented annually and be made available to the public.
The police, social services and mental health trusts should:
Recommendation 19: provide joint training on section 136 and mental health. This will help to improve communication and understanding about the different roles and responsibilities between the various organisations.
Recommendation 20: clarify the current situation by providing joint training on information sharing and what can be shared legally about a section 136 detainee.
Further research should:
Recommendation 21: examine and seek to explain disproportionality in the ethnic make up of section 136 detainees.
Recommendation 22: explore the experiences and perceptions of section 136 service users' experiences. This is an important gap in our knowledge and understanding the experiences of these individuals could help improve the detention process and the care that people receive.
Mr Bynoe added:
"This is an important piece of research which has implications for the police, health and social care services. We have written to the chief xxecutives of all primary care and mental health trusts, as well as all chief constables of police forces in England and Wales to make them aware of the findings and recommendations and encourage them to act upon these.
"Over the next year IPCC Commissioners will monitor whether their forces and local health and social care authorities have developed new protocols on the use of section 136 in their area taking account of the new Mental Health Act and the revised Code of Practice limiting the use of police custody to exceptional situations."
"The IPCC will now work with ACPO, the Royal College of Psychiatrists and the Sainsbury Centre for Mental Health to ensure that our work and recommendations are taken forward."
* 'Police Custody as a "Place of Safety":
Examining the Use of Section 136 of the Mental Health Act
1983', Maria Docking, Kerry Grace and Tom Bucke, IPCC, London
ISBN 978-0-9556387-1-8. The report can be found at http://www.ipcc.gov.uk/index/resources/research/mh_polcustody.htm
or it is available from the IPCC, 90 High Holborn, London WC1V 6BH.