Dated: 29 Jan 2018
POLICY TITLE: Mental Health
OWNING DIRECTORATE: Major Crime & Intelligence
AUTHOR: Detective Chief Inspector, Safeguarding Department
CONTACT DETAILS: 101
EQUALITY IMPACT ASSESSMENT: In Progress
AUTHORISED PROFESSIONAL PRACTICE (APP) NATIONAL GUIDANCE: AVAILABLE
AIM OF POLICY: To outline Northumbria Police response to individuals with mental ill health and Individuals who may be suffering mental health crisis.
BENEFIT OF POLICY: Northumbria Police will protect life and property from harm. By recognising mental illness at an early stage, individuals will be enabled to access the required services.
REASON FOR POLICY: To demonstrate how Northumbria Police fulfils its duties in relation to the Mental Health Act (MHA)1983 and the Mental Capacity Act 2005. This policy reflect changes to the MHA by the Policing and Crime Bill 2017.
Northumbria Police will treat all people with mental disorders and learning disabilities with dignity and respect and will use legislation and statutory guidance to bring to justice those who exploit and abuse persons who lack mental capacity.
Officers and staff will have:
- A core basic awareness of mental health issues, learning disabilities and vulnerability;
- Skills for managing people at the point of contact through the use of effective communication;
- De-escalation skills and an understanding of the dangers of using restraint techniques with vulnerable people;
- An awareness of liaison and diversion opportunities for people with mental health and learning disabilities;
- A good understanding of how to apply mental health legislation and the Mental Health Act (MHA) 1983 codes of practice.
The Mental Health Act Code of Practice (2015) states: Mental Disorder is defined for the purposes of the Act as ‘any disorder or disability of the mind’.
This term covers all areas of vulnerability relating to legal frameworks. ie Mental Illness and Learning Disability.
Local Multi Agency Protocols
The Northumberland, Tyne and Wear NHS Foundation Trust (NTW) have Practice Guidance Notes/Policies for S136 and S135 that set out the provision of multi-agency services to individuals who are likely to be patients under s136 or s135 of the MHA. These protocols ensure:
- Compliance with relevant legislation, national guidance and other sources of standards for the NHS, Local Authority, Police and partner agencies;
- The use of a dedicated mental health Place of Safety (PoS) on the majority of occasions;
- The use of emergency departments only where this is consistent with concerns about urgent healthcare requirements;
- The use of police stations, only in exceptional circumstances and where it is medically safe to do so; and the person is over 18. Persons under 18 should not be brought to Police stations as places of safety under any circumstances; and,
- Seek to facilitate the rapid assessment of persons removed to a place of safety.
Use of Mental Capacity Act (MCA) 2005
The MCA gives a legal basis for providing care and treatment for people aged 16 years and over who lack the mental capacity to give their consent to such care and treatment. It does not matter whether the impairment or disturbance is permanent or temporary.
Police officers may need to make immediate decisions that relate to containing, controlling and potentially restraining an individual who lacks the capacity to make the decision in question in the best interests of the individual, while awaiting further input or direction from a heath or social care professional.
When applying the MCA Northumbria Police will:
- Assume that a person has capacity unless it is established that they lack capacity;
- Not treat a person as unable to make a decision unless all practicable steps have been taken to help the person to do so, without success;
- Not treat a person as unable to make a decision merely because they make an unwise decision;
- Act or make decisions under this Act for or on behalf of a person who lacks capacity in that person’s best interests;
- Before acting or making a decision, consider whether the required purpose can be effectively achieved in a way that is less restrictive of the individual’s rights and freedom of action; and,
- Justify any such decision on capacity on the relevant police log.
Mental Disorder in a Public Place
Acute Behavioural Disturbance (ABD)
Northumbria Police officers and staff will be trained to recognize the signs of ABD.
If there is any suspicion that violence stems from a medical condition, the person will be treated as a medical emergency and an ambulance summoned to take the person to an emergency department without delay. If no ambulance is immediately available, the person will be transported to hospital in a suitable police vehicle.
People who appear to have ABD will only be restrained in an emergency and will be contained rather than restrained until medical assistance can be obtained.
Two mobile Street Triage Teams, operate across the Force area. They aim to improve access to mental health services and avoid preventable detentions when using section 136 of the Mental Health Act. There is a joint operational policy for the service.
‘Safe and well’ checks
Safe and well checks for persons under the care of mental health services should not be conducted by Police, unless there is credible intelligence and/or circumstances which suggest risk to life and limb.
When conducting safe and well checks on people who are vulnerable, police are limited to:
finding the individual, and ascertaining whether they are alive, breathing and conscious (ABC);
calling for medical assessment of people who are found (where necessary); and
feeding this information back to the person / organisation requesting the check.
If the person is located in a place to which the public have access and:
- Appears to be suffering from a mental disorder, and
- Is in immediate need of care or control, and
- It is in their best interests, or
- it is necessary for the protection of others, officers may use their power to detain the person for assessment under s136 MHA.
Where practicable, before detaining a person under section 136, the officer should consult with a mental health professional. Outside of the operating hours of the Street Triage Team this would ordinarily be the Initial Response Service / Crisis Team for the area.
The presentation of the individual should determine the appropriate use of this power and in cases where the person is clearly unwell then consultation is not required before detention.
A joint policy entitled ‘Working with police and the Criminal Justice System’ also exists with the mental health Trust in relation to such checks.
