Statistics â€“ everyoneâ€™s favourite topic!
We have quite a problem that has existed for years and whilst I knew things were bad, I hadnâ€™t realised the extent of it until last week.Â The problem is â€“ on sections 135 and 136 of the Mental Health Act â€“ that we havenâ€™t got a barking clue what is going on, nationally because there are too many problems with the data.
I could go on!?
In debates over the last year or so it has been claimed that the low â€˜conversion rateâ€™ of section 136 detentions to admissions is itself evidence that the police threshold for the use of this authority is too low. Last year it was claimed that just 17% of detentions by the police resulted in a patientâ€™s admission to hopsital and it was barely higher the previous year, at 20%.
A question was posed to me on an email this week about what the converstion rate actually was and I confidently retorted with the CQC published numbers: 17% last year and 20% the year before. A new colleague then added something to the mix which didnâ€™t seem quite right to me so I thought Iâ€™d go back to the source documents and check â€“ it turns out we were both wrong!
The Care Quality Commission publishes an annual report on the operation of the Mental Health Act and they rely upon data gathered by the Health and Social Care Information Centre. The HSCIC gather a â€˜minimum data setâ€™ from the NHS each year and it is then used for various reasons. When you look at the section 136 data you notice something that blew me away and which makes me realise we havenâ€™t got a chuffing clue what is going on:
The 17% and 20% figures relate not to hospital admissions but to detained MHA patient admissions. I looked to find how many people detained under s136 MHA were then admitted informally as inpatients but it turns out we donâ€™t know! We know how many people detained under a136 subsequently had an â€˜informal statusâ€™ but that figure was so large that it cannot realistically relate to those people who were just admitted informally â€“ it must relate to more than that. Most likely, it indicates those who became or remained patients of the MH trust after release from s136 â€“ both inpatients and outpatients.
POLICE AND A&E
Weâ€™ve known for years that the HSCIC data set includes on Hospital Place of Safety data. They described recent attempts to include what police station PoS data they can secure as â€˜experimentalâ€™. More than that however, we can pretty confident that those patients who are wholly managed in A&E in areas where A&E is not â€˜designatedâ€™ a PoS are not included either.
So when the HSCIC inform us that the power was used around 22,500 times in 2013/14 they issue caveats about experimental data and arenâ€™t really sure. And against a background of not being entirely confident about how many times police officers remove someoneâ€™s liberty under this provision we donâ€™t know what they do with them once they have.
We know that claims are made that around two-thirds of people access the NHS but we donâ€™t always know precisely which kinds of facilities they access and we donâ€™t know roughly how many are just not counted because they went to A&E and never reached a mental health unit PoS or police station.Â We know in some areas that even if a multi-agency form exists to record all section s
Against this backdrop we are now spending millions based on the premise that the police are over-using section and applying too low a threshold for its application. But it turns out those data donâ€™t relate to what the claimants think it relates to. And we donâ€™t know what we donâ€™t know about A&E and police custody.
We also know that various policy reviews are ongoing: the Mental Health Act Code of Practice is being reviewed for publication potentially in April. We know that the Government are reviewing legislation â€“ and Iâ€™m wondering why theyâ€™d change anything if no-one can explain what the hell is happening now and therefore how things would change if the law was altered!?
Also, we know that both NHS England and the CQC are doing various urgent care reviews which touch on mental health crisis care to one degree or another. Donâ€™t forget either the work that most areas should now be doing under the leadership of their health services on the Crisis Care Concordat.
How will we fully know what we need to do to make the world a better place if we havenâ€™t got a clue whatâ€™s really going on nationally? â€“ and in specific detail?!
I admit to wanting data, more data and even more data!
The Mental Health Cop blog
â€“ won the ConnectedCOPS â€˜Top Copâ€™ Award for leveraging social media in policing.
â€“ won the Digital Media Award from the UKâ€™s leading mental health charity, Mind â€“ won a World of MentalistsÂ #TWIMAward for the best in mental health blogs
â€“ was highlighted by the Independent Commission on Policing & Mental Health
â€“ was referenced in the UK Parliamentary debate on Policing & Mental Healthâ€“ was commended by the Home Affairs Select Committee of the UK Parliament.