An east London coroner issued a preventing future deaths report this week, following a suicide in the capital after a man was discharged from a hospital to which he had been ‘sectioned’ under the Mental Health Act.  What interested me for a number of reasons, was what was NOT flagged as a ‘matter of concern’ because it happens often enough, albeit most usually in connection with incidents which end  non-fatally.  Perhaps that’s why it’s usually less obvious …

Mr Steven Stout was detained by the Metropolitan Police on the morning of 14th October 2019 under section 136 of the Mental Health Act.  He was intoxicated and appeared to have self-injured so he was taken to an Emergency Department for treatment to injuries, before being transferred to a s136 Place of Safety, presumably in a mental health unit.  The PFD notice says, “after a Mental Health Act assessment, Mr Stout was made subject to an order under section 2 of the Mental Health Act.  After a three-day delay, Mr Stout was admitted to a mental health ward on 17th October 2019.”

Three questions –

• If he was subject to the section 2 order after the MHA assessment, why did it take three days to move him to the hospital after the application had been made? – why was there such a delay in moving him?!
• If he was not, in fact, subject to a s2 application until just before he was moved to the inpatient unit, why did it take three days to find that hospital and what was the legal status of the man, during that three day period?!
• Why is the legality of all this not questioned?! – either, there has been a shocking delay in admitting someone to the hospital that’s ready to receive him and that denies him care; OR there was an potentially unlawful delay in admitting him, which denies him care.
• There may be another possibility, though – but you’ll have to wait until the end of the post for it and I’m not convinced from the PFD that it would be what happened …

Professor Sir Simon Wessely’s Mental Health Act review alluded to this sort of thing: delays in admitting patients after contact with the police, albeit that was with reference to people admitted from police custody having initially been arrested.  It was always true that there were further admission problems, of which it seems this is just one example, following detention under s136 MHA.  In a speech to the NPCC / College of Policing National Mental Health Conference in Cardiff in 2018, Chief Constable Mark Collins stated that the extent of these problems runs to “thousands” of cases per year.  Each of them potentially unlawful, each of them potentially engaging fundamental human rights issues.

WHAT I’M NOT SAYING

Of course, the PFD notice is flagging areas of concern that may contribute to future deaths and the Coroner may have noticed this but felt that it is not something likely to contribute to a death.  Once the patient was admitted to hospital on the 17th, he spent around one day there until he was discharged on 18th October and there should have been a referral to a Home Treatment Team which did not, in fact, happen and that was the focus on the Coroner’s concern, quite fairly.  What I end up wondering is the impact upon people who are literally forced to spend several days waiting for care that lasts one day and then they’re sent home without the follow they require being ensured, presumably after he was told it would be heading his way?

Across the broader range of incidents where there are delays in admission to hospital, we don’t see much analysis of what this kind of thing does to the mental state of vulnerable people and in this case three days wait to achieve one day of care then rapid discharge … can’t help but wonder how all that made this poor guy feel, overall?  And we’ll never know.

For the avoidance of doubt: I am not saying these questions and technicalities make an obvious difference in this case – I can’t know that either way and the Coroner didn’t say that it does after hearing the evidence, but given the way the PFD itself is worded, I have to wonder whether the precise legalities were spotted?  You’re not actually subject to an “order” under s2 MHA until the AMHP in the case make a written application to a particular hospital.  If Mr Stout was detained by the police on the morning of the 14th October, his detention under s136 runs out 24hrs later.  (I’m going to guess that there was no legal extension necessary because of intoxication and injury treatment, because the PFD implies the MHA assessment took place on the 14th.)

LIBERTIES AND TECHNICALITIES

So how was his liberty governed during that roughly 48hr period from 14th October when the MHA concluded that he needed admission and his eventual reception in a hospital on 17th? – was he subject to an application for s2 admission made before the 24hr point and if not, why not; or was he simply held without legal authority beyond 24hrs until the application could be made at roughly 72hrs?! … and it may be thought irrelevant: he obviously needed admission, they were just keeping him safe until the bed could be found.  Perhaps it’s the fourth option … a “swing bed”?!

Either way – we wouldn’t be so potentially casual about civil liberties if prisons or police were keeping people detained for two days where the legal authority was, let’s say, a little opaque and highly improvised; and more importantly, there are legal frameworks in play for these kinds of situations (s13 MHA, s140 MHA, s6 HRA) to ensure this doesn’t happen.  It   also raises the question about how often this happens.  In another London mental health trust, such breaches of s136 MHA (if that is what has happened here) are known to have occurred a few hundreds times a year, the longest stay in a Place of Safety being thirty days.  You’ll notice in the article just linked that the Trust claim legal justification for this but without in any way telling us what this is.

It may well be the ‘swing bed’ argument – where a patient is indicated as requiring s2 admission but this cannot occur in the normal way because there is no inpatient bed.  In some situations the AMHP makes a s2 application to the hospital where the s136 Place of Safety is and the person remains in the s136 suite.  Perhaps that’s what happened in Mr Stout’s case? – but it would then raise the question about why it took two days for a doctor to see him and think of discharge after being considered as an inpatient.  So many questions, no easy or obvious answers – I just think it’s important to keep discussing this, because it materially affects the safety, the dignity and the rights of patients in ways that keep playing out in our Coroners’ Courts.

Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

All views expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2021

I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current.  Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.

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