Mental Disorder on Private Premises
Under s.135 (1) MHA a magistrate may issue a warrant authorising any constable to enter specified private premises, by force if required, to facilitate an assessment and remove the individual to a place of safety if necessary. This warrant can only be applied for by an Approved Mental Health Professional (AMHP).
The purpose of a Section 135(2) warrant is to provide police officers with a power of entry to private premises for the purposes of removing a patient who is liable to be taken or returned to hospital (e.g. absconded, Community Treatment Orders) or any other place or into custody under the Act. This warrant can be applied for by an AMHP, Police, or Hospital Authority.
Warrants under s135 to recall patients to hospital or arrange mental health assessments in a private address are co-ordinated by NTW Trust with a local agreement and joint training in place.
Where no warrant under s135 (1) & (2) has been issued (e.g. where access has been granted by the individual or co-owner), police are usually asked to attend a mental health assessment on private premises when it is anticipated that there is a risk of harm to those attending to undertake the assessment and that assistance may be required to keep the situation safe. They may also be required to convey the patient to hospital under S6 MHA.
When considering private places, Amendments to the Mental Health Act following the Policing and Crime Bill 2017 suggests that protection of individuals from harm in settings such a railway lines or rooftops etc. would not require a warrant.
Without an s135 warrant, officers can still use the following powers in response to spontaneous situations where the risk of harm is likely:
- Section 17(1)(e) Police and Criminal Evidence Act 1984 – permits entry to premises to save life or limb;
- Section 3 Criminal Law Act 1967 3(1) – ‘a person may use such force as is reasonable in the circumstances in the prevention of crime, or in effecting or assisting in the lawful arrest of offenders or suspected offenders or of persons unlawfully at large’.
- Sections 5 and 6 Mental Capacity Act 2005 – protects decision makers who decide to use restraint in certain circumstances, including where necessary to prevent self-harm.
As stated in the MHA Section 6 allows for the use of such force as is reasonably necessary to achieve the objective of conveying the patient to hospital and deems the patient to be in legal custody.
Police officers may search a person subject to S135 / 136 if they have reasonable grounds for believing a person has dangerous concealed items and may present a risk to themselves or others.
Persons detained under S135/136 may be detained for a MAXIMUM of 24 hours (subject to a 12 hour extension in exceptional circumstances and only agreed by a medical Practitioner plus Superintendent if Custody).
Mentally Vulnerable People in Police Custody
Northumbria Police adhere to Authorised Professional Practice (APP) National Guidance in relation to Detention and Custody, including where detained persons suffer from mental ill health or learning difficulties.
Transfer and Conveyance
Transport by ambulance is the preferred mode of transport to convey an individual to the place of safety. Only in exceptional circumstances will a police vehicle be used, as dictated by the risk assessment process.
Where an ambulance is used, a police officer will accompany the person in the rear of the ambulance if necessary, or with the agreement of the ambulance crew, will escort the ambulance to the place of safety, in a separate police vehicle.
Patient Recalls and AWOLS
Once a recall notice has been issued and taken effect, a Community Treatment Order patient is, for policing purposes, an AWOL patient and officers may rely on s18 MHA to detain the patient and return them to hospital. This power may also be used in relation to detained patients who go missing from hospital wards.
Where the location of a patient is known, Northumbria Police will provide support where this is proportionate to the risks involved.
Warrants Under Section 42 MHA 1983
S42 MHA warrants to recall a person to hospital, who are conditionally discharged from the provisions of Section 37/41 of the act. The recall warrants are sought from the Ministry of Justice by the professional involved in their care and treatment. This would always be done in the safest way possible in conjunction with NTW.
Offences Within Inpatient Psychiatric mental health/learning disability facilities
Where there is evidence of an offence and it is in the public interest, an inpatient hospital may be charged and prosecuted.
In responding to allegations made by staff in a inpatient unit, officers will:
- Not presume that a mental health condition or learning disability, or detention in hospital under MHA, means that a suspect did not understand their actions or that what they were doing was wrong;
- Secure evidence in the normal way and seek as much background information and professional opinion as possible on the patient and their relevant history;
- Take into account any previously unreported violence towards NHS staff and any escalating pattern of behavior which may help inform the CPS public interest decision.
Northumbria Police has dedicated Hospital Liaison Officers linked to relevant Neighbourhood Policing Teams in the areas where hospitals are based.
There is a joint policy with mental health trust covering these areas as well as emergency attendance at wards.
Initially, police officers are required to consider whether there is enough evidence to charge the suspect. To the extent that they are able to use discretion about whether to prosecute for an offence, officers will also consider the suspect’s level of vulnerability.
The support of an appropriate adult will be sought as necessary to help formalise the outcome of the investigation.
In some circumstances the purpose or value of prosecuting a vulnerable adult may be considered low, and not in the interests of the public or justice.
Certain powers and protections under MHA can only be instigated by criminal courts. Prosecution will be appropriate when criminal courts are best placed to weigh the full context and circumstances of a particular case, in the light of full psychiatric reports.
For more serious offences prosecution may be necessary, even where vulnerable suspects are potentially seriously unwell and remand application may be the only safest option.
Non Court disposals - following discussion with mental health professionals regarding suitability and appropriate use, this can be an excellent tool to deal with non-serious offences in Mental Health facilities.
SOURCE DOCUMENT: Mental Health Act 1983, Mental Capacity Act 2005 Policing and Crime Bill 2017, Authorised Professional Practice
GROUPS AFFECTED: All staff
ACCESS AND DISCLOSURE RESTRICTIONS: None