The police are often a first point of contact for a person in a mental health crisis. Last year the police detained more than 2,000 people across Wales under the Mental Health Act. Nearly 10% of incidents which the police deal with are thought to have a mental health dimension.
Changes introduced by the Policing and Crime Act 2017 were intended to improve responses to people in mental health crises where police officers are the first to attend. A key change was to put an end to the practice of a police station being used as a ‘place of safety’. This means that police stations cannot be used as a place of safety for people under the age of 18, and for adults, only in specific “exceptional” circumstances.
In October 2019, the Health, Social Care and Sport Committee undertook a short inquiry to satisfy itself that police custody is no longer being used as place of safety.
There has been a significant decrease in using police cells as a ‘place of safety’
The Committee were told there had been no cases of a police cell being used as a place of safety for a person aged under 18 in Wales since 2015. The Committee also received assurances from senior police officers, inspectors and Welsh Government officials that police custody is no longer being used as a place of safety for adults except in the exceptional circumstances allowed, resulting in a 90 per cent reduction in the number of adult police cell detentions.
However, while the number of people in mental health crisis being held in police custody has decreased, the number of detentions under the Mental Health Act appears to be increasing. Home Office data shows there were 2,256 detentions in Wales under section 136 in 2018/19, compared to 1,955 in 2017/18.
Neither police forces nor Welsh Government could explain why detentions under the Mental Health Act are increasing
The Committee heard that while the use of police custody as places of safety has fallen significantly over the past four years, there is a general trend of rising section 136 detentions.
Section 136 of the Mental Health Act enables a police officer to remove, from a public place, someone who they believe to be suffering from a mental disorder and in need of immediate care and control, and take them to place a safety – for example, a health or social care facility.
The purpose of the detention is to enable the person to be assessed by a doctor and an Approved Mental Health Professional (for example a specially trained social worker or nurse), and for the making of any necessary arrangements for treatment or care.
Nearly all police forces in Wales have seen an increase in detentions under the Mental Health Act. Neither the police nor Welsh Government were able to provide an explanation of why the number of detentions under the Mental Health Act is increasing, with the Committee recommending that some analysis of the data is needed. The Welsh Government accepted this recommendation ‘in principle’, stating that analysing the evidence is a core responsibility of the Mental Health Crisis Care Concordat Assurance Group.
The latest statistical release on the use of detentions under the Mental Health Act in Wales was published on 5 December 2019. Despite being a new dataset, the Committee believes it still needs improving because there are difficulties in getting a full picture of the use of Section 136 detentions. It shows that in the first six months of 2019/20, only 36% of people detained were admitted to hospital but there is no little information on outcomes for individuals.
The role of the police
There will always be a role for the police to play in dealing with people who are in mental health crisis. They are, after all, an emergency service. In its report, the Committee concluded that the police need to be in a position to hand over responsibility for the person with mental health problems to other agencies who can more appropriately meet their needs. However, this can only be done safely if two fundamental components in health service provision are in place.
First, health services need to be available for the police to access advice and support. There are different triage schemes in place across Wales but the impact of these different models is unclear. The Committee recommended that the Welsh Government works with the police to review the emerging evidence on the effectiveness of the different triage schemes in Wales, which it accepted.
Secondly, police officers need access to safe places in the health service. All Health Boards have designated health-based places of safety, but provision varies across Wales. The Committee recognised that health service boundaries are not wholly aligned with the geographical areas covered by police forces and recommended that the benefits of adopting regional models should be considered. The Welsh Government accepted this recommendation, stating it would write to Health Boards for assurance that capacity is meeting demand.
The police also play a role in transporting people to a place of safety. It can be extremely distressing for the person experiencing a mental health crisis and their family for them to be taken away in a police car. Home Office statistics show that in 2018/19 police vehicles were used to convey 86% of people detained under the Mental Health (section 136); the equivalent figure for England was 43%. The Committee wants to see people who need to be detained during a mental health crisis transported by health vehicles.
The Welsh Government accepted this recommendation, stating that it will be part of the review it has commissioned, which is due to published in April 2020 (referred to a Mental Health Urgent Access and Conveyance Review). However, despite accepting the recommendation, the Committee’s call for urgency isn’t reflected in the Welsh Government’s response, particularly as further action will be dependent on the review’s recommendations.
The Welsh Government’s response to the Committee’s report could be seen as very positive. However, while there seems to be a commitment to making progress in this area, the pace and urgency in which the Committee’s recommendations are being addressed may be questioned. Much of the Welsh Government’s response refers to the Mental Health Urgent Access and Conveyance Review currently being undertaken by the NHS National Collaborative Commissioning Unit, which is expected to be published in April 2020. This will determine how the Welsh Government takes forward work in this area.
Article by Sarah Hatherley, Senedd Research, National Assembly for Wales