The media often provides regular coverage of issues in the ambulance service, esp more recent – their occasional inability to manage demand is up for discussion after photographs of some trusts with half their fleet outside Emergency Departments, unable to offload patients and all the impact that has on their ability to manage incoming demand.  We can all see there are plenty of pressures on our colleagues in green and paramedics are speaking out about it, both directly and indirectly.  The BBC has covered the queues as well as leaked reports suggesting hundreds of thousands of patients are (potentially) at risk because of these difficulties and those of us who know plenty of people working at this coalface know how difficult it is.  As ever, they have been unending respect and gratitude for what they do and I worry about my friends’ welfare, working as they must to keep us safe.

Amidst all this, and leading to this post, is a comment by a particular, unnamed paramedic who spoke to the media – it’s obvious from the comment, they...

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Another recent Preventing Future Deaths notice from a Coroner has pricked my attention, concerning the sad death of Hannah Breadshaw from Greater Manchester.  Inevitably, PFDs are brief and not all details are included, but to my reading, this may be about the ever-blurred distinction between a threat to life incident and a somewhat more routine “welfare check”.

The relevant timeline regarding a call to Greater Manchester Police (GMP) about Hannah’s welfare is given as –

• A friend of Hannah’s rings GMP at 12:30pm to raise “welfare concerns” and it was allocated a 1hr response time;
• An ambulance was requested at 12:45pm and they arrive on scene first, at 2:10pm;
• They request police for force entry at 2:26pm and chase GMP several times over two hours until police arrive at 4:47pm;
• Entry forced, patient found deceased.

The IOPC were informed of the incident and they flagged three particular concerns prior to the inquest.  1)  a failure to escalate the incident, 2) a failure to make method of entry equipment more readily available; and...

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It is being heavily trailed in the media that the Queen’s Speech this year, will contain a Mental Health Act (Reform) Bill – the beginning of the process of amending the Mental Health Act 1983, in its first significant upgrade since 2007, but trailed as a first major upgrade in forty years, since it was first enacted.  In fact, much of the 1983 Act is just the 1959 re-numbered, so it’s more like 63yrs old, but I disgress.

We do not yet have sight of the draft Bill but for those who want a quick catch up ahead of seeing what happens, the recent history is —

• In 2017, Professor Sir Simon Wessely began chairing a review of the Mental Health Act which reported in late 2018.
• In 2020, the Government produced a White Paper, outlining various ideas for discussion and public consultation.
• In 2021, the Government produced its response to the public consultation on the White Paper.
• 2022 – we are likely to see an actual Bill placed before Parliament for its consideration.

The links above are to the posts I wrote at the time on those milestones...

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I’ve often known police officers wonder aloud as to why patients detained in mental health units under the Mental Health Act are permitted to have leave from hospital when they are a known flight or suicide risk.  Section 17 MHA allows the Responsible Clinician (MHA term for lead clinician in charge of someone’s care, usually a psychiatrist) to permit a patient to leave hospital, sometimes with conditions attached and it’s a crucial part of the process of mental health care, ahead of patients being discharged as part of their recovery.  Some patients can be detained for a considerable period of time after being acutely unwell, to imagine a person who at one point had lost the ability to make many of their own decisions and just keep them detained until they could be fully discharged, would be weird and fraught with risk – authorised leave is a part of preparing patients from discharge and building up resilience and decision-making capacity, ahead of full discharge.

GRANTING LEAVE

But none of this means all leave granted is reasonable and it...

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The All Party Parliamentary Group on Women in the Penal System has published a briefing on “Women’s Health and Wellbeing in Prisons”.  This post is about one specific claim only, within that briefing – that prisons are regularly but inappropriately being used a “place of safety” (PoS) and this is an unintended consequence of a change of policy to prevent women languishing in police cells (presumably, there as a place of safety). The briefing itself is short (10 pages) and this one point is only mentioned in brief, relying in turn on a report from Her Majesty’s Inspector of Prisons and Probation about an inspection which obviously must have wider implications across the prison system.

Before I get in to this: of course, prisons are over-relied upon to accommodate highly vulnerable people in circumstances where they should be able to access mental health beds in a much more timely way.  Additionally, but separately, it can be said there are difficulties securing access to MHA beds for those who require admission to hospital from...

