Written evidence submitted by the Metropolitan Police Service (MPS) (MHB0103)

 

Introduction

 

1.      We welcome this opportunity to provide written evidence to the Joint Committee in its scrutiny of the Government’s draft Mental Health Bill (the Bill). We present our evidence in two parts. Part 1 focuses on overarching observations on the police’s role within mental health. Part 2 provides evidence in relation to a specific issue around section 135 of the Mental Health Act 1983 (the Act) and how the Government could seek to rectify this issue within the Bill.

 

2.      Whilst this evidence is presented by the MPS (and is therefore grounded in MPS data and experiences), we have benefited greatly from the input and oversight of national policing colleagues and in particular by the College of Policing and the National Police Chiefs Council.

 

Part 1 – Overarching observations on the police’s role within mental health

 

3.      We accept there may always be a need for the police to play a role in mental health where there are high-risk incidents, likelihood of serious harm, or where a criminal investigation is required. However, we are increasingly seeing the police becoming not just the ‘first response’ service to mental health incidents but also having to remain with people who are mentally unwell far beyond what should be expected. Our officers simply cannot provide the specialist care needed, exposing both patients and officers to extreme risks.

 

4.      A central tenet of the Act is for the least restrictive option to be considered by police when dealing with persons suffering from mental ill health and for the patient to be under the care of health professionals at the earliest opportunity. As such, our ambition is that the right intervention is provided by the right agency at the right time. In almost every instance, this should be a health intervention from a health agency. 

 

5.      However, our data suggests that we are seeing an ever increasing amount of police time spent dealing with mental health incidents. This serves neither our officers, the public or, most importantly, those suffering mental ill health. Since 2013, the MPS’ usage of section 135 and section 136 powers has increased by 590% and 450% respectively. Over the same time period, the volume of mental health related calls received by the MPS has steadily decreased, so this is not a case of an overall swell in demand. Our view is that the police are being pushed into a primary health care role due to a lack of provision of services by other public agencies. 

 

6.      We would draw the Committee’s attention to three specific issues of how this is impacting the MPS and those in mental health crisis, namely: bed provision and onward care; handover from police to medical staff; and conveyance.

 

 

Inadequate bed provision and onward care

 

7.      We have seen increased pressure as a result of bed capacity issues within Health Based Places of Safety (HBPOS). Following the pandemic, the number of mental health beds in HBPOS’ in London reduced by 111 from 1,713 down to 1,602. In addition, there was a 78% increase in beds occupied by people medically ready for discharge with a lack of suitable accommodation in which to move them into. This lack of capacity increases the use of other health settings like A&E, which can lack the security and/or capacity to manage mental health crisis care effectively, as the case study below demonstrates:

 

a.     Case Study: Police were called to an address following reports of a male causing a disturbance. It was discovered that the male was a patient who had absconded from a nearby hospital. Police contacted the hospital to return the patient as no substantial criminal offences were found. Police were informed there was no bed space as the hospital has relinquished the patient’s bed space following him absconding. The patient was taken by the police to A&E where they were informed they would not take responsibility for the patient and had no security provision to watch over him. The patient was guarded by police to prevent him becoming a high-risk missing person. For over 29 hours, MPS resource sat with the male patient (utilising eight police constables).   

 

Handover from police to medical staff

 

8.      Officers cannot discharge their duty to a patient subject to a section 136 detention until a medical professional has confirmed their duty of care for that patient. Officers take this duty seriously, and for good reason. Agreed guidance has been published on section 136 pathways entitled, ‘Mental Health Crisis Care for Londoners’ (known colloquially as ‘the Blue Book’). That guidance states, in relation to handover of patients from the police to a mental health trust:

 

If requested by staff, Police will remain at the Health Based Place of Safety up to a maximum of an hour, but in most cases the Police should be free to leave within 30 minutes of the handover. If the person represents a significant risk of violence, the safety of the individual and staff should be explicitly assessed.

 

9.      However, we know this guidance is rarely adhered to based on available data. The NHS Benchmarking Network Census report from 2021 revealed officers spent an average of 14.3 hours dealing with section 136 detentions. During this 14.3 hours, officers are not dealing with crime priorities and patients are under the supervision of police, who do not have the specialist training to best manage mental health crisis. Health partners are given regular updates on this type of handover data.

