On the 01st October 2020, we anticipate the Mental Capacity (Amendment) Act 2019 will take effect, bringing certain changes to the Mental Capacity Act 2005.  Some of the terminology the emergency services may  hear and occasionally wrestle with will change, and the wording of section 4B of the MCA, which governs urgent deprivations of liberty for life-sustaining treatment, will be made more wordy!  Calls to #Team999 occasionally do involve patients who are subject to (the current) ‘deprivation of liberty safeguards’, known as DoLS in the current framework, but from October, these orders be replaced by Liberty Protection Safeguards, following literally years of discussions and debate about the DoLS frameworks introduced just over a decade ago.  It’s never quite worked as hoped and the 2014 Cheshire West case brought thousands more people with the grasp of DoLS and there have been problems and debates ever since.

Liberty Protection Safeguards are the end result of a Law Commission report and the Government’s own deliberations...

Continues, Read More...

I’m not sure how many inquiries and thematic reviews in to public services have ended up focussing on clear communication and information exchange – this has certainly been said during investigations and inquests where the police became involved in mental health incidents. There more than are a few situations where clarity of communication between organisations tends to be problematic and I want to focus on a few of them, by way of making the same point: that we need to be both clear and precise with each other about what we’re asking and saying as we work in partnership to put those of us affected by our mental health at the centre of decision making.

• Threat / risk assessment – if we’re saying that someone is facing a level of risk and we need to support each other in managing it, what is that risk and how likely is it to be realised?
• Legal context – what is the legal situation within which the request sits? For example, is the patient you’re asking us to return, subject to a legal framework which allows for this?
• What,...
  
  Continues, Read More...

This post comes at the direct request of a mental health professional, touching on matters I’ve written about before but which keep coming up, somewhat resistantly – it follows an incident where officers local to them came to an Emergency Department with a person in handcuffs for NHS assessment around their mental health and where the liaison staff had questions about the legal situation. During discussion, it was suggested the police should consider the application of s136 MHA, but the officers (who no doubt have a perspective to offer that may not be identical) chose not to follow this suggestion. And to be completely fair, they may have had their reasons – many people don’t realise, for example, that the use of handcuffs by the police is not JUST something that is done following an arrest; or even during a detention under the Mental Health Act 1983.

Police officers can and do use handcuffs to restrain people in a number of situations, relying on a number of legislative authorities to do so. For example, it’s not unknown for...

Continues, Read More...

One of the last things I did at the College of Policing was attend a meeting in London with the Crown Prosecution Service who had begun to review their guidance on the ‘prosecution of mentally disordered offenders’. The CPS issue prosecution guidance on a large number of topics, all publicly available on their website and they’d decided mental health guidance needed revising. First things first: the title of the old guidance sounded date and pejorative by modern standards so I’m glad to find that new guidance gets rid of the term ‘mentally disordered offenders’. Apart from anything else, as Professor Jill PEAY points out in her (wonderful) book “Mental Health and Crime” from 2010, it’s not a straight-forward enterprise to determine a mentally ‘disordered’ offender from a mentally ‘ordered’ one.

So in October 2019, the CPS issued two new documents –

If you’re involved in criminal investigation in the police, you’ll need to read both of these.

CAPACITY

In light of the number of discussions I had over the years with...

Continues, Read More...

We’ve started the new year with some familiar messages – more preventing future death reports (PFDs) from UK coroners after someone tragically lost their life in circumstances which gave rise to fears that aspects could be repeated and lead to future tragedy. PFDs are statutory notices, something the Coroner issues to an agency who may control aspects of what went wrong or contributed to the outcome. This could be anything from training of staff, to policies and procedures within or across agencies to anything else thought relevant. The organisation in receipt of such a notice has 56days to respond outlining their reaction to the recommendation(s) and these things are usually uploaded to the Office of the Chief Coroner’s website, where the notices are categorised by theme.

I’ve regularly browsed this website for a number of years and this post comes after another recent session – you may find these links useful, if you wish to do the same. These things are tagged in the way that a social media blog would be, so you may find the same...

Continues, Read More...

