The number of people who are experiencing mental ill health that end up in police cells is a “scandal” according to a Parliamentary Committee, and is a failure of NHS clinical commissioning groups (CCGs) to provide enough health-based spaces.
In addition, the Committee called for the Mental Health Act 1983 to be amended so that police cells are no longer stated as ‘places of safety’ for people detained under section 136 of the Act.
The Committee’s critical report said that it is clear that too many CCGs are failing in their duty to provide enough health-based places of safety that are available 24 hours a day, seven days a week, and are adequately staffed. It said CCGs must not only acknowledge local levels of demand and commission suitable health-based places of safety; they must also design local backup policies to deal with situations where places are occupied. CCGs need to provide more “places of safety” in NHS hospitals so the police are not forced into filling the gap.
In addition, the report blamed the fact that children are still detained in police cells under section 136 on a failure of commissioning by CCGs. It said the de facto use of police cells as an alternative relieves the pressure on CCGs to commission appropriate levels of provision for children experiencing a mental-health crisis. It called for the NHS to make places available to look after such children locally.
As well as this, the police need to make sure they use their powers in relation to mental health correctly, to reduce the numbers detained and so reduce pressure on both the police and the NHS, the report said. Frontline staff need to learn from one another, and each organisation needs to understand the priorities of others.
The report also found regional variations in the use of police cells as a ‘place of safety’. For instance, the Metropolitan Police detained 1,645 adults under s. 136 but only 75 adults went to police cells. The Met also detained 45 under-18s and zero were detained in a police cell. But Sussex Police detained 1,355 adults under s.136 and 855 went to police cells. Additionally, Sussex detained 45 under-18s with 20 going to a police cell.
But the report did note that early indications show that the Street Triage scheme is effective, but said it was important that the scheme is fully appraised. It recommended that the government committed to make funding available for schemes that have been proven to be cost-effective.
Scandal of detention
Keith Vaz MP, chairman of the Committee, said: "The prevalence of people with mental health illnesses in the criminal justice system is a scandal. It is unacceptable that the police should be filling the gap because the NHS does not have the facilities to look after mentally ill people. The detention of over 6000 adults under s.136 in police cells in England last year is far too high. These people are not criminals, they are ill and often are experiencing a great deal of trauma.”
Vaz also called for the detention of children with mental health issues in police cells to cease immediately. “Last year 236 children were detained in a police cell under s.136. NHS places must be made available for children locally.
“The cost to policing budgets of police officers in custody suites having to deal with mentally ill people is huge. This puts enormous pressure on officers who are not suitably trained and is the starting point for those that are mentally ill to enter the criminal justice system. Many begin a journey which will eventually end in prison.
“Street triage has been shown to work effectively but needs clear funding. In addition, transporting mentally ill people to hospital in an ambulance, rather than a police car, shows that this is a health problem, not a policing one."
Operational and commissioning failures
However, while the Royal College of Psychiatrists agreed that the numbers taken to police cells under s136 were “unacceptable” it did not believe it was necessary to remove police stations from the definition of “places of safety” in the Mental Health Act 1983. “The current excessive use of police cells is the result of operational and commissioning failings rather than the wording of the Mental Health Act or its accompanying Code of Practice, which explicitly states that police cells should only be used in “exceptional circumstances,” said Dr Mary Jane Tacchi, crisis care lead at the Royal College of Psychiatrists.
“The solution to this, as the Committee indeed recognises, is for clinical commissioning groups to prioritise investment in crisis care services and commission adequate provision of health based places of safety as a matter of urgency. This is particularly important with regards to crisis care services for children and young people, which are currently poorly developed in comparison to adults – in fact a recent study found that only 40% of child and adolescent mental health services have crisis care pathways in place.
“It is vital that the Police and NHS commit to working closely together to ensure that anyone experiencing a mental health crisis gets safe, appropriate care. The Committee’s recommendation for joint training between the police and mental health nurses, paramedics and approved mental health professionals, involving mental health charities and people who have been detained under s136 will go a significant way towards achieving this.”