A Home Affairs Committee report calling for a change in mental health law is widely reported by the media in February. The committee report was critical of Clinical Commissioning Groups (CCGs) and called for a change in the law so that police cells are no longer deemed a "place of safety". In March, Her Majesty’s Inspectorate of Constabulary (HMIC) published a new report “The welfare of vulnerable people in police custody” which found that ‘… custody could have been avoided for a number of vulnerable adults and children, had other action been taken by police officers, or other services been available to support these individuals’.
We absolutely agree that police cells should not be a place of safety and would also agree with the Home Affairs Committee that it is rarely right for people experiencing a mental health crisis to be transported by police car to a place of safety. We welcome the HMIC report, in particular the recognition that ‘joint working arrangements with mental health services in some forces [are] successfully diverting people with mental health problems away from custody by offering them advice and support.’
Working with the police, ambulance service and other partners we have significantly reduced the number of patients detained under section 136 of the Mental Health Act. A multi-agency group meets monthly to look at place of safety statistics and address any concerns arising.
Our regular monitoring demonstrates a continued downward trend in section 136 detentions. Furthermore, police transportation is reducing as South Central Ambulance Service is transporting many more of our mental health patients to a place of safety.
In Berkshire we do not agree with the Home Affairs Committee view that CCGs are 'failing in their duty to provide enough health-based places of safety', or that we are not 'acknowledging local levels of demand.'
The use of health-based 'Places of Safety' has increased by 51% in Reading
Berkshire West Clinical Commissioning Groups now provide three places of safety on the recently refurbished Snowdrop Ward at Prospect Park Hospital in Tilehurst. These places are available 24/7 and are not subject to exclusions. We believe this is sufficient for current demands.
A Street Triage Project, where a mental health worker accompanies the police, has been jointly commissioned by Berkshire West CCGs and Local Authorities. We're expecting this service to be operational by end of March 2015 in Berkshire West and are hopeful that the initiative will; further reduce the numbers of section 136 detentions, reduce the number of repeat detentions and reduce the overall need for places of safety.
In addition Berkshire West CCGs have commissioned an Ambulance Triage Pilot Scheme, using the winter resilience fund to support Ambulance Crews to assess and triage mental health patients to the least restrictive support services.
The Home Affairs Committee report suggests CCGs are failing to provide local places of safety for children with mental-health issues. While very few children in Berkshire are admitted to a place of safety, where this does prove to be necessary we endeavour to place children in the Paediatric Ward at Royal Berkshire Hospital and, whenever possible, accompanied by a parent.
The Home Affairs Committee is right to express national concerns, but it is also right to say that Berkshire West Clinical Commissioning Groups have made good progress on this issue.
(Article originally published 6th February, updated 10th March 2015 following publication of HMIC report).
Media contact for Berkshire West CCGs
Steven Buckley - firstname.lastname@example.org / 07789 933 276
Notes for editors
- Section 136 detentions
The police can use section 136 (S136) of the Mental Health Act to take a person to a place of safety when they are in a public place. The police can do this if they think a person has a mental illness and is in need of care. A place of safety can be a hospital or a police station though the Care Quality Commission makes clear that patients should only be taken to a police station in exceptional circumstances. A person removed to a place of safety under S136 may be detained there for a period not exceeding 72 hours. The police can currently move patients between places of safety.
- Street triage
In Oxford a similar project dramatically decreased the need to use places of safety as well as reducing the number of Section 136s issued. A reduction of 25% in S136 detentions was achieved during that pilot.
- Examples of Section 136 detentions in Berkshire
Examples of reasons for the police S136 detentions in Berkshire include self-harming patients where ambulance staff need additional police support, suicidal patients near the railway, people walking on motorways or driving a car in the wrong direction, and people who are mentally unwell who come to police attention due to criminal acts. The use or not of Berkshire Places of Safety is not dependent on where a patient has a GP or where they live, it is based on where the Section 136 is applied.
- Patients turned away from Health Based Places of Safety (HBPOS)
There are no exclusion criteria in place in Berkshire. The only time now that a patient is turned away is if the health based places of safety are all in use at the same time, or if the person is seriously disturbed and would be best taken to a custody POS.
- Mental Health
Mental illness is the single largest cause of disability in the UK. At least one in four people will experience a mental health problem at some point in their life and one in six adults have a mental health problem at any one time. Among people under 65, nearly half of all ill health is mental illness. Approximately 1% of the UK population has a severe mental health problem and many will have begun to suffer from this in their teens or early twenties.
- CQC map of health based places of safety
- BBC News report "Scandal of mentally ill being held in police cells"
- Prospect Park Hospital
- HMIC report, ‘The welfare of vulnerable people in police custody’