I’ve written about the issue of the Mental Health Act and hotel rooms before – focussing on the stated case of ‘Rosso’. I’m not hyperlinking to the old blog post precisely because it is now redundant and out of date – it was written a few years ago, well before the 2017 changes to the Mental Health Act which took effect in December 2018. Forget it – Rosso is now history and has been for a while.  I want to go through how the police now need to think about hotel rooms and the Mental Health Act 1983, specifically sections 135/136 MHA. This post follows the desperately sad inquest in to the death of Dr Deborah Lamont who, the Coroner ruled today, died by suicide in a Cardiff hotel in March 2019.

It will be necessary and relevant to see the full PFD report from the Coroner to answer some of the questions I’m interested in, but a big issue emerges from this inquest in the immediate media coverage and which addresses a question I was asked only yesterday, during the delivery of training in my own force:

Is a hotel room a place where...

Continues, Read More...

This post arises from a specific event, but it’s far from unique.  I want to use it as an example of something so straight-forward and obvious, yet complex and intractable and which raises a number of questions I suspect are often overlooked or set aside.  It relates to the conveyance of patients who have absconded from hospital and then turned up out of area – ie, out of the area of the police force to which they’ve been reported missing.  It’s about the return of AWOL patients (those who are absent without leave under the Mental Health Act 1983) but it allows me to cover a few things I’ve mentioned before, in a new context of a real incident.  So apologies to those who’ve read of some of these things before, but I’m re-painting the Forth Bridge here, as requested!

Last week at work, another police force had re-detained a patient in their area who was missing from a hospital in our area.  When the patient was reported missing to us by the hospital, we had undertaken certain initial enquiries and asked the other force to conduct...

Continues, Read More...

Mental health stuff in policing is not my job any more – not really.  I’m still asked to offer advice or opinion from time to time and most of the other inspectors on my team have used the phone-a-friend service which is inherently on offer when I’m on duty!  I’ve reviewed some incidents and policies when requested, written the odd guidance document over the last nine months but I stopped working full-time on mental health at the end of March last year.  Since April, I’ve been an operational police officer, working 24/7 across the West Midlands and in a few days, I’ll move to another 24/7 role in our force control room, working as a Tactical Firearms Commander (determining whether armed police are deployed to high-threat incidents involving firearms or other potentially lethal weapons and dangers offenders).  It was against the background of my professional role changing I decided some time away from mental health and social media was required whilst I focussed on my new role and took stock of myself as I started to see this...

Continues, Read More...

No-one involved in the discussions and debates around mental health care provision can have failed at one point or another to have bumped up against the question of whether we have enough psychiatric inpatient beds for the country’s needs. There are loads of reasons to wonder about this and plenty of time has been spent discussing it: formal reports, print media and no doubt in mental health units, GP surgeries, police custody areas across the land. If you go back a few decades, there were over 67,000 inpatient psychiatric beds in England – we now have fewer than 18,500 and this reduction needs to be seen against a backdrop of a growing population, increased psychiatric morbidity in the population and increased demand for mental health services.

A bit of background before I get to the point of this post: I have no objection to the principle that we need to reduce the number of inpatient beds to the minimum and reserve compulsory hospitalisation for those situations where nothing else will do. I often hear people say we need more beds and...

Continues, Read More...

On New Year’s Eve 2018, a man seriously assaulted a number of people at Manchester Victoria railway station – including one of the police officers who arrested him shortly after the attack began. I remember blogging about the incident, frustrated at the immediate calls for his extra-judicial murder and frustrate that many suggested that he’d “play the mental health card” or that him being ‘sectioned’ under the Mental Health Act was some kind of ‘easy way out’. We often see these things in cases of serious crime involving someone affected by their mental health. All normal so far.

Mahdi Mohamud was sentenced to life imprisonment today, with a recommendation from the judge that he serve a minimum of 11yrs. In addition, the judge imposed a so-called ‘hybrid order’ under s45A of the Mental Health Act 1983, which means that Mohamud will be detained in a psychiatric hospital in the first instance and this short post just seeks to explain what s45A does in practice, in the context of this particular case. In addition,...

Continues, Read More...