Short post mainly for those ranking officers who have statutory roles to play under the revised Mental Health Act 1983 (MHA) provisions which focus on those rare occasions where custody is still used as a Place of Safety under the Act. This is just bringing together a few of the issues which have emerged during the few months since December. It might be worth the custody officers in particular saving this link to your desktops in custody: it is the Mental Health Act (Place of Safety) Regulations 2017, issued under the MHA.
The big thing to be wary of before we even get to ongoing supervision and care in custody which is something for both the duty inspector and the custody sergeant to think about: whether the presentation the detaining officers are describing has been sufficiently triaged by NHS staff to rule out the need for A&E assessment or treatment shortly after detention. Itâ€™s all very well those criteria in Regulation 2 being satisfied to allow the use of a police station, but what if that presentation is also consistent with a medical emergency that is somehow being slightly forgotten about whilst we think through whether or not the law allows us to do something and whilst weâ€™re focussed on managing a more difficult restraint incident:
My general rule of thumb since the new law was set out for us has been and this is what Iâ€™d do if I were operationally again tomorrow:
No-one goes to custody unless theyâ€™ve been seen by a member of NHS staff who is putting their professional registration to the decision that the person does not need A&E care. We know that â€˜imminent risk of serious injury or deathâ€™ presentations will probably mean restraint of at leastÂ some kind has been applied not least because weâ€™re also saying that â€˜no place of safety in the force areaâ€™ can manage that presentation â€¦ well, history shows that could be ABD, meningitis, post-ictal psychosis, Addisonâ€™s disease, brain tumours, diabetes, etc.. No triage: no custody, in my opinion. No police officer in this country could confidently use their first-aid certificate to state there is not something potentially life-altering or life-threatening going on there. The emergency NHS is wheels have roles to play here and if not, Iâ€™d be removing people to A&E and then explaining why I wouldnâ€™t have done so if only an ambulance had turned up.
Please donâ€™t think that such debates and deliberations are hypothetical: these things have been key features in determining police officersâ€™ liabilities during death in custody inquiries. I can think of three examples without trying hard.
So, letâ€™s now assume that custody has been authorised after the inspector is satisfied of suitable triage. The person has been booked in by the custody officer and risk assessed and weâ€™re now settled in to the rhythm of supervision until the s136 assessment is arranged or the person transferred elsewhere.
Three main things under the Regulations:
So, this is your handy checklist, if you like â€”
This is all subject to one caveat in terms of an obligation to remove because of inability to comply with Regulation 4 or because a review under Regulation 5 determines the original grounds are no longer met: the removal to the other location should not occur if arrangements to have them assessed under the MHA have already been made and transfer would unnecessarily delay this or cause the person significant distress. This is Regulation 7.
Other Notes of Potential Interest â€“
For more detail on the 2017 amendments to the MHA, including on the topics covered in this post, see a series of posts on the various changes.
Winner of the Presidentâ€™s Medal from
the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award.