This is a second post looking at the January 2021 UK Government White Paper on Reforming the Mental Health Act 1983 — the first post covered proposed criteria for developments on detention in hospital, this will look at various issues to do with rights and risk.

We’re going to have to get used to spotting the difference between a “substantial likelihood” and a “substantial risk”.  My best guess is that “likelihood” would mean something approaching probable, whereas “risk” may end something closer to possible (p25).  Introduction of both terms is suggested in the paper amidst the criteria for various things – substantial likelihood for initial detention or re-detention under the Act (ie, admission) but substantial risk to authorise or review the use of Community Treatment Orders (CTOs), “a substantial risk of significant harm [without using a CTO.  It is argued, CTOs are over-used and the White Paper suggests that consideration was given to removing them from the legislation. ...

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My break from blogging was deliberate decision to step back from it all but the publication of the Government’s White Paper on Reforming the Mental Health Act 1983 motivated me to think some things did need saying and summarising, for whatever that’s worth.  I was involved in this review which leads to the White Paper and I cant deny my interest in how it develops towards potential legal reform.  My first post of 2021 covered in brief some of the more-obvious police-related implications of the White Paper, written after a fairly brief read.  Having now made a more concerted effort, there are other points worth making and which are not linked (directly) to policing but are for general awareness of what may be coming.  It gives a context about the broader system in which the police will always play a limited role.

Of course, this is still just a White Paper, it changes nothing in law (yet) and the various proposals may or may not make it to the statute book.  At the first meeting of Professor Sir Simon Wessely’s Advisory Group...

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The Government has today published its White Paper on Reforming the Mental Health Act 1983 (MHA) —

This publication follows the report of Professor Sir Simon Wessely in 2018, after an independent review of the Act.  It’s 184 pages long and it covers a lot of ground, some of it surprising, some of it not.  The UK.GOV website also has a host of other formats, inc easy-read, executive summaries, Welsh language editions and so on.  This post is restricted to the police-related aspects only, for your information and consideration.  (May blog again later on the other stuff, as I’ve quite enjoyed writing this one, after many months away from it all!)

I want to highlight five main issues —

• Legislation to end all use of police cells as a Place of Safety under the MHA by 2023/24.
• Revision of s5 of the MHA, to allow for detention by healthcare staff in an Emergency Department
• Reform of s35/36 of the MHA, to allow Magistrates to remand mentally unwell defendants to hospital at first appearance
• Section 140 MHA
• Conveyance after use of...
  
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I missed something last year, probably because I’d changed roles and I’m not focussing on this stuff as before.  In 2019, the Care Quality Commission reported some findings after a review of the implementation of the Code of Practice to the Mental Health Act 1983. Those who have followed this blog since the start will know I’ve done a number of articles highlighting parts of the Code which are especially obscure, helpful to know or widely misunderstood. My particular favourite has always been paragraph 28.14 (and helpfully, this paragraph reference number is correct for both the 2015 English Code of Practice and the 2016 Welsh Code of Practice but this post relates only to the CQCs review of the English Code):  28.14 reminds us that where patients are Absent Without Leave under the Act, it is ordinarily the responsibility of hospitals to return them to the ward.  Support from the police should only occur ‘where necessary’ (and I’ve covered how we should think about that, elsewhere).

It is also worth remembering what the status of...

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The Mental Capacity Act continues to consume a number of the queries I receive about policing and mental health.  The point of this post is not to repeat the content of those I’ve already written, but just to highlight the ongoing issues which form my focus when I listen to the questions coming on social media.  You can read the previous posts I’ve written in the paramedic series of blogs (which, of itself, tells you that many of these situations involve the police’s interface with the ambulance service) and of course, the Quick Guide on the MCA.  It’s worth bearing in mind also, the Mental Capacity (Amendment) Act 2019 will take effect at some point and this will provide far more words within section 4B of the Act, which you’ll see shortly, is key to many of the problems we continue to see.

I want to emphasise three things here, above what I’ve written before –

• The balance of probabilities
• The least restrictive principle
• ‘Restraint’ versus a ‘deprivation of liberty’.

THE BALANCE OF PROBABILITIES

I may, later today,...

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A short post, to address a question that has come to me a number of times over the years and when it recently re-emerged I ended up double-checking this was covered on the BLOG, but found I hadn’t done a specific post on it.  Such references as there were seemed a little buried within other posts could be hard be hard to find, as such, the question for us to clear up here is whether a patient who is ‘absent without leave’ (AWOL) from detention in hospital under the Mental Health Act 1983 (MHA) is considered ‘unlawfully at large’ for the purposes of the police forcing entry to private premises.

A couple of points of background before I explain why the answer is “Yes – they are unlawfully at large” —

A police officer is permitted in law to force entry to a premises in a number of legal circumstances, for example, in order to arrest someone for an indictable (ie, serious) offence. If you’re a suspect for grievous bodily harm and we think you’re in your house, officers can force entry under s17 of the Police and Criminal...

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I’m sure most people heard of the sickening attack on a young boy at the Tate Modern in 2019 – I don’t intend to cover the details as they are widely available (trigger warning for the hyperlink that follows) and this post intends to focus on nothing other than a key decision for the judge at the criminal trial of Jonty Bravery who pleaded guilty to attempted murder following the attack.  Last week, the judge heard argument from lawyers and opinion from psychiatrists about whether the defendant should be hospitalised or imprisoned, after his guilty plea.  A legal decision of this kind sits solely with the trial judge, who must consider reports from experts and hear the legal arguments, before reaching their decision.  On the one hand, the defendant has a history of mental health issues of a kind which convinced two forensic psychiatrists to provide a medical recommendation for admission to hospital which would allow the judge to consider various kinds of order under Part III of the Mental Health Act, usually a (restricted) hospital order.  On...

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For some time now, I’ve been concerned about the impact on vulnerable people of ‘normalising’ the involvement of the police in their mental health care.  Regular readers will no doubt recall some observations I’ve made based on real cases or things I’ve learned by listening to people.  It’s because of my concern, I decided a blog is called for, despite now writing here much less often.  It follows my reading of a case which yet again makes plain this point, but it actually goes one step further than anything I’ve come across before: the impact of involvement of the police was directly linked in a Preventing Future Deaths (PDF) report from a Coroner as a ‘probable’ cause of death.  Of course, as with all situations involving complex and vulnerable people, there is rarely one single explanation for why someone died and it’s not listed as the only thing which contributed to someone’s death.  There were nine things overall, but remove any of them and would we still have an inquest? … who knows.

Lauren Finch was a 23yr old...

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I don’t think I fully realised last week what a privilege it actually is to have to physically go to work – I get to ride 10miles there, get out of my home for a bit, see other people outside my family and then ride back again in the fresh air.  I’m now on my fourth rest day (of four) and very much itching to get out on my bike for a quick lap of the lanes; and perversely looking forward to my 4:30am alarm call to get out of the house again and off to work.  Mrs B and Master B are working / schooling from home and I can see the restrictions taking effect on them in small ways.  I’m also conscious of my elderly mother living on her own in the North-East who is pretty much locked in and being supplied by others, as required.

So what does the law say (on Monday 30th March! – because it may change later if tougher restrictions are brought in, as may be considered potentially necessary).  There are various reasons I’ve decided to write-this, but all of them rotate around the frustration of misinformation and misunderstanding! —

STATUTORY...

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Last week, I published a post about the temporary amendments to the Mental Health Act 1983 which will be brought in by the Coronavirus Bill 2020, if passed ‘as is’.  That Bill goes before Parliament today, to commence its process towards becoming law and it may or may not change as the process unfolds.  Me being me(!), I was a bit curious about the other health related implications for the police service so I kept reading beyond the Mental Health Act amendment stuff and this post summarises the police related powers in Schedule 20 of the Bill as they relate to ‘infectious persons’.  If you want to read this for yourself, open the draft Bill and go to Schedule 20 on p215 – I will warn you now(!), it’s quite a dense read, hence I thought I’d try to summarise the main aspects of it.

You may quite reasonably wonder what this has to do with policing and mental health?! … potentially nothing at all and I’m conscious of straying outside my domain of interest – this is legislation related to so-called ‘physical’ healthcare...

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