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I’ve often wondered if the Codes of Practice to the Mental Health Act 1983 are the least read documents in all of what I’ve spent time blogging about.  I say “codes” (plural) because there are separate documents for England (2015) and for Wales (2016) and for those who don’t know, a Code of Practice is statutory guidance issued by a Secretary of State or Welsh Minister to offer guidance about the law should be applied or interpreted.

Here’s my main point now I’ve specified the years of most recent publication: the law changed in 2017 and yet the Codes remain the same!

In each of them, chapters 16/17 as well as 27/28 relate to the issues which affect the use of various police powers and reliance upon the police.  The fact the law changed in 2017 renders many aspects of these chapters redundant.  And yet here we are, seven or eight years after last update and almost five years since the law was changed and yet the Codes remain unaltered.

There are a few issues, arising –

• There are some simple enough issues: s135/136 detention can...
  
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The Court of Appeal (criminal division) recently issued a judgement in R v Keal (2022), all focussing on the meaning of the word “wrong”, in the legal definition of insanity.  A little history for those who are not aware of the background: in the nineteenth century, the M’Naghten Rules defined what it means to be legally insane and this has formed the basis of English law ever since, indeed it went on to influence insanity law and many other jurisdictions as well.  If you want to read more detailed background on all that, my original post on insanity is available.  I’ll assume you’ve now read this or know the topic, in terms of what follows.

On 22 June 2021 in the Crown Court at Winchester, Mr Keal was convicted of three counts of attempted murder and was sentenced to a restricted hospital order under section 37/41 Mental Health Act 1983.  The appellant having put forward a defence of insanity which was rejected by the jury, he appealed against his conviction for the offences on the basis the trial judge erred in law...

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I know I’m just one of thousands of people shocked to learn the terribly sad news that former Chief Constable of Leicestershire Police, Simon Cole QPM, had died suddenly.  Mr Cole was found at his home in Leicestershire on Wednesday having retired from his position as Chief Constable only six days earlier and was 55yrs of age.

He was a leader, a gentleman and I’m one of many how who will miss him.

Betweeen 2012-14, Simon was the Association of Chief Police Officers lead on mental health and disability and it was in this capacity that I first really knew him.  I’d just started this blog when I learned he’d taken over the role from my former boss, the previous ACPO lead, and I messaged Mr Cole to check he was OK with me doing this or to take any guidance or direction he wanted to give, including that I wouldn’t do it that’s what he preferred.  His reply was simple and encouraging: I should keep chipping away, he was aware of the blog and had his support.  In the coming months and years, he would often message me and retweet the posts I wrote,...

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The BBC used Freedom of Information laws to secure access to a 2018 report by the Cabinet Office Implementation Unit about unlawful detention in police custody, for those of us who are deemed to require hospital admission under the Mental Health Act 1983.

The report estimates that between 3,900 and 4,500 people were then unlawfully detained in police custody in a year because of delays in accessing a mental health bed.  As you read on, please remember three kinds of situation which can lead to hospital admission under the MHA and which we’ll come back to at the end —

• MHA assessment and hospital admission after arrest is just one route to hopsital care – and its not even the most common route (scenario 1).  << This is what the Cabinet Office report is about.
• Some of us are assessed in a Place of Safety under the MHA after being detained by officers under s135/136 MHA (scenario 2).  << This is what the Cabinet Office report is *not* about!
• Some people are assessed by mental health professionals when subject to no legal restriction by...
  
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A new Preventing Future Deaths report has been issued already this year, concerning the subject of returning patients to hospital who are absent without leave under the Mental Health Act.  It follows the sad case of Jack TAYLOR in Sussex who had been a s3 MHA patient in a local psychiatric unit and absconded during a period of escorted leave.  Having been reported missing to Sussex Police, the Coroner’s report suggests various for the police and the mental health trust in resourcing attempts to return him.  I am going to have to make an assumption about some of circumstances for the purposes of writing this post, so remember as you read, it is an assumption! – that the whereabouts of Jack was known in order to give relevance to the MH trust duty to return a patient.

Let’s start at the legal beginning –

• Where someone becomes AWOL after absconding from a mental health unit (including from escorted leave or by failing to return from authorised unescorted leave), s18 of the Mental Health Act allows that person to be returned to the...
  
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