 

10.  Further, the NPCC are conducting a national productivity review into policing on behalf of the Home Secretary. Part of this work has included a deep-dive into mental health demand which provides revealing (and recent) statistics on the use of A&E for those subject to section 136 powers. In September 2022:

 

a.     In the MPS, 610 individuals were subject to section 136 detention. 41% were taken to A&E. Of this 41% only a third needed to attend A&E on medical grounds. The average time officers spent in A&E/HBPOS was 10 hours;

 

b.     In Kent, 64 individuals were subject to section 136 detention. 64% were taken to A&E. The average time officers spent in A&E/HBPOS was 12 hours;

 

c.      In Cumbria, 23 individuals were subject to section 136 detention. As trusts in Cumbria do not recognise A&E's as a place of safety, only one had to go to A&E which was for a medical need. Cumbria reported officers spent 5 hours in A&E.

 

11.  We also know that leaving patients with police officers can exacerbate mental health crisis. This is demonstrated by the case study below:

 

a.     Case Study: A female patient was detained in a police van under section 136. No bed space was available in the relevant mental health trust so the patient was taken to A&E. Officers were told there was no space for the patient in A&E so they would have to wait with her in the police van. The patient’s behavior became more erratic as she spent more time in the police van, including banging her head on the caged door in the van. Officers had to use restraints to prevent her from injuring herself and the officers present, causing further distress. Officers had to chase up hospital staff on several occasions for the patient to be admitted. Hospital staff said they had forgotten officers were outside in the police van with the patient. In total, the handover time from police to health staff took 23 hours.  

 

Conveyance of mental health patients in police vehicles

 

12.  MPS data shows that in 2021, 60% of section 136 patients were conveyed in a police vehicle compared to 49% in 2019. For the first time in 2021, more patients were conveyed to a health setting in a police vehicle than in an ambulance. In the majority of cases this is inappropriate. This is also not a core policing focus and undermines the police being able to deliver local services.

 

Part 2 – section 135 of the Act

 

13.  Under section 135 of the Act, if an approved mental health professional (AMHP) has reasonable cause to believe that an individual is in mental health crisis, then they may apply for a section 135 warrant. The granting of a warrant permits the police to enter a premises with an AMHP in order for a patient to be taken (or kept at) a place of safety in order that a mental health assessment be carried out.

 

14.  Currently, section 135 of the Act provides strict parameters as to how a warrant must be executed. In particular, it states that a warrant may only be issued authorisingany constable” to enter a premises. We believe there is a strong case to build in a degree of flexibility to the Act to allow, for example, “any authorised individual” to enter a premises to execute a warrant. This could include a private security provision, should an AMHP see this as necessary. We have consulted with the College of Policing and the National Police Chiefs Council who have given their support in reviewing this area of legislation.

 

15.  Our rationale for this suggestion is as follows:

 

a.     Where an individual is not-known to be violent, we would suggest the police are overly engaged in these warrants purely as a consequence of the wording of the legislation. Lower-risk cases do not, practically speaking, require a police presence and we know that uniformed police can add to anxieties for those suffering mental health crisis, despite high standards of sensitivity from officers.

 

b.     The very nature of automatic police involvement in section 135 warrants raises the risk of over-criminalising people in need of health care. This is especially relevant for mentally unwell community members from diverse communities whose confidence in policing is lower than others and who may see the presence of officers as over-bearing.   

 

c.      We are seeing increasing requests to attend and execute section 135 warrants. This prevents policing ability to respond to crime. Section 135 deployments have increased from 253 in 2013 to 1,495 in 2021.

 

d.     Resourcing challenges mean that there are often delays in the execution of a section 135 warrant which can be up to two weeks. Behind this delay is an individual with serious mental health illness who is not getting timely care and is therefore very likely to end up being detained whether under s136 or by arrest if they suffer a crisis or become violent when out in the community.

 

e.     There is analogous precedent for this approach in the Act already. Section 18 of the Act, which provides for the return of patients to hospital where they have absconded, states that a patient may be taken into custody and returned to the hospital by “any officer on the staff of the hospital, by any constable, or by any person authorised in writing by the managers of the hospital.”

 

16.  Whilst this proposal would require a discussion between AMHPs and their local police mental health team, we do not see this as additional burden or bureaucracy. Indeed, partners are already encouraged to agree a joint risk assessments before a section 135 warrant is applied for within the Act’s Code of Practice.[1] We also believe that encouraging early conversations between health and policing partners provides the opportunity to explore alternative (and less intrusive) pathways for patients.

 

17.  We have discussed this section 135 proposal with health colleagues on an informal basis. Given the informal nature of these discussions, we would not seek to speak for health colleagues but would update that these initial discussions have been positive and partners share our view that this proposal should be explored in more detail.

 

18.  We thank the Joint Committee for considering this evidence.

 

November 2022

 

 


[1] See 14.48 of ‘Mental Health Act 1983: Code of